Bronchial branch tracing navigation in ultrathin bronchoscopy-guided radial endobronchial ultrasound for peripheral pulmonary nodule.

IF 2.6 3区医学 Q2 RESPIRATORY SYSTEM

BMC Pulmonary Medicine Pub Date : 2024-09-20 DOI:10.1186/s12890-024-03279-0

Sze Shyang Kho, Shirin Hui Tan, Swee Kim Chan, Chan Sin Chai, Siew Teck Tie

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引用次数: 0

Abstract

Background: Most malignant peripheral pulmonary lesions (PPLs) are situated in the peripheral region of the lung. Although the ultrathin bronchoscope (UTB) can access these areas, a robust navigation system is essential for precise localisation of these small peripheral PPLs. Since many UTB procedures rely on automated virtual bronchoscopic navigation (VBN), this study aims to determine the accuracy and diagnostic yield of the manual bronchial branch tracing (BBT) navigation in UTB-guided radial endobronchial ultrasound (rEBUS) procedures.

Methods: Single-centre retrospective study of UTB-rEBUS patients with PPLs smaller than 3 cm over a two year period.

Results: Our cohort consisted of 47 patients with a mean age of 61.6 (SD 9.53) years and a mean target size of 1.91 (SD 0.53) cm. Among these lesions, 46.8% were located in the 6th airway generation, and 78.7% exhibited a direct bronchus sign. Navigation success using BBT was 91.5% based on positive rEBUS identification. The index diagnostic yield was 82.9%, increasing to 91.5% at 12 months of follow-up. Malignant lesions accounted for 65.1% of cases, while 34.9% were non-malignant. The presence of a direct bronchus sign was the sole factor associated with higher navigation success and diagnostic yield. Cryobiopsy outperformed forceps biopsy in non-concentric rEBUS lesions (90.9% vs. 50.0%, p < 0.05), but not in concentric orientated lesions. One pneumothorax occurred in our cohort.

Conclusions: BBT as an exclusive navigation method for small PPLs in UTB-rEBUS procedures has proved to be safe and feasible. Combination of UTB with cryobiopsy remains efficient for eccentric and adjacently oriented rEBUS lesions.

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超薄支气管镜引导下径向支气管内超声治疗外周肺结节的支气管分支追踪导航。

背景：大多数恶性外周肺病变（PPL）位于肺的外周区域。虽然超细支气管镜（UTB）可以进入这些区域，但要精确定位这些小的外周肺病变，强大的导航系统是必不可少的。由于许多UTB手术依赖于自动虚拟支气管镜导航（VBN），本研究旨在确定UTB引导下径向支气管内超声（rEBUS）手术中手动支气管分支追踪（BBT）导航的准确性和诊断率：方法：对小于 3 厘米的 PPL 的UTB-rEBUS 患者进行为期两年的单中心回顾性研究：我们的研究对象包括 47 名患者，平均年龄为 61.6 岁（SD 9.53），平均目标大小为 1.91 厘米（SD 0.53）。在这些病灶中，46.8%位于第6气道代，78.7%表现为支气管直达征。根据阳性的 rEBUS 识别结果，使用 BBT 导航的成功率为 91.5%。指数诊断率为82.9%，随访12个月后上升至91.5%。恶性病变占 65.1%，非恶性病变占 34.9%。存在直接支气管征象是导航成功率和诊断率较高的唯一相关因素。在非中心性 rEBUS 病变中，冷冻活检的效果优于镊子活检（90.9% 对 50.0%，P 结论：在非中心性 rEBUS 病变中，冷冻活检的效果优于镊子活检：在UTB-rEBUS手术中，BBT作为小PPL的唯一导航方法已被证明是安全可行的。UTB与冷冻活检的结合对于偏心和邻近方向的rEBUS病变仍然有效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BMC Pulmonary Medicine RESPIRATORY SYSTEM-

CiteScore

4.40

自引率

3.20%

发文量

423

审稿时长

6-12 weeks

期刊介绍： BMC Pulmonary Medicine is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of pulmonary and associated disorders, as well as related molecular genetics, pathophysiology, and epidemiology.