A. Zaitseva, E. Krasnikova, L. Semenova, I. Sivokozov, N. Karpina, А. Ergeshov
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Depending on the final verification, were endosonographic images divided into 2 groups: the Neo group (n=63), whose biopsy (during bronchoscopic or surgical diagnosis) verified the malignancy PPls, and the TB+NTM group (n=82) – infectious PPLs caused by mycobacterial infection (73 cases – pulmonary TB, 9 cases – mycobacteriosis). Results. It was established that differences were statistically significant in shape, contour/border, and the presence of inclusions (linear arcs, zones of hypo-anechogenesis) between the comparison groups. If there are echoic features of malignancy PPLs on EGI with rEBUS (irregular shape (found in 60,3%), lobulated shape (in 17,4%), visualized but blurred contour (in 57.2%), fuzzy/poorly visualized contour (in 25.4%), heteroechoic structure, with “linear arcs” (49.2%) with an air bronchogram (in 36,5%)), tissue bronchobiopsy (brush and TBBL) are priority for cytological and histological examination. If there are echoic features of delimited infectious inflammation on EGI of PPLs in rEBUS (round or oval shape (found in 34.1% of cases), definite, closed contour (in 78.0%), homoechoic structure (29,3%), heteroechoic structure with zones of hypo-anechoicity (in 32.9%) with an air bronchogram (in 23.2%)), bronchobiopsy is a priority, allowing to cover the largest area of the lungs (BAL) for microbiological examination (microscopy, PCR-RT, culture) in combination with tissue biopsy (cytological examination). A classification has been created that includes 3 types of EGI to determine rational approaches to bronchobiopsy for the purpose of differential diagnosis of TB, mycobacteriosis and neoplasia. Conclusions. The use of EGI of PPLs assessment during bronchoscopy with rEBUS navigation determines rational approaches to the complex of navigational bronchobiopsies in the differential diagnosis of TB, mycobacteriosis and malignant processes.","PeriodicalId":23748,"journal":{"name":"Vrach","volume":"302 11","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2024-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Evaluation of the radial endosonographic image of peripheral lung lesions for choosing the bronchobiopsies in the differential diagnosis of tuberculosis, mycobacteriosis and malignancy\",\"authors\":\"A. Zaitseva, E. Krasnikova, L. Semenova, I. Sivokozov, N. Karpina, А. Ergeshov\",\"doi\":\"10.29296/25877305-2023-05-01\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Objective. To evaluate endosonographic images (EGI) for different peripheral lung lesions (PPLs) genesis, to identify patterns of malignancy in the differential diagnosis of tuberculosis (TB), mycobacteriosis (NTM), malignancy neoplasm, to compare the main combinations of variants of the echo characteristics of lung lesions visualized during rEBUS navigation with the data of a comprehensive microbiological, cytological and morphological studies. Methods. A cohort retrospective study included 145 patients (81 women (mean age 44.94±0.24 years) and 64 men (mean age 47.91±0.24)), with newly diagnosed PPLs and with negative sputum TB tests, who underwent diagnostic navigational bronchoscopy (rEBUS) and surgical diagnostics, and EGI of PPLs was visualized with rEBUS. Depending on the final verification, were endosonographic images divided into 2 groups: the Neo group (n=63), whose biopsy (during bronchoscopic or surgical diagnosis) verified the malignancy PPls, and the TB+NTM group (n=82) – infectious PPLs caused by mycobacterial infection (73 cases – pulmonary TB, 9 cases – mycobacteriosis). Results. It was established that differences were statistically significant in shape, contour/border, and the presence of inclusions (linear arcs, zones of hypo-anechogenesis) between the comparison groups. If there are echoic features of malignancy PPLs on EGI with rEBUS (irregular shape (found in 60,3%), lobulated shape (in 17,4%), visualized but blurred contour (in 57.2%), fuzzy/poorly visualized contour (in 25.4%), heteroechoic structure, with “linear arcs” (49.2%) with an air bronchogram (in 36,5%)), tissue bronchobiopsy (brush and TBBL) are priority for cytological and histological examination. If there are echoic features of delimited infectious inflammation on EGI of PPLs in rEBUS (round or oval shape (found in 34.1% of cases), definite, closed contour (in 78.0%), homoechoic structure (29,3%), heteroechoic structure with zones of hypo-anechoicity (in 32.9%) with an air bronchogram (in 23.2%)), bronchobiopsy is a priority, allowing to cover the largest area of the lungs (BAL) for microbiological examination (microscopy, PCR-RT, culture) in combination with tissue biopsy (cytological examination). A classification has been created that includes 3 types of EGI to determine rational approaches to bronchobiopsy for the purpose of differential diagnosis of TB, mycobacteriosis and neoplasia. Conclusions. The use of EGI of PPLs assessment during bronchoscopy with rEBUS navigation determines rational approaches to the complex of navigational bronchobiopsies in the differential diagnosis of TB, mycobacteriosis and malignant processes.\",\"PeriodicalId\":23748,\"journal\":{\"name\":\"Vrach\",\"volume\":\"302 11\",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-05-05\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Vrach\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.29296/25877305-2023-05-01\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Vrach","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.29296/25877305-2023-05-01","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
目的评估不同外周肺部病变(PPLs)成因的内超声图像(EGI),确定结核病(TB)、分枝杆菌病(NTM)、恶性肿瘤鉴别诊断中的恶性肿瘤模式,比较 rEBUS 导航过程中观察到的肺部病变回声特征的主要变异组合与微生物学、细胞学和形态学综合研究的数据。研究方法一项队列回顾性研究纳入了 145 名患者(81 名女性(平均年龄为(44.94±0.24)岁)和 64 名男性(平均年龄为(47.91±0.24)岁),这些患者新近确诊为 PPL,痰结核检测阴性,接受了诊断性导航支气管镜(rEBUS)和手术诊断,并用 rEBUS 观察了 PPL 的 EGI。根据最终验证结果,内窥镜图像被分为两组:Neo组(n=63),其活检(支气管镜或手术诊断期间)证实为恶性PPls;TB+NTM组(n=82)--由分枝杆菌感染引起的感染性PPL(73例--肺结核,9例--分枝杆菌病)。结果结果表明,对比组之间在形状、轮廓/边界以及是否存在内含物(线性弧线、低anechogenesis 区域)方面的差异具有统计学意义。如果使用 rEBUS 进行 EGI 检查时发现恶性 PPL 具有回声特征(形状不规则(60.3%)、分叶状(17.4%)、轮廓可视但模糊(57.2%)、轮廓模糊/可视性差(25.4%)、异回声结构),则对照组之间的差异具有统计学意义。4%)、异回声结构,伴有 "线性弧形"(49.2%)和气管造影(36.5%)),组织支气管活检(刷状和 TBBL)优先进行细胞学和组织学检查。如果 rEBUS 中 PPL 的 EGI 显示有局限性感染性炎症的回声特征(圆形或椭圆形(34.1% 的病例中发现)、明确的封闭轮廓(78.0%)、同回声结构(29.3%)、带低回声区的异回声结构(32.气支气管造影(23.2%)),支气管活检是优先考虑的检查方法,可覆盖肺部最大区域(BAL)进行微生物检查(显微镜检查、PCR-RT、培养),并结合组织活检(细胞学检查)。目前已建立了包括 3 种 EGI 的分类,以确定支气管活检的合理方法,从而对肺结核、分枝杆菌病和肿瘤进行鉴别诊断。结论。在使用 rEBUS 导航的支气管镜检查过程中,使用 EGI 对 PPLs 进行评估,可确定在鉴别诊断肺结核、分枝杆菌病和恶性病变过程中进行导航支气管活检的合理方法。
Evaluation of the radial endosonographic image of peripheral lung lesions for choosing the bronchobiopsies in the differential diagnosis of tuberculosis, mycobacteriosis and malignancy
Objective. To evaluate endosonographic images (EGI) for different peripheral lung lesions (PPLs) genesis, to identify patterns of malignancy in the differential diagnosis of tuberculosis (TB), mycobacteriosis (NTM), malignancy neoplasm, to compare the main combinations of variants of the echo characteristics of lung lesions visualized during rEBUS navigation with the data of a comprehensive microbiological, cytological and morphological studies. Methods. A cohort retrospective study included 145 patients (81 women (mean age 44.94±0.24 years) and 64 men (mean age 47.91±0.24)), with newly diagnosed PPLs and with negative sputum TB tests, who underwent diagnostic navigational bronchoscopy (rEBUS) and surgical diagnostics, and EGI of PPLs was visualized with rEBUS. Depending on the final verification, were endosonographic images divided into 2 groups: the Neo group (n=63), whose biopsy (during bronchoscopic or surgical diagnosis) verified the malignancy PPls, and the TB+NTM group (n=82) – infectious PPLs caused by mycobacterial infection (73 cases – pulmonary TB, 9 cases – mycobacteriosis). Results. It was established that differences were statistically significant in shape, contour/border, and the presence of inclusions (linear arcs, zones of hypo-anechogenesis) between the comparison groups. If there are echoic features of malignancy PPLs on EGI with rEBUS (irregular shape (found in 60,3%), lobulated shape (in 17,4%), visualized but blurred contour (in 57.2%), fuzzy/poorly visualized contour (in 25.4%), heteroechoic structure, with “linear arcs” (49.2%) with an air bronchogram (in 36,5%)), tissue bronchobiopsy (brush and TBBL) are priority for cytological and histological examination. If there are echoic features of delimited infectious inflammation on EGI of PPLs in rEBUS (round or oval shape (found in 34.1% of cases), definite, closed contour (in 78.0%), homoechoic structure (29,3%), heteroechoic structure with zones of hypo-anechoicity (in 32.9%) with an air bronchogram (in 23.2%)), bronchobiopsy is a priority, allowing to cover the largest area of the lungs (BAL) for microbiological examination (microscopy, PCR-RT, culture) in combination with tissue biopsy (cytological examination). A classification has been created that includes 3 types of EGI to determine rational approaches to bronchobiopsy for the purpose of differential diagnosis of TB, mycobacteriosis and neoplasia. Conclusions. The use of EGI of PPLs assessment during bronchoscopy with rEBUS navigation determines rational approaches to the complex of navigational bronchobiopsies in the differential diagnosis of TB, mycobacteriosis and malignant processes.