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BACKGROUND@#Virtual bronchoscopic navigation (VBN) assisted endobronchial ultrasonography with guide sheath (EBUS-GS) has reduced the difficulty and even avoiding radiation exposure during performing transbronchus lung biopsy (TBLB). To evaluate the feasibility and safety of virtual bronchoscopic navigation assisted endobronchial ultrasonography with guide sheath for peripheral pulmonary lesions.@*METHODS@#We performed a retrospective analysis of the patients with PPLs who received VBN assisted EBUS-GS-TBLB in Peking University Cancer Hospital from January 2016 to December 2017. Their clinicopathologic data and complications were assessed.@*RESULTS@#A total of 121 patients were enrolled in the study. The patients included 65 men and 56 women, with a mean age of (58.8±10.3) years. A total of 121 PPLs were examined, and 108 lesions of which could be detected by EBUS. The overall diagnostic yield of EBUS-GS was 73.5%. The diagnostic yield of malignancy was 82.5%. The combination of transbronchial lung biopsy, brush smear and bronchoalveolar lavage fluid provided the greatest diagnostic yield (χ²=6.084, P=0.014). Factors that significantly affected and predicted diagnostic success were EBUS probe within the lesions (χ²=20.372, P=0.000) and PPLs located in the central two-thirds of the lung (χ²=10.810, P=0.001). 1 patient (0.8%) suffered from intraoperative bleeding which could be managed under endoscopy.@*CONCLUSIONS@#VBN assisted EBUS-GS-TBLB for PPLs was an effective and safe procedure.
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Female , Humans , Male , Middle Aged , Bronchoscopy , Methods , Endosonography , Methods , Lung Neoplasms , Diagnostic Imaging , General Surgery , Retrospective Studies , SafetyABSTRACT
Objective To investigate the diagnostic value of transbronchial lung biopsy (TBLB) under virtual bronchoscopic navigation (direct path), endobronchial ultrasonography with a guide sheath (GS) and rapid on-site evaluation (ROSE) for solitary pulmonary nodules (SPNs). Methods One hundred and seventy-eight patients who were underwent transbronchial lung biopsy in the Tianjin Medical University General Hospital between January 2015 to December 2016 were retrospectively evaluated. CT images of all patients showed solitary pulmonary nodules surrounded by lung tissue, and ROSE was undergone during the procedure. The patients were divided into conventional (C-TBLB) group, virtual bronchoscopic navigation (VBN) group, endobronchial ultrasonography with a guide sheath (GS) group, and virtual bronchoscopic navigation combined with endobronchial ultrasonography with a guide sheath group (combination) depending on the different devices. The diagnostic yield and the location or the effect of lesion on the diagnostic rate were compared between four groups. The coincidence rate of ROSE and the histopathological findings of TBLB were compared. The value of ROSE for the early diagnosis of disease was further evaluated. Results The diagnostic rates were 32.5％(13/40), 66.7％(24/36), 68.2％(30/44) and 75.8％(44/58) for C-TBLB group, VBN group, GS group and combination group, respectively. There were significant differences in diagnostic rates between C-TBLB group and other tree groups (χ2=8.853, 10.677 and 18.293, P0.008). The diagnostic rates for peripheral pulmonary nodules were 12.5％ (2/16), 42.9％ (6/14), 40.0％ (4/10) and 75.9％(22/29) in C-TBLB group, VBN group, GS group and combination group. The diagnostic rate was significantly higher in combination group than that of other three groups (χ2=17.434, P<0.05). The result of ROSE was consistent with result of histopathology (Kappa = 0.775, P<0.001). The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of ROSE during transbronchial biopsy for solitary pulmonary nodules were 90.7％, 87.0％, 86.7％, 90.9％ and 88.8％, respectively. No pneumothorax, hemoptysis or other serious complications were found in patients. Conclusion Virtual bronchoscopic navigation, endobronchial ultrasonography with a guide sheath for solitary pulmonary nodules by transbronchial lung biopsy can improve the diagnostic rate of solitary pulmonary nodules.
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Objective To investigate the application of radial endobronchial ultrasound (R-EBUS)-guided bronchoscopy in the diagnosis of peripheral pulmonary lesions (PPLs),assess its safety and diagnostic value,and explore the influencing factors.Methods Clinical data of 140 patients who underwent R-EBUS transbronchial biopsy (TBB) and brush biopsy in our department of respiratory endoscopy from January 2015 to March 2017 were collected and retrospectively analyzed in the study.Eighty-three cases were diagnosed as PPLs.The detection rate,ability to locate the peripheral lesions,and influencing factors of EBUS were analyzed.The incidence rate of complications was observed to assess its safety.Results Of the 83 PPLs patients,they were 55 males and 28 females,and at a mean age of 59.81 ± 11.85 years.The total success rate of EBUS-guided bronchoscopic diagnosis was 59.04％ (49/83),and the diagnostic rate was 50.94％ (27/53) for malignant lesions,and 73.33％ (22/30) for benign diseases.The rate of EBUS-TBB (56.92％,37/65) was significantly higher than that of brush biopsy (30.12％,25/83,Chi square =10.76,P =0.001).EBUS-guided diagnostic methods had an accuracy of 60.00％ (45/75),while the EBUS-guided bronchoscopy had a rate of 50.0％ (4/8),but no significant difference was seen between the 2 methods (Chi square =0.03,P =0.87).The sizes of the lesions ranged from 10.0 to 52.4 mm,and the diagnostic yield for PPLs ≤20 mm in diameter (36.84％,7/19) was lower than that for those ＞20 mm (65.62％,42/64,Chi square =5.02,P =0.003).There was no significant difference (Chi square =10.05,P =0.07)in the diagnostic yield for different sites,with that of right upper lobe of 46.15％ (12/26),right middle lobe 100.00％ (8/8),right lower lobe 53.85％ (7/13),left upper lobe 37.50％ (3/8),left lingula lobe 63.64％ (7/11),left lower lobe 70.59％ (12/17).But the detection rate was obviously lower in the upper lobe (22/45,48.89％) than the middle/lower lobe (27/38,71.05％,Chi square =5.02,P =0.003).Of all the 83 patients,74 ones (89.16％) were successfully identified using radial probe EBUS,but the lesions were not found in 9 patients.When the radial probe position was within the target lesion,the diagnostic yield was 81.58％ (31/38),notably higher than that when the probe was positioned adjacent to the lesion (50.00％,18/36,Chi square =8.24,P =0.004).Mild bleeding was observed when performing biopsy under bronchoscope,and no pneumothorax,or other serious complications were observed.Conclusion Radial EBUS is a safe and feasible nethod to accurately identify PPLs and improve its diagnostic rate.EBUS-guided bronchoscopy has higher positive detection rate for PPLs,and is cost saving.The relationship of the probe and the site of lesion is the main factor influencing the diagnostic rate.
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Objective To evaluate the diagnostic yield and safety of transbronchial lung biopsy (TBLB) under virtual bronchoscopic navigation (Direct Path), endobronchial ultrasonography with a guide sheath (GS) and rapid on-site evaluation using an ultrathin bronchoscopy (UNRE) for bacterial infection located in the peripheral third of the lung field. Methods Ninety-seven patients with bacterial infection, which located in the peripheral third of the lung field on CT images, were ran-domly assigned to UNRE (n=49) or non-UNRE (NUNRE, n=48) groups, who were treated in General Hospital of Tianjin Medical University between April 1, 2014 and March 31, 2015. The TBLB guided by UNRE was performed in two groups. The diagnostic yield, safety and complication rate were compared between two groups. Moreover, the differences of autofluo-rescence intensity of alveolar macrophage in alveolar lavage fluid were compared between two groups of patients. Results The diagnostic yield was significantly higher in UNRE group than that of NUNRE group (81.6% vs 56.2%, χ2=7.313, P <0.01). The diagnostic yield was higher in UNRE group with bronchus sign compared to that of NUNRE. All patients had a mild bleeding at the time of biopsy. There were no hemoptysis, pneumothorax or other serious complications. The autofluores-cence intensity of alveolar macrophage was different in different levels of infection in patients. Conclusion The procedure of UNRE has higher diagnostic rate and fewer complications. The careful selection of suitable cases can further improve the diagnostic accuracy. The autofluorescence intensity of alveolar macrophage in alveolar lavage fluid indicates the severity of infection in patients.
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Tracheobronchopathia osteochondroplastica (TO) is a rare benign disease of unknown etiology characterized by accumulation of calcium phosphate in the submucosa of large airways and benign proliferation of bone and cartilage resulting in nodular formation. We report a case of tracheobronchopathia osteochondroplastica diagnosed by Endobronchial ultrasonography in a 56-year-old man. Chest Computed Tomography revealed thickening of tracheal and bronchial wall, and multiple nodules through whole trachea. Endobronchial ultrasonography showed numerous submucosal nodules with hetero-echogenecity in the third and fourth layers. Histopathological examination revealed nonspecific bronchitis with squamous metaplasia and metaplastic ossification. We confirmed tracheobronchopathia osteochondroplastica. The patient's symptoms were successfully treated with antibiotics and oxygen supplyment. endobronchial ultrasonography can helpful diagnosis in tracheobronchopathia osteochondroplastica.