电磁导航支气管镜引导冷冻肺活检对肺外周结节的诊断价值

Electromagnetic navigation bronchoscopy guidance transbronchial lung cryobiopsy for the diagnosis of small peripheral pulmonary lesions

摘要:

摘要：目的 评价电磁导航引导冷冻肺活检对外周型肺孤立型小结节（SPN）的诊断价值。方法 回顾性分析2016年1月1日－2018年7月8日于该院用不同方法行经支气管肺组织活检的76例外周型SPN（直径≤3.0 cm）患者的临床资料，根据活检方法的不同分为电磁导航引导冷冻肺活检（ENBCB）组和电磁导航引导活检钳肺活检（ENBLB）组，比较两种活检方法的标本大小、诊断率、操作时间及并发症，最后诊断结果通过外科手术切除病灶行病理检查或者随访2年至临床治愈确诊。结果 ENBCB组和ENBLB组的病灶平均直径分别为（21.0±8.0）和（22.0±8.0）mm。两组病灶大小比较，差异无统计学意义（t =0.68，P =0.590）。ENBCB组及ENBLB组活检标本大小分别为（10.5±4.2）和（2.9±1.3）mm2，差异有统计学意义（t =-14.56，P <0.05）；ENBCB组和ENBLB组的诊断率分别为89.2%（33/37）和69.2%（27/39），ENBCB组诊断率高于ENBLB组（χ2=4.55，P =0.033）。亚组分析：病灶直径为2.0～3.0 cm时两组诊断率差异无统计学意义（χ2=0.00，P =1.000）；病灶直径<2.0 cm时，ENBCB组诊断率高于ENBLB组（χ2=4.88，P =0.027）。ENBCB组与ENBLB组的操作时间分别为（64.7±14.2）和（36.4±12.8）min，两组差异有统计学意义（t =-18.78，P =0.002）；并发症方面，两组均未发生严重大出血和气胸，轻到中度出血的病例ENBCB组为40.5%（15/37），ENBLB组为17.9%（7/39），差异有统计学意义（χ2=4.71，P =0.030）。结论 与ENBLB相比，ENBCB操作时间相对较长，但在获得标本大小及提高外周型SPN的诊断率方面具有优势，安全性良好。

Abstract:

Abstract: Objective To investigate the diagnostic value of electromagnetic navigation bronchoscopy guidance transbronchial lung cryobiopsy for solitary pulmonary nodules (SPN). Methods 76 patients with peripheral pulmonary lesions (diameter < 3.0 cm) who experienced diverse manners of transbronchial lung biopsy from January 1, 2016 to July 8, 2018 were analyzed retrospectively. The patients were divided into electromagnetic navigation bronchoscopy guidance cryobiopsy (ENBCB) group and electromagnetic navigation bronchoscopy guidance lung biopsy (ENBLB) group. We compared the size of biopsy specimens, diagnostic yield, operation time and complications between these two groups. The final diagnosis was identified by pathologic examination of surgically resected lesions or by 2 year follow-up until clinical cure stage. Results The lesion size of the ENBCB group, the ENBLB group were (21.0 ± 8.0) mm, (22.0 ± 8.0) mm. Furthermore, no significant difference was found in diagnostic yields by lesion size (t = 0.68, P = 0.590). The size of biopsy specimens in ENBCB group (10.5 ± 4.2) mm2 is bigger than that in ENBLB group (2.9 ± 1.3) mm2 (t = -14.56, P < 0.05). Pathological results indicated that the diagnostic yield of ENBCB group was 89.2% (33/37) and that of ENBLB group was 69.2% (27/39), the difference between the addressed groups being statistical significant (χ2 = 4.55, P = 0.033). Subgroup analysis demonstrated that , as the lesion diameter was 2.0 ~ 3.0 cm, there was no statistical difference of diagnostic yield between the two groups (χ2 = 0.00, P = 1.000), while as the lesion diameter was < 2.0 cm, the diagnostic yield in ENBCB group was increased compared with ENBLB group (χ2 = 4.88, P = 0.027). The procedure time remained significantly longer in the ENBCB group (64.7 ± 14.2) min than ENBLB group (36.4 ± 12.8) min (t = -18.78, P = 0.002). There was no pneumothorax or severe bleeding after operation. The rate of mild to moderate bleeding in ENBCB group and ENBLB group was 40.5% (15/37) and 17.9% (7/39) (χ2 = 4.71, P = 0.030) respectively. Conclusions Compared with ENBLB biopsy group, the procedure time of ENBCB group remained significantly longer. However, ENBCB for small peripheral pulmonary lesions is secure, and has higher diagnostic rate.