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@#Objective To investigate the diagnostic value and safety of electromagnetic navigation bronchoscopy combined with radial endobronchial ultrasound in peripheral pulmonary nodules. Methods The clinical imaging, surgical and pathological data of 60 patients with 76 peripheral pulmonary nodules who underwent electromagnetic navigation bronchoscopy combined with radial endobronchial ultrasound guided biopsy in the Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School from June 2020 to June 2021 were retrospectively analyzed. The diagnosis rate and complications were analyzed and summarized. The 76 pulmonary nodules were divided into a small pulmonary nodules group (10 nodules, diameter≤1 cm) and a pulmonary nodules group (1 cm<diameter≤3 cm, 66 nodules) according to diameter. The two groups were compared in terms of operation and diagnosis rate. Results Pulmonary nodules diameter was 1.8±0.6 cm, operation time 29.8±8.6 min, navigation 2.9±0.9 times, biopsy 9.5±1.9 pieces. In the 76 pulmonary nodules, 55 were confirmed by pathology, with a total diagnosis rate of 72.4%, including 32 of malignant lesions and 23 of benign lesions. In the 76 pulmonary nodules, 59 had grade 0 hemorrhage, 17 had grade 1 hemorrhage, and none had grade 2 or more serious hemorrhage. Eight patients developed pneumothorax after surgery, and the degree of lung compression was less than 30%, which was improved after symptomatic treatment with oxygen inhalation. The operation time in the small pulmonary nodules group was significantly longer than that in the pulmonary nodules group, and there was no significant difference in diagnosis rate or complications between the two groups. Conclusion Electromagnetic navigation bronchoscopy combined with radial endobronchial ultrasound is a safe and effective method for the diagnosis of periphery pulmonary nodules, and it also has a high diagnostic rate for small pulmonary nodules (≤1 cm), which is worthy of clinical promotion and application.
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Electromagnetic navigation bronchoscopy (ENB) is a novel type of bronchoscopy based on electromagnetic positioning technique combined with virtual bronchoscopy, three-dimensional computed tomography (CT) imaging and respiratory gating technique, which has been widely applied in clinic practice. In recent years, the domestic electromagnetic navigation system has also been developed rapidly, and its effectiveness and safety in the diagnosis, localization, and treatment of peripheral pulmonary lesions have been initially verified. In order to optimize and standardize the technical specifications of domestic ENB and guide its application in clinical practice, the consensus statement has been organized and written in a collaborative effort by the Professional Committee on Respiratory Equipment Technology of Chinese Medical Equipment Association and the Expert Group on Technical of Domestic Electromagnetic Navigation Bronchoscopy. .
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Objective:To investigate the value of ultrasound-guided coaxial trocar biopsy combined with contrast-enhanced ultrasound in peripheral pulmonary lesions.Methods:From April 2019 to October 2020, 110 patients with peri-pulmonary lesions underwent ultrasound-guided coaxial trocar biopsy and contrast-enhanced ultrasound (CEUS) in Zhongshan People′s Hospital were retrospectively analyzed. All patients were performed contrast-enhanced ultrasound, at the same time, under the guidance of ultrasound, coaxial cannula was used for precise positioning and puncture biopsy of peripheral lung tumors. The times of puncture, the situation of sampling, pathological diagnosis and complications after puncture were recorded.Results:There were 110 lesions in 110 patients with peripheral lesions, and the maximum diameter of the lesions was (3.4±1.2)cm. Ultrasound guided coaxial trocar can be used for multiple, multi angle and multi-layer deep biopsy. The average number of sampling was 1-3, and the success rate of puncture was 100%(110/110). The pathological diagnosis rate was 95.5%(105/110), among which 83 cases (79.0%) were malignant: 42 cases of adenocarcinoma, 19 cases of squamous cell carcinoma, 7 cases of metastatic adenocarcinoma, 4 cases of lymphoepitheliomatoid carcinoma, 4 cases of small cell carcinoma, 2 cases of non-small cell carcinoma, 2 cases of non-keratinized undifferentiated carcinoma, 2 cases of poorly differentiated carcinoma, and 1 case of rhabdomyosarcoma. 22 benign cases (21.0%): 10 inflammatory lesions, 4 pneumonia, 3 necrotic tissue, 2 tuberculosis, 1 atypical adenomatoid hyperplasia of alveolar epithelium, 1 pulmonary cryptococcosis, and 1 inflammatory pseudotumor. The postpuncture complications included pneumothorax 2.7%(3/110) and hemoptysis 0.9%(1/110).Conclusions:Percutaneous ultrasound-guided coaxial puncture biopsy combined with contrast-enhanced ultrasound has high success rate, rapid sampling, clear display of lesions, identification of tumor activity and necrosis area, accurate positioning of puncture target, multi-point sampling in case of one puncture, reducing puncture time and complications, and high clinical application value.
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BACKGROUND@#Electromagnetic navigation bronchoscopy (ENB) has become the latest minimally invasive diagnostic and therapeutic technique due to its characteristics, e.g., non-invasion, accuracy, real-time positioning. In this study, we investigated the application of ENB biopsy combined with Massage staining in the diagnosis and treatment of peripheral pulmonary lesions (PPL).@*METHODS@#The clinical data of 15 PPL patients undergoing ENB biopsy plus Massage staining between August 2017 and January 2018 were retrospectively reviewed. Among them, there were 12 male and 3 female, and the mean age was (51.3±2.1) years old.@*RESULTS@#The diameter of PPLs ranged from 6 mm to 36 mm (mean: 14.0 mm). The successful biopsy rate was 66.7%. All patients successfully underwent Massage staining. The distance between the centers of staining and lesion was (1.0±0.4) cm, and the diameter of staining was (2.8±0.6) cm. The mean operation time was (26.7±5.3 ) min, and the mean blood loss during surgery was (3.3±1.5) mL. There was no pneumothorax, hemothorax and pulmonary vascular injury during the procedure.@*CONCLUSIONS@#The ENB biopsy plus Massage staining technique caused very few complications, and provided high precision, which warrants further application.
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Female , Humans , Male , Middle Aged , Bronchoscopy , Methods , Electromagnetic Fields , Lung Diseases , Diagnosis , General Surgery , Lung Neoplasms , Diagnosis , General Surgery , Reproducibility of Results , Retrospective Studies , Sensitivity and Specificity , Staining and Labeling , MethodsABSTRACT
Objective To evaluate the diagnostic value and safety of domestic electromagnetic navigation bronchoscopy (ENB) guided transbronchial lung biopsy (TBLB) for peripheral pulmonary lesions.Methods Sixty-four patients with peripheral pulmonary lesions shown by thoracic CT in Zhongshan Hospital,Fudan University between Jul.and Dec.,2014 were collected.The patients were randomly assigned to test group (underwent ENB in combination with X-ray guided TBLB) and control group (underwent X-ray guided TBLB).The final diagnosis was confirmed by pathologic examination of surgically removed lesions or by 24 months clinical follow-up.The operative time as well as the intraoperative and postoperative complications were also recorded.Results Sixty-four patients had 70 peripheral pulmonary lesions.There was no difference in age,sex,the lesion size or location between the two groups.Pathology results showed that the diagnostic yield of test group and control group were 88.6％ and 62.9％,respectively,with statistical significance (P =0.012).Subgroup analysis showed that if the lesion's diameter was ≤2 cm,the diagnosis yield of test group was higher than control group (66.7％ vs.20.0％,P =0.266);if the lesion was ＞2 and ≤3 cm,the diagnosis yield of test group and control group were 100 ％ and 81.8 ％,respectively (P =0.485).But if the lesion was＞3 cm,the diagnostic yield of the 2 group was significantly different (94.4 ％ in test group,63.1％ in control group,P =0.042).Mean operation duration of the 2 group was (966 ± 372)s and (1 040 ± 470) s,respectively,with no statistical difference (P =0.600).However,there was statistical difference between the 2 groups on the X-ray time needed to find the pulmonary lessions [(7.0 ± 4.8)s vs.(37.0 ± 37.5) s,P =0.008).There was no pneumothoraxes and excessive bleeding in patients undergoing ENB.Conclusions Compared with X-ray guide TBLB,ENB guided TBLB for peripheral pulmonary lesions has a certain degree of security,and has superiority in reducing the X-ray time required to find the lesion and improving diagnostic yield especially when the lesion's diameter was ＞3 cm.
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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 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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Objective To evaluate the comprehensive application of the CT guided transbronchial lung biopsy (CT TBLB) and CT guided percutaneous needle lung biopsy (CT_NLB) in pulmonary peripheral lesions.Methods According to the lesion location in lung field,51 patients were selected to CT TBLB and 46 patients to CT NLB.Results In the comprehensive application of the two lung biopsy methods,the comphensive biopsy success rate was 100%,pathological diagnostic positive rate 87.6% and diagnostic correct rate 97.9% (of them 100% in CT TBLB).The complications of pneumothorax and haemoptysis were decreased significantly.The positive rate and diagnostic correct rate seem higher,but there was no significant difference between the two methods (P