比较大曼彻斯特有和没有快速现场评估（ROSE）的两个大容量EBUS服务的诊断性能。

IF 3.5 3区医学 Q2 RESPIRATORY SYSTEM

Respiration Pub Date : 2025-03-21 DOI:10.1159/000545164

Haider Al-Najjar, Marwah Almadhi, Azita Rajai, Nadira Narine, Durgesh Rana, Haval Balata, Matthew Evison

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引用次数: 0

摘要

简介：ROSE需要在手术室对诊断标本进行即时病理评估，便于向操作员实时反馈标本是否充足和诊断情况。关于其在支气管内超声经支气管针抽吸（EBUS-TBNA）领域的作用一直存在争议。方法：回顾性队列分析前瞻性维护的大曼彻斯特EBUS数据库，该数据库包括rose中心2017年1月1日至2018年12月31日期间的所有线性EBUS程序，以及非rose中心同期的所有线性EBUS程序。检查诊断表现和程序因素，如淋巴结（LN）采样站和镇静剂量，然后根据EBUS适应证分层。结果：在两个中心共检查了1650例连续的EBUS手术。对于大多数适应症，使用ROSE可显著减少淋巴结取样数量、病理时间和镇静剂量。在697例分期EBUS中，rose中心的敏感性为95% (95% CI 91-97%)，阴性预测值（NPV）为93% (95% CI 88-96%)，纵膈淋巴结转移率为27%(103/376)，非rose敏感性为85% (95% CI 79-90%)，阴性预测值为86% (95% CI 80-90%)，纵膈淋巴结转移率为32%（103/321）。在329例诊断性EBUS中，使用ROSE导致每次手术取样LN站点数量的统计学显著减少(ROSE的中位数为1个站点[1-1]，而2个站点[1-2]，p结论：本研究表明ROSE可能在EBUS的诊断性能中提供额外的价值，值得在不断发展的肺癌和支气管镜检查中进一步讨论。

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Comparing diagnostic performance across two high-volume EBUS services in Greater Manchester with and without Rapid On-Site Evaluation (ROSE).

Introduction: ROSE entails immediate pathological evaluation of diagnostic specimens in the procedure room, facilitating real-time feedback to operator on specimen adequacy and diagnosis. There is ongoing debate about its role in the field of Endobronchial Ultrasound Transbronchial Needle Aspiration (EBUS-TBNA).

Methods: Retrospective cohort analysis of prospectively maintained Greater Manchester EBUS database encompassing all linear EBUS procedures between 01/01/2017 and 31/12/2018 at the ROSE-centre versus all linear EBUS procedures in the same period at a non-ROSE centre. Diagnostic performance plus procedural factors such as lymph node (LN) stations sampled and sedation doses were examined then stratified according to EBUS indication.

Results: In total 1650 consecutive EBUS procedures were examined across two centres. Using ROSE resulted in statistically significant reduction in number of nodes sampled, time to pathology and sedation doses for most indications. In 697 staging EBUS, sensitivity at the ROSE-centre was 95% (95% CI 91-97%), negative predictive value (NPV) 93% (95% CI 88-96%) with prevalence of mediastinal nodal metastases of 27% (103/376) versus non-ROSE sensitivity 85% (95% CI 79-90%), negative predictive value 86% (95% CI 80-90%) with prevalence of mediastinal nodal metastases of 32% (103/321). In 329 diagnostic EBUS, using ROSE resulted in a statistically significant reduction in number of LN stations sampled per procedure (median 1 station [1-1] with ROSE vs 2 [1-2], p <0.001). Diagnostic performance was higher at the ROSE centre including increases in sensitivity of 7% for diagnostic EBUS in advanced lung cancer, 20% for Isolated Mediastinal Hilar Lymphadenopathy (IMHL) and 17% for diagnosis of nodal metastases from extra-thoracic malignancy.

Conclusion: This study suggests ROSE may provide additional value in diagnostic performance in EBUS and warrants further discussion in an evolving lung cancer and bronchoscopic landscape.

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来源期刊

Respiration 医学-呼吸系统

CiteScore

7.30

自引率

5.40%

发文量

审稿时长

4-8 weeks

期刊介绍： ''Respiration'' brings together the results of both clinical and experimental investigations on all aspects of the respiratory system in health and disease. Clinical improvements in the diagnosis and treatment of chest and lung diseases are covered, as are the latest findings in physiology, biochemistry, pathology, immunology and pharmacology. The journal includes classic features such as editorials that accompany original articles in clinical and basic science research, reviews and letters to the editor. Further sections are: Technical Notes, The Eye Catcher, What’s Your Diagnosis?, The Opinion Corner, New Drugs in Respiratory Medicine, New Insights from Clinical Practice and Guidelines. ''Respiration'' is the official journal of the Swiss Society for Pneumology (SGP) and also home to the European Association for Bronchology and Interventional Pulmonology (EABIP), which occupies a dedicated section on Interventional Pulmonology in the journal. This modern mix of different features and a stringent peer-review process by a dedicated editorial board make ''Respiration'' a complete guide to progress in thoracic medicine.