Application Of Endobronchial Ultrasound Transbronchial Lung Biopsy With Guide-sheath Technique For Diagnosis Of Peripheral Pulmonary Lesions

Objective: To evaluate the diagnostic value and safety of endobronchial ultrasound transbronchial biopsy using guide-sheath in peripheral pulmonary lesions.Methods: A retrospective analysis of the patients with peripheral lung lesions from October2014 to October 2017 in the Second Hospital of Lanzhou University,these patients were a total of66 cases.The operation method was divided into the EBUS-GS group(n = 31)and the traditional group(n = 35)according to the patient’s intention and the guiding equipment.All the patients were confirmed pulmonary lesions by pulmonary CT,and the lesions were surrounded by the lung parenchyma.The conventional bronchoscopy are generally normal.Among the all patients,31 patients underwent EBUS-GS examination,and peripheral lesions with EBUS images were biopsied under ultrasound guidance;the traditional group have 35 patients,35 patients underwent blind inspection of the bronchoscope according to the location which was indicated by the imaging data before operation.For patients who failed to get the diagnosis of lesions and biopsy,CT-guided percutaneous pulmonary biopsy or surgical biopsy or at least 6 months of clinical and radiological follow-up was performed on according to the patients’ choices.The diagnostic rate of peripheral pulmonary lesions,the safety and the related factors that impacts the EBUS-GS group were diagnosed positive rate were analyzed.Results:1.EBUS-GS group and traditional groupThere was no significant difference in gender and age between the EBUS-GS group and the traditional group(P>0.05).EBUS-GS group was 74.2%(23/31),the traditinal group was 45.7%(16/35),EBUS-GS group had higher diagnostic rate(P<0.05),the difference was statistically significant.the malignant lesions were 79.2%(19/24)and the benign lesions were 57.1%(4/7)in EBUS-GS group.the malignant lesions was 48.2%(14/29),the benign lesions was 33.3%(2/6)in the traditional group.there was no significant difference in the diagnostic rate of benign lesions between the EBUS-GS group and the traditional group(P>0.05).when the lesion diameter was ≤2cm,the diagnostic positive rates of EBUS-GS group and traditional group were 46.2%(6/13)and10.5%(2/19),respectively.The diagnostic rate of EBUS-GS group was higher(P<0.05),The difference was statistically significant.when the lesion diameter was >2 cm,the diagnostic positive rates of EBUS-GS group and traditional group were 88.9%(16/18)and 87.5%(14/16),respectively.There was no significant difference between EBUS-GS group and traditional group(P>0.05),The difference was not statistically significant.2.Analysis of correlative factors of diagnostic rate in EBUS-GS GroupWhen the lesions were located in the right upper lobe,right middle lobe,right lower lobe,left upper lobe,left lingual lobe,left lower lobe,the positive rate of EBUS-GS diagnosis was: 66.7%(2/3),80%(4/5),75%(3/4),66.7%(2/3),80%(4/5),75%(3/4).There was no significant difference between the different parts(P>0.05).The positive rates of EBUS-GS group diagnosis were 94.4%(17/18)and 46.2%(6/13)when the diameters of lesions were >2 cm and≤2cm.The diameters of lesions were >2cm was significantly higher than that of lesions ≤2cm patients(P<0.05),the difference was statistically significant.The positive rate of EBUS-GS diagnosis was86.3%(19/22)and 44.4%(4/9),respectively,when the probe position was within the lesion or was near lesion,however,the location of probe within the lesion was high(P<0.05)。 The difference was statistically significant.3.ComplicationAll examiners are well tolerated.In the traditional group,there was 1 case with bleeding less than 20 mL,and there was 1 case with chest pain.No obvious abnormalities were found after clinical treatment.No complications such as hemoptysis or pneumothorax occurred during the operation of the EBUS-GS group.ConclusionCompared with the traditional group,the EBUS-GS group had a higher diagnostic rate for peripheral pulmonary lesions,And the diagnostic rate was particularly significant for small lesions below 2 cm.The diagnostic positive rate is related to the size of the lesion and the position of the ultrasound probe,and has a high safety.