径向超声非实时引导下经支气管镜肺活检对周围型肺癌的诊断价值和假阴性分析

Value of non-real-time radial probe endobronchial ultrasound guided transbronchial lung biopsy in the diagnosis of peripheral lung cancer and analysis of false negative results

摘要:

目的 探讨径向超声（RP-EBUS）非实时引导下经支气管镜肺活检（TBLB）对周围型肺癌的 诊断价值和假阴性的原因。方法 回顾性分析2013 年3 月-2016 年12 月在南方医科大学顺德医院确诊为周 围型肺癌的患者256 例，所有患者在常规支气管检查正常后行RP-EBUS 检查，能获得超声图像的有189 例， 在撤出超声探头后，沿超声探头路径伸入活检钳对病灶进行活检。评价RP-EBUS 非实时引导下TBLB 对周 围型肺癌的诊断意义并分析其假阴性原因。结果 RP-EBUS 对周围型肺癌的总体发现率为73.83%（189/256）， RP-EBUS 非实时引导下TBLB 对周围型肺癌的诊断阳性率为61.33%（157/256）。病灶直径>2 cm、不贴近 胸膜、包绕RP-EBUS 探头、超声图像呈实性低回声伴周边强回声带的周围型肺癌在RP-EBUS 非实时引导 下TBLB 的诊断阳性率高（P <0.05）；诊断阳性率与RP-EBUS 探头是否通过病灶和钳检次数无关（P >0.05）。 主要并发症为咯血、胸痛、气胸，均无需特殊处理可缓解。结论 RP-EBUS 非实时引导下TBLB 对诊断周 围型肺癌具有较高临床应用价值，其诊断阳性率与病灶大小、病灶是否贴近胸膜、超声图像特征、病灶是否 包绕RP-EBUS 探头有关，提高操作者的技术水平可降低假阴性率。

Abstract:

Objective To explore the diagnostic value of non-real-time radial probe endobronchial ultrasound (RP-EBUS) guided transbronchial lung biopsy (TBLB) for peripheral lung cancer and analysis of false negative results. Methods A retrospective analysis of the clinical and imaging data of 256 patients with peripheral lung cancer between March 2013 and December 2016, all the cases underwent non-real-time RP-EBUS guided TBLB, then evaluate its significance in the diagnosis of peripheral lung cancer and analyze the reasons of false negative results. Result In 256 patients who received non-real-time RP-EBUS examinations, 73.83% (189/256) of peripheral lung cancer were detected by RP-EBUS and the positive rate of RP-EBUS guided TBLB was 61.33% (157/256). The positive rate of non-real-time RP-EBUS guided TBLB was correlated with lesions >2 cm in diameter, lesions close to visceral pleura, ultrasonic image characteristics and the RP-EBUS probe surrounding by lesion (P < 0.05). The positive rate of non-real-time RP-EBUS guided TBLB was not correlated with RP-EBUS probe passed through lesions and times of biopsy (P > 0.05). Complications including bleeding, chest pain and pneumothorax recovered spontaneously. Conclusion Non-real-time RP-EBUS guided TBLB was a practical technology for diagnosis of peripheral lung cancer with high diagnostic rate and good safety. Lesion size, connection to visceral pleura, ultrasonic image characteristics and the RP-EBUS probe surrounding by lesion influenced the diagnostic yield. Improvement of operative skills can reduce false negative results.