- 期刊
Diagnostic Yield of Endobronchial Ultrasound-Guided Transbronchial Biopsy in Peripheral Pulmonary Lesions
支氣管內超音波導引經支氣管切片診斷肺部周邊病灶
摘要
前言：支氣管內超音波（Endobronchial ultrasound, EBUS）的臨床應用，讓支氣管鏡檢查產生新的進展。藉由幅射型微小探頭（radial-type mininature probe）定位肺部周邊病灶，有助於導引經支氣管切片，但診斷率會因為操作者經驗而影響。本研究的目的是分析EBUS在具有豐富經驗者的操作下，導引經支氣管切片診斷肺部周邊病灶的影響因子。方法：將2009年至2010年間，所有於本院因肺部周邊病灶接受EBUS檢查的病患，進行回溯性病歷及影像資料分析。結果：研究期間共144位病患因肺部周邊病灶接受EBUS檢查，120位（83.3%）可得著EBUS影像，病灶大小是主要決定因子。在所有得到最後診斷的131 位病患中，則有114位可得EBUS影像，94位藉由EBUS導引經支氣管切片，直接得確切診斷。因此，當EBUS可見病灶時，診斷率為82.4%（94/114）。就所有接受EBUS檢查的病患而言，整體診斷率為65.3%（94/144)。二項式邏輯迴歸分析（Binary logistic regression analysis）顯示，病灶大於3公分相較小於等於3 公分、EBUS探頭置於病灶內相較於鄰接病灶、及病灶位於左上葉相較於右下葉，是影響EBUS導引經支氣管切片診斷率的獨立影響因子（p=0.029, 0.029 and 0.036）。結論：就肺部周邊病灶而言，病灶大小是影響可否得著EBUS 影像的決定因子。病灶大小、EBUS探頭位置、及病灶位於左上葉相較於右下葉，則是影響EBUS導引經支氣管切片診斷率的獨立影響因子。
並列摘要
Objective: Endobronchial ultrasound (EBUS) has emerged as a new diagnostic tool that allows bronchoscopists to see beyond the airway. The radial-type miniature probe can localize peripheral pulmonary lesions (PPLs) prior to transbronchial biopsy (TBB). The purpose of this retrospective study was to evaluate the factors affecting the diagnostic yield of lung lesions using EBUS-guided bronchoscopic examinations performed by highly experienced bronchoscopists.Methods: From 2009 to 2010, 144 patients with pulmonary lesions that were beyond the segmental bronchus received EBUS examinations at E-DA Hospital. Their medical records were reviewed and analyzed retrospectively.Results: Pulmonary lesions were found in 120 patients (83.3%) using EBUS. Lesion size was a determining factor for the visibility of the PPLs. A definitive diagnosis was established in 114 of the 120 patients. The diagnostic rate of EBUS-TBB in EBUS-visible lesions was 82.4% (94/114). The overall diagnostic yield of EBUS-guided bronchial examinations was 65.3% (94/144). Binary logistic regression analysis revealed that a lesion size larger than 3 cm, the probe within the lesion, and the lesion located in the left upper lobe relative to the right lower lobe were independent predictors of diagnostic yield (p=0.029, 0.029 and 0.036, respectively). Conclusions: Lesion size is a significant factor influencing the visibility of PLLs. The lesion size, the probe position and the lesion location (left upper lobe relative to the right lower lobe) were independent predictors of diagnostic yield by EBUS-guided bronchoscopic examination.
延伸閱讀
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