| Lung cancer is one of the common diseases of the respiratory system.Early screening and detection are the key to improve the overall prognosis of lung cancer.Pulmonary solid lesions are one of the common imaging manifestations of respiratory diseases.With the popularization of chest CT screening,more and more pulmonary solid lesions have been discovered.The diagnosis of benign or malignant lesions is still based on pathological diagnosis.Traditional bronchoscopic technologies obtain pathological diagnosis of lesions in the lumen of the central airway,however,the diagnosis yields of pulmonary peripheral lesions as well as the lesions outside the central or segmental airway wall is still low.With the development of endobronchial ultrasound with related guidance technologies,Bronchoscopists have the abilities to obtain pathological diagnosis of lesions above endobronchially.This study collected patients' data from March 2013 to August 2015 in the Department of Respiratory and Critical Care Medicine of Changhai Hospital.According to the different distributions of the pulmonary solid lesions,multiple guided technologies based on radial probe endobronchial ultrasound were used to diagnosis the solid peripheral pulmonary lesions,endobronchial ultrasound assisted conventional transbronchial needle aspiration was used to diagnosis the solid peribronchial pulmonary lesions located in the segmental bronchi,endobronchial ultrasound elastography was used to diagnosis the solid lesions outside the central airway.Retrospective research methods were used to analyze clinical data,summarize the diagnostic methods and evaluate the effectiveness and safety of various diagnostic Methods.PART 1 Multiple guided technologies based on radial probe endobronchial ultrasound for the diagnosis of pulmonary peripheral solid lesions Objective To evaluate the value of multiple guided technologies based on radial probe endobronchial ultrasound in the application of the diagnosis of pulmonary peripheral solid lesions.Methods Analysis of diagnostic yield in 4 groups patients with different combined multiple guided technologies based on RP-EBUS,94 patients with 94 pulmonary peripheral solid lesions from Mar,2013 to Nov,2014 in Shanghai Changhai Hospital.Results 1.The diagnostic yield of Group A(RP-EBUS)was 65.0%(13/20),Group B(EBUS-GS)was 75.6%(34/45),Group C(EBUS-GS with fluoroscopy)was 81.8%(9/11),Group D(virtual bronchoscopic navigation guided EBUS-GS with fluoroscopy)was 91.7%(11/12).2.The overall histopathological diagnostic yield was 56%(53/94).The overall diagnostic yield was 74.5%(70/94)with the application of forcep biopsies combined with bronchial brushing and washing.3.Better histopathological diagnostic yield was associated with application of multiple guided technologies based on EBUS-GS,lesions located in non-lower lobes,lesion's diameter >2cm,radial probe within the lesions and lidocaine nebulization combined with intravenous anesthesia.4.There were no severe complications in all the 94 cases.A ultrasonic radial probe was broken when exploring a lesion located in the apical-posterior segment of left upper lobe.Conclusions 1.Multiple guided technologies based on RP-EBUS were safe and effective in the diagnosis of solid PPLs.2.In practice,the diagnosis yield improved with the application of forcep biopsies combined with bronchial brushing and washing.PART 2 Endobronchial ultrasound assisted conventional transbronchial needle aspiration in the diagnosis of peribronchial pulmonary solid lesions located in the segmental bronchi Objective The aim of the present study was to evaluate the diagnostic accuracy and safety of the novel technique with radial probe endobronchial ultrasound(RP-EBUS)assisted conventional transbronchial needle aspiration(C-TBNA)in the diagnosis of solitary peribronchial pulmonary lesions located in segmental bronchi from 3th to 5th order.Methods From December 2014 to December 2015,16 patients with peribronchial pulmonary solid lesions in the segmental bronchi from 3th to 5th order confirmed by computed tomography(CT)were enrolled.The lesions were located using radial probe endobronchial ultrasound(RP-EBUS)to determine the sites of conventional transbronchial needle aspiration(C-TBNA),then,histopathological specimens were obtained using the technique of C-TBNA.The final pathological diagnosis was made based on the findings from the surgical specimens.Statistical analyses were performed for specimen results and complications.Results 1?On pathological evaluation,14 of the 16 specimens were malignant,including 8 adenocarcinomas,4 squamous cell carcinomas,and 2 small cell carcinomas,while 2 were non-malignant diseases.2?The diagnostic accuracy rate,sensitivity and missed diagnosis rates were 93.75%,87.5% and 12.5%.3?There were 2 cases of bleeding complications >5 m L after C-TBNA,and both were resolved with endobronchial management.Conclusions 1?The combination of RP-EBUS with C-TBNA was advantageous and safe for the diagnosis of solitary peribronchial pulmonary lesions located in the segmental bronchi.2?This method could obtain the clinical diagnosis results of high diagnostic rate,high sensitivity without high-risk complications.However,possible bleeding complications should be anticipated with needle aspiration.PART 3 Diagnosis of the solid lesions outside the central airway by endobronchial ultrasound elastography Objective The aims of this study were to investigate the diagnostic value of Endobronchial ultrasound(EBUS)elastography for distinguishing the difference between benign and malignant lymph nodes among mediastinal and hilar lymph node.Methods From June 2015 to August 2015,47 patients confirmed of mediastinal and hilar lymph node enlargement through examination of Computed tomography(CT)were enrolled,and a total of 78 lymph nodes were evaluated by endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA).EBUS-guided elastography of lymph nodes was performed prior to EBUS-TBNA.A convex probe EBUS was used with a new EBUS processor to assess elastographic patterns that were classified based on color distribution as follows: Type 1,predominantly non-blue(green,yellow and red);Type 2,part blue,part non-blue(green,yellow and red);Type 3,predominantly blue.Pathological determination of malignant or benign lymph nodes was used as the gold standard for this study.The elastographic patterns were compared with the final pathologic results from EBUS-TBNA.Results 1?On pathological evaluation of the lymph nodes,45 were benign and 33 were malignant.2?The lymph nodes that were classified as Type 1 on endobronchial ultrasound elastography were benign in 26/27(96.3%)and malignant in 1/27(3.7%);for Type 2 lymph nodes,15/20(75.0%)were benign and 5/20(25.0%)were malignant;Type 3 lymph nodes were benign in 4/31(12.9%)and malignant in 27/31(87.1%).3?In classifying Type 1 as ‘benign' and Type 3 as ‘malignant,' the sensitivity was were 96.43%,the specificity was 86.67%,positive predictive value was 87.10%,negative predictive value and diagnostic accuracy rates were 96.30%,91.38% respectively.Conclusions 1 ? EBUS elastography of mediastinal and hilar lymph nodes is a noninvasive technique that can be performed reliably.2?EBUS elastography may be helpful in the prediction of benign and malignant lymph nodes among mediastinal and hilar lymph node during EBUS-TBNA. |
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