Clinical Study Of Virtual Navigation System Combined With Radial Ultrasound Bronchoscope In The Diagnosis Of Peripheral Pulmonary Diseases

Objective:In recent years,the detection rate of peripheral lung diseases is getting higher and higher,and clinical diagnostic methods are also constantly updated.Each diagnostic method has its advantages and disadvantages.This article aims to explore the diagnostic value of radial ultrasound bronchoscopy combined with virtual navigation system for peripheral lung diseases and evaluate its safety,so as to provide a basis for selecting the diagnosis mode of PPLs in the future.Methods:From June 2019 to December 2022,patients with peripheral pulmonary lesions diagnosed by chest CT in the affiliated Hospital of Guizhou Medical University were retrospectively analyzed.They were divided into three groups according to the diagnosis: conventional bronchoscope group(n = 220),VBN-r EBUS group(n = 171)and CT-PTNB group(n = 109).The clinical data such as sex,age,smoking history,focus location,size,lung field distribution,distance from chest wall,case diagnosis,final diagnosis and related complications were collected.The diagnostic rate and safety of three diagnostic methods for PPLs were analyzed and compared,and the indications of three diagnostic methods were analyzed by subgroup to comprehensively evaluate the diagnostic value and safety of VBN-r EBUS in patients with PPLs.Results:1.General information results: a total of 500 cases were included,including292 males and 208 females.The average age of routine bronchoscopy group,VBN-r EBUS group and CT-PTNB group were 58.46 ±14.04 years,60.61±12.90 years and 60.99±12.91 years respectively.There was no significant difference in age,sex,smoking history,focus location,distance from chest wall,lung field distribution and focus size among the three groups(P>0.05).2.Pathological diagnosis: 96 cases were clearly diagnosed by conventional bronchoscopy,including 52 cases of malignancy,including 8 cases of squamous cell carcinoma,17 cases of adenocarcinoma,11 cases of non-small cell lung cancer,1 case of large cell carcinoma,2 cases of small cell carcinoma,and 13 cases of unclassified malignant tumors;a total of 44 cases of benign lesions,15 cases of pneumonia,9 cases of inflammatory nodules,10 cases of tuberculosis,10 cases of lung abscess.In the VBN-r EBUS group,104 cases were clearly diagnosed,including 55 cases of malignancy,8 cases of squamous cell carcinoma,29 cases of adenocarcinoma,1 case of adenosquamous cell carcinoma,10 cases of non-small cell lung cancer,1 case of neuroendocrine tumor,and 1 case of small cell carcinoma.There were 4 cases of classified malignant tumors and 1 case of metastatic tumors;49 cases of benign lesions,13 cases of pneumonia,10 cases of inflammatory nodules,19 cases of pulmonary tuberculosis,6 cases of pulmonary abscess and 1 case of pulmonary fungal infection.In the CT-PTNB group,83 cases were clearly diagnosed,including 60 cases of malignancy,5 cases of squamous cell carcinoma,27 cases of adenocarcinoma,7cases of non-small cell lung cancer,1 case of small cell carcinoma,18 cases of unclassified malignant tumor,and 2 cases of metastatic tumor;there were 23 cases of benign lesions,8 cases of pneumonia,3 cases of inflammatory nodules,8 cases of pulmonary tuberculosis,1 case of lung abscess,1 case of organizing pneumonia and 2cases of pulmonary fungal infection.3.Comparison of diagnosis rate: the diagnosis rate of conventional bronchoscopy group was 43.6%(96/ 220),that of VBN-r EBUS group was 60.8%(104 / 171),and that of CT-PTNB group was 74.1%(83 / 109).The diagnosis rate of VBN-r EBUS group and CT-PTNB group was higher than that of conventional bronchoscopy group,and that of CT-PTNB group was higher than that of VBN-r EBUS group.4.The diagnostic rates of three diagnostic methods in different subgroups were compared: for lesions with < 3cm,distance from chest wall < 2cm,located in upper lobe of both lungs and middle zone of lung field,the diagnostic rate of CT-PTNB was higher than that of conventional bronchoscopy and VBN-r EBUS(P<0.05).For lesions ≥ 3cm,distance from chest wall ≥ 2cm,located in bilateral lower lobe,right middle lobe,inner and outer zone of lung field,there was no significant difference between VBN-r EBUS and CT-PTNB.The diagnosis rate of conventional bronchoscopy is the lowest.5.Comparison of complications: In this study,the common complications were hemorrhage and pneumothorax,with hemorrhage <50 ml in patients with hemorrhage and lung compression <30% in patients with pneumothorax.The incidence in the bronchoscope group was 3.1%.The incidence in the VBN-r EBUS group was 10.5%.The incidence in the PTNB group was 23.9%.The incidence in the VBN-r EBUS group was higher than that in the PTNB group and the PTNB group,and that in the PTNB group was higher than that in the PTNB group(P<0.05).Two patients in CT-PTNB group developed hemopneumothorax at the same time.Conclusions:1.Conventional bronchoscopy,VBN-r EBUS and CT-PTNB can all be used in the diagnosis of PPLs,but they all have limitations.2.In the diagnosis of PPLs,compared with VBN-r EBUS,CT-PTNB has higher diagnostic value;compared with conventional bronchoscopy,VBN-r EBUS has higher diagnostic value;VBN-r EBUS technology is worth popularizing and applying in clinic.3.The complication rate of VBN-r EBUS is significantly lower than that of CT-PTNB,and it is safer in the diagnosis of PPLs.4.VBN-r EBUS can be used with lesions > 3cm,≥ 2cm from the chest wall,located in the lower lobe of both lungs,the middle lobe of the right lung and the inner and outer zone of the lung field.5.CT-PTNB is more suitable for lesions with ≤ 3cm,distance from chest wall <2cm,located in upper lobe of both lungs and in the middle zone of lung field.