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首页> 外文期刊>European Clinical Respiratory Journal >Retrospective analysis of radial EBUS outcome for the diagnosis of peripheral pulmonary lesion: sensitivity and complications
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Retrospective analysis of radial EBUS outcome for the diagnosis of peripheral pulmonary lesion: sensitivity and complications

机译：放射状EBUS结局诊断外周肺病变的回顾性分析：敏感性和并发症

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BackgroundThe purpose of the current study was to clarify the sensitivity and complication rate of the radial (endobronchial ultrasound, EBUS) without the use of guide-sheath (GS) and fluoroscopy for lung cancer (LC), by measuring the distance from the orifice of the bronchus to the pulmonary lesion, as well as to analyze factors that can predict the diagnostic outcome.Materials and methodsA total of 147 patients with peripheral pulmonary lesions (PPL) underwent radial EBUS-guided transbronchial biopsy (TBB) in between August 1, 2013, and August 31, 2014. We analyzed retrospectively radiological data, diagnostic work-up in everyday clinical settings, final diagnosis and complication rates, as well as factors influencing the diagnostic outcome.ResultsAround 63.9% of PPLs were visualized by ultrasound. A definitive malignant diagnosis was established in 39 patients (26.5%) using radial EBUS. In the remaining 108 patients, additional procedures were performed. We missed LC diagnosis in 40 cases that results in a sensitivity of 49%. For malignant lesions visualized by radial EBUS, the sensitivity was 60%, compared with 24% for not visualized lesions. For malignant lesions, logistic regression was performed to identify the factors that had significant influence on visualization of the lesion and on diagnostic yield. Logistic regression analysis showed significant odds ratios (OR) for visualization depending on location of the lesion; upper lobe lesions were identified more frequent with OR of 3.85 (95% CI 1.42 – 10.98, p =0.009). Size above 30 mm had a non-significant OR of 2.11 (95% CI 0.80?5.73, p =0.134) for visualization.Diagnostic yield was only significantly influenced by visualization with the radial EBUS, OR 3.70 (95% CI 1.35?11.02, p =0.014). Location (p =0.745) and size above 30 mm (p =0.308) showed no significant increase in diagnostic yield.Other lesion characteristics defined on computed tomography, such as distance to carina and pleura, did not show any significant influence on the diagnostic yield. The complications rate was low with three cases of pneumothorax.ConclusionRadial EBUS has definitely its place in the diagnostic work-up of PPL, especially for the lesions that can be visualized by radial ultrasound. However, prospective randomized controlled studies are necessary to raise the diagnostic yield and to define factors that can predict the outcome, which will consequently enable selection of the ‘right’ patients for this diagnostic procedure.
机译：背景本研究的目的是通过测量距of骨孔口的距离，以明确without骨（支气管内超声，EBUS）在不使用引导鞘（GS）和透视检查的情况下对肺癌（LC）的敏感性和并发症发生率。材料和方法2013年8月1日之间，共有147例周围性肺部病变（PPL）患者接受了以EBUS引导的放射状穿刺活检（TBB） ，以及2014年8月31日。我们回顾性分析了放射学数据，日常临床环境中的诊断检查，最终诊断和并发症的发生率以及影响诊断结果的因素。结果超声检查显示约有63.9％的PPL。使用放射状EBUS对39例患者（26.5％）进行了明确的恶性诊断。在其余的108名患者中，进行了额外的程序。我们错过了40例LC诊断的结果，敏感性为49％。对于通过放射状EBUS可视化的恶性病变，敏感性为60％，而对于不可视化的病变为24％。对于恶性病变，进行逻辑回归分析以鉴定对病变的可视化和诊断率有重大影响的因素。 Logistic回归分析显示可视化的明显比值比（OR），具体取决于病变的位置。上叶病变的发生率更高，OR为3.85（95％CI 1.42 – 10.98，p = 0.009）。对于可视化，尺寸大于30 mm的OR的不显着性为2.11（95％CI 0.80？5.73，p = 0.134）。放射状EBUS可视化仅显着影响诊断率，或为3.70（95％CI 1.35） α11.02，p ＝ 0.014）。位置（i p = 0.745）和大小在30 mm以上（i p = 0.308）均未显示诊断率的显着提高。计算机X线断层扫描所定义的其他病变特征，例如与隆突和胸膜的距离均未显示对诊断产量有重大影响。结论3例气胸患者的并发症发生率很低。结论放射EBUS在PPL的诊断检查中无疑占有一席之地，尤其是对于可以通过放射线超声观察的病变。但是，前瞻性随机对照研究对于提高诊断率和定义可预测结果的因素是必要的，因此将有可能为该诊断程序选择“合适的”患者。

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