Rong Lih Ho, Joong Hyun Ahn, Jung Ho Han, Junsu Choe, Sun Hye Shin, Byeong-Ho Jeong, Sang-Won Eom, Hojoong Kim, Kyungjong Lee
{"title":"桡骨支气管超声引导下经支气管穿刺（TBNA）提高肺结节活检的诊断率。","authors":"Rong Lih Ho, Joong Hyun Ahn, Jung Ho Han, Junsu Choe, Sun Hye Shin, Byeong-Ho Jeong, Sang-Won Eom, Hojoong Kim, Kyungjong Lee","doi":"10.21037/tlcr-2025-68","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Diagnosing pulmonary lesions remains challenging despite various modalities. The PeriView Flex aspiration needle offers a promising solution to forceps biopsy limitations. This study aims to assess whether combining radial endobronchial ultrasound (rEBUS)-guided transbronchial needle aspiration (TBNA) and transbronchial lung biopsy (TBLB) may enhance tissue acquisition for inaccessible lesions using forceps.</p><p><strong>Methods: </strong>This retrospective study included 33 patients with pulmonary lesions who underwent a combination of rEBUS-guided TBNA and TBLB between September 2023 and August 2024. Diagnostic yields were calculated using a strict definition and were compared with those of propensity score-matched controls who underwent rEBUS-guided TBLB alone.</p><p><strong>Results: </strong>The median age of the cohort was 68 years, with a male-to-female ratio of 1.2:1.0. About 65% of lesions were in the outer two-thirds of the thorax, with a median size of 16.75 mm (interquartile range: 13.00-23.88 mm). Most lesions were solid (81.8%), followed by consolidation (9.1%), part-solid (6.1%) and cavitary lesions (3%). In our cohort, 21.2% had type Ia and 15.2% had type Ib, classified as favorable bronchial patterns on computed tomography (CT). However, approximately two-thirds had unfavorable bronchial patterns, including type Ic (12.1%), IIa (45.5%), and IIb (6.1%). An adjacent rEBUS view was present in 52% of the cases. The combined TBNA-TBLB approach achieved a diagnostic yield of 66.7%, which was highest in CT bronchus types Ia and Ib (83.3%) and lowest in types Ic, IIa, and IIb (57.1%). Propensity score matching (1:3) showed a higher diagnostic yield with TBNA-TBLB (66.7%) than with TBLB alone (48.5%), P=0.10. Post-procedural pneumothorax occurred in one patient (3.0%) in TBNA-TBLB group compare to 2.3% in TBLB group.</p><p><strong>Conclusions: </strong>Adding TBNA to TBLB improved the diagnostic yield for pulmonary nodules with adjacent or tunnel-type bronchi. This combined approach offers a practical strategy for enhancing diagnostic accuracy.</p>","PeriodicalId":23271,"journal":{"name":"Translational lung cancer research","volume":"14 5","pages":"1611-1621"},"PeriodicalIF":3.5000,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170253/pdf/","citationCount":"0","resultStr":"{\"title\":\"Radial endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) enhances diagnostic yield in pulmonary nodule biopsy.\",\"authors\":\"Rong Lih Ho, Joong Hyun Ahn, Jung Ho Han, Junsu Choe, Sun Hye Shin, Byeong-Ho Jeong, Sang-Won Eom, Hojoong Kim, Kyungjong Lee\",\"doi\":\"10.21037/tlcr-2025-68\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Diagnosing pulmonary lesions remains challenging despite various modalities. The PeriView Flex aspiration needle offers a promising solution to forceps biopsy limitations. This study aims to assess whether combining radial endobronchial ultrasound (rEBUS)-guided transbronchial needle aspiration (TBNA) and transbronchial lung biopsy (TBLB) may enhance tissue acquisition for inaccessible lesions using forceps.</p><p><strong>Methods: </strong>This retrospective study included 33 patients with pulmonary lesions who underwent a combination of rEBUS-guided TBNA and TBLB between September 2023 and August 2024. Diagnostic yields were calculated using a strict definition and were compared with those of propensity score-matched controls who underwent rEBUS-guided TBLB alone.</p><p><strong>Results: </strong>The median age of the cohort was 68 years, with a male-to-female ratio of 1.2:1.0. About 65% of lesions were in the outer two-thirds of the thorax, with a median size of 16.75 mm (interquartile range: 13.00-23.88 mm). Most lesions were solid (81.8%), followed by consolidation (9.1%), part-solid (6.1%) and cavitary lesions (3%). In our cohort, 21.2% had type Ia and 15.2% had type Ib, classified as favorable bronchial patterns on computed tomography (CT). However, approximately two-thirds had unfavorable bronchial patterns, including type Ic (12.1%), IIa (45.5%), and IIb (6.1%). An adjacent rEBUS view was present in 52% of the cases. The combined TBNA-TBLB approach achieved a diagnostic yield of 66.7%, which was highest in CT bronchus types Ia and Ib (83.3%) and lowest in types Ic, IIa, and IIb (57.1%). Propensity score matching (1:3) showed a higher diagnostic yield with TBNA-TBLB (66.7%) than with TBLB alone (48.5%), P=0.10. Post-procedural pneumothorax occurred in one patient (3.0%) in TBNA-TBLB group compare to 2.3% in TBLB group.</p><p><strong>Conclusions: </strong>Adding TBNA to TBLB improved the diagnostic yield for pulmonary nodules with adjacent or tunnel-type bronchi. 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Background: Diagnosing pulmonary lesions remains challenging despite various modalities. The PeriView Flex aspiration needle offers a promising solution to forceps biopsy limitations. This study aims to assess whether combining radial endobronchial ultrasound (rEBUS)-guided transbronchial needle aspiration (TBNA) and transbronchial lung biopsy (TBLB) may enhance tissue acquisition for inaccessible lesions using forceps.
Methods: This retrospective study included 33 patients with pulmonary lesions who underwent a combination of rEBUS-guided TBNA and TBLB between September 2023 and August 2024. Diagnostic yields were calculated using a strict definition and were compared with those of propensity score-matched controls who underwent rEBUS-guided TBLB alone.
Results: The median age of the cohort was 68 years, with a male-to-female ratio of 1.2:1.0. About 65% of lesions were in the outer two-thirds of the thorax, with a median size of 16.75 mm (interquartile range: 13.00-23.88 mm). Most lesions were solid (81.8%), followed by consolidation (9.1%), part-solid (6.1%) and cavitary lesions (3%). In our cohort, 21.2% had type Ia and 15.2% had type Ib, classified as favorable bronchial patterns on computed tomography (CT). However, approximately two-thirds had unfavorable bronchial patterns, including type Ic (12.1%), IIa (45.5%), and IIb (6.1%). An adjacent rEBUS view was present in 52% of the cases. The combined TBNA-TBLB approach achieved a diagnostic yield of 66.7%, which was highest in CT bronchus types Ia and Ib (83.3%) and lowest in types Ic, IIa, and IIb (57.1%). Propensity score matching (1:3) showed a higher diagnostic yield with TBNA-TBLB (66.7%) than with TBLB alone (48.5%), P=0.10. Post-procedural pneumothorax occurred in one patient (3.0%) in TBNA-TBLB group compare to 2.3% in TBLB group.
Conclusions: Adding TBNA to TBLB improved the diagnostic yield for pulmonary nodules with adjacent or tunnel-type bronchi. This combined approach offers a practical strategy for enhancing diagnostic accuracy.
期刊介绍：
Translational Lung Cancer Research(TLCR, Transl Lung Cancer Res, Print ISSN 2218-6751; Online ISSN 2226-4477) is an international, peer-reviewed, open-access journal, which was founded in March 2012. TLCR is indexed by PubMed/PubMed Central and the Chemical Abstracts Service (CAS) Databases. It is published quarterly the first year, and published bimonthly since February 2013. It provides practical up-to-date information on prevention, early detection, diagnosis, and treatment of lung cancer. Specific areas of its interest include, but not limited to, multimodality therapy, markers, imaging, tumor biology, pathology, chemoprevention, and technical advances related to lung cancer.
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