电磁导航支气管镜与经胸针吸活检诊断支气管征阳性肺部病变的比较

SCI

24 May 2023

Comparison of electromagnetic navigation bronchoscopy and transthoracic needle biopsy for diagnosing bronchus sign-positive pulmonary lesions

(Lung Cancer; IF:6.081)

Y. Wook Kim, H-J. Kim, S. Hyun Yoon, M. Jin Song, B. Soo Kwon, S. Yoon Lim, Y. Joo Lee, J. Sun Park, Y-J. Cho, J. Ho Lee, C-T. Lee, Comparison of electromagnetic navigation bronchoscopy and transthoracic needle biopsy for diagnosing bronchus sign-positive pulmonary lesions, Lung Cancer (2023), doi: https://doi.org/10.1016/j.lungcan.2023.107234

Correspondence to:Yeon Wook Kim, MD, PhD Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-Ro, Bundang-gu, Seongnam 13620, Republic of Korea E-mail: kimyw@snu.ac.kr

Objectives目的

Electromagnetic navigation bronchoscopy (ENB) is an advanced technique for diagnosing peripheral pulmonary lesions, and the bronchus sign is a well-established factor for improving the diagnostic performance. However, ENB is a novel technology compared to the commonly adopted transthoracic needle biopsy (TTNB). There are limited data on the comparison of these techniques for diagnosing bronchus sign-positive lesions. Therefore, we aimed to compare the diagnostic yield and complication rates of ENB and TTNB for diagnosing lung cancer in bronchus sign-positive pulmonary lesions.

电磁导航支气管镜(ENB)是诊断肺外周病变的先进技术，支气管征是提高诊断能力的重要因素。然而，与常用的经胸穿刺活检(TTNB)相比，ENB是一种新的技术。关于这些技术诊断支气管征阳性病变的比较数据有限。因此，本研究旨在比较ENB和TTNB在支气管征阳性肺部病变中诊断肺癌的诊断率和并发症发生率。

Materials and Methods材料和方法

We assessed 2,258 individuals who underwent either of the techniques for initial biopsy between September 2016 and May 2022 at a tertiary center in South Korea and analyzed 1,248 participants (153 ENB and 1,095 TTNB cases) with a positive bronchus sign. We performed multivariable logistic regression analyses to evaluate the factors associated with the diagnostic yield, sensitivity for malignancy, and procedure-related complications. In addition, the outcomes were compared between the two techniques after a 1:2 propensity score-matching to control for pre-procedural factors.

我们评估了2016年9月至2022年5月在韩国一家三级医疗中心接受了其中一种初始活检技术的2,258人，并分析了支气管征阳性的1,248例参与者(153例ENB和1,095例TTNB病例)。我们进行了多变量logistic回归分析，以评估与诊断率、恶性肿瘤的敏感性和手术相关并发症相关的因素。此外，为了控制术前因素，采用1∶2倾向性评分匹配后，比较了两种技术的结局。

Results结果

After adjustments for clinical/radiological factors, performing TTNB over ENB was not significantly associated with a higher diagnostic yield but with a higher risk of pneumothorax (OR=9.69, 95% CI=4.15-22.59). Propensity score-matching resulted in 459 participants (153 ENB and 306 TTNB cases) with balanced pre-procedural characteristics. The overall diagnostic yield did not differ significantly between ENB and TTNB (85.0% vs. 89.9%, p=0.124). The diagnostic yield (86.7% vs. 90.3%, p=0.280) and sensitivity for malignancy (85.3% vs. 88.8%, p=0.361) were comparable among patients with a class 2 bronchus sign. However, TTNB demonstrated a significantly higher complication rate of pneumothorax (28.8% vs. 3.9%, p<0.001) and pneumothorax requiring tube drainage (6.5% vs. 2.0%, p=0.034) than ENB.

校正临床/影像学因素后，与ENB相比，TTNB与更高的诊断率无显著相关性，但具有更高的气胸风险(OR=9.69, 95% CI=4.15 ~ 22.59)。倾向性评分匹配平衡了459例患者(153例ENB和306例TTNB)术前特征。ENB和TTNB的总体诊断率没有显著差异(85.0%VS89.9%，p=0.124)。在有2级支气管征的患者中，诊断率(86.7%对90.3%，p=0.280)和对恶性肿瘤的敏感性(85.3%VS88.8%，p=0.361)相当。然而，TTNB组气胸(28.8% vs. 3.9%， p<0.001)和需要引流的气胸 (6.5% vs. 2.0%， p=0.034)的并发症发生率显著高于ENB组。

Conclusion结论

ENB demonstrated a diagnostic yield comparable with that of TTNB for diagnosing bronchus sign-positive peripheral pulmonary lesions with significantly lower complication rates.

ENB对支气管征阳性的周围型肺占位性病变的诊断效能与TTNB相当，且并发症发生率较低。