支气管超声引导下经支气管针吸活检术研究进展

<正>支气管超声(EBUS)引导下经支气管针吸活检术(TBNA)自引入临床至今已有十年余,这项微创技术的使用从根本上影响了胸部疾病的诊断手段,尤其是在肺癌方面,在世界范围内得到了认可。起初,普通支气管镜用于诊断支气管内病变,后常规经支气管针吸活检(cTBNA)发明被用于诊断部分支气管腔外病变,但成功率较低,且盲法操作易损伤血管,EBUS-TBNA应运而生。EBUS不仅允许操作者观察支气管黏膜和其周围组织,近年来还发展了淋巴结弹性成像技术,可大     

经支气管镜针吸活检术在支气管周围及肺门/纵膈病变诊断中的应用

正在临床工作中,当我们遇到既往诊断/新发的支气管管腔外病变(支气管周围2 cm内)及肺门/纵膈淋巴明显结肿大时,需明确病理诊断进而制定下一步诊疗方案。取得病理标本的方法很多,而内科常见技术包括常规支气管镜检查、经支气管镜针吸活检术(transbronchial needle aspiration,TNBA)、经胸壁针吸活检术(transthoracic needle aspiration,     

经EBUS-TBNA诊断肾透明细胞癌纵膈淋巴结转移一例

<正>纵膈的解剖结构复杂,内部器官较多,组织来源各异,是多种良、恶性病变的好发部位。随着影像学技术的发展,纵膈淋巴结肿大已成为常见的临床征象,其已知病因包括结节病、结核、恶性肿瘤、炎症等^[1-3]。但由于无特征性的临床表现和影像学改变,疾病诊断的难度较大。超声内镜引导下的经支气管针吸活检技术(endobronchial ultrasound-guided transbronchial needle aspiration,EBUS-TBNA)     

小探头超声在指引经支气管镜针吸活检术的应用体会

<正>经支气管针吸活检术(transbronchial needle aspiration,TBNA)是临床上常用的对气管或支气管腔外病变进行诊治的手段,但传统TBNA(C-TBNA)阳性率差异很大~([1-4]);而经支气管镜超声引导针吸活检术(endobronchial ultrasoundTBNA,EBUS-TBNA)虽然阳性率高,但其价格昂贵且操作复杂导致其难以普及,我科自2015年6月至2016年5月将小     

气道内超声对经支气管针吸活检的作用

气道内超声(endobronchial ultrasonography,EBUS)检查是一种新型的气道腔内诊断技术,将超声微探头通过气管镜工作通道送入气道内进行横断面环形扫描,对气管道壁各层结构具有高分辨率,判断肿瘤对气道壁的浸润深度;可扩展气管镜的检查范围至管腔外,清楚显示气道外邻近的血管、淋巴结以及占位性病变,有效引导经支气管针吸活检,提高经支气管针吸活检术的诊断率.     

支气管内超声引导经支气管淋巴结针吸活检术在肺癌纵隔淋巴结分期诊断应用研究

支气管内超声引导经支气管淋巴结针吸活检术(EBUS-TBNA)是肺癌纵隔淋巴结分期的新方法,其具有微创、安全等特点,进行纵隔淋巴结分期具有较高的灵敏度和特异度,优于CT、PET和经支气管淋巴结针吸活检术(TBNA),和纵隔镜相当,联合EBUS-TBNA和经食管内镜超声引导细针抽吸活检术(EUS-FNA)可获得几乎完全的纵隔淋巴结分期。可一线应用于肺癌的纵隔淋巴结分期及纵隔淋巴结病变活检。EBUS-TBNA不足之处是相对较高的假阴性率,对于阴性患者,建议行进一步的侵袭性分期方法如纵隔镜检查。     

虚拟支气管镜导航结合支气管内超声引导下经支气管肺活检对孤立性肺结节的实用性

目的评估虚拟支气管镜导航(VBN)结合支气管内超声(EBUS)指导的经支气管肺活检对孤立性肺结节(SPN)的诊断实用性。方法选取2018年1月到2020年1月在我院接受单纯EBUS引导或VBN+EBUS引导下TBLB治疗的SPN患者164例。将患者随机分为EBUS组和VBN+EBUS组。比较两组的诊断率和检查时间。结果 VBN+EBUS组和EBUS组之间的诊断率差异有显著性(P=0.015)。当分析直径小于20 mm的病变时,VBN+EBUS组的诊断率高于EBUS组(P=0.017)。VBN+EBUS组的病变定位时间少于EBUS组(P=0.015)。但两组的总检查时间差异无统计学意义(P=0.236)。两组的并发症发生率差异无统计学意义。结论 VBN可以缩短定位时间,是一种安全有效的肺结节技术。     

优化细针抽吸活检细胞病理学检查

在过去的20年中,随着细针抽吸活检(fine needle aspiration biopsies,FNAB)等微创诊断方法和技术的发展,FNAB在肺部及纵隔淋巴结病变的诊断中的应用越来越普及~([1-5]).肺内肿块及纵隔淋巴结可在支气管内超声(EBUS)、经皮超声或CT引导下经胸壁外或经支气管内行FNAB.尽管FNAB在肺内肿块及纵隔淋巴结病变的鉴别中具有明确作用,但目前其使患者获益的程度仍存在争议,尚有多种方法可优化FNAB的操作.     

纤维支气管镜检查对结节病诊断的临床价值

目的 评价经纤维支气管镜下不同取材对结节病诊断的价值.方法 回顾性分析50例经纤维支气管镜检查,采用肺内活检(包括经支气管黏膜活检和经纤维支气管镜肺活检)、经气管镜针吸活检(TBNA)和经气管镜超声引导针吸活检术(EBUS-TBNA)等方法获取标本,经病理学或细胞学检查确诊为结节病的患者,比较不同取材及联合取材检测结节...     

EBUS-TBNA与EBUS-GS-TBLB对合并肺门及纵隔淋巴结肿大的肺占位性病变诊断效能比较

目的 对比超声引导下经支气管针吸活检(EBUS-TBNA)和导向鞘引导支气管超声经支气管针吸活检(EBUS-GS-TBLB)对合并肺门及纵隔结肿大的肺占位性病变的诊断效能.方法 胸部CT检查提示肺部占位性病变(肿瘤直径≥2 cm)合并有肺门及纵隔淋巴结肿大(直径≥1.5 cm)的患者145例,70例行EBUS-TBNA...     

超声内镜引导下经气管针吸活检的临床应用

超声内镜引导下经气管针吸活检在原发性支气管肺癌、肺转移癌的诊断与治疗以及结节病、纵隔肿瘤、肺内病变的诊断方面发挥了重要的作用.超声内镜引导下经气管针吸活检并发症少,特异性和敏感性高,是一项非常有用的检查手段.     

超声内镜引导下经气管针吸活检的临床应用

超声内镜引导下经气管针吸活检在原发性支气管肺癌、肺转移癌的诊断与治疗以及结节病、纵隔肿瘤、肺内病变的诊断方面发挥了重要的作用.超声内镜引导下经气管针吸活检并发症少,特异性和敏感性高,是一项非常有用的检查手段.     

超声内镜引导下经气管针吸活检的临床应用

超声内镜引导下经气管针吸活检在原发性支气管肺癌、肺转移癌的诊断与治疗以及结节病、纵隔肿瘤、肺内病变的诊断方面发挥了重要的作用.超声内镜引导下经气管针吸活检并发症少,特异性和敏感性高,是一项非常有用的检查手段.     

The value of virtual bronchoscopic navigation and radial endobronchial ultrasound-guided transbronchial lung cryobiopsies for pulmonary lymphangitic carcinomatosis

BackgroundPulmonary lymphangitic carcinomatosis (PLC) is characterized by malignant infiltration into lung lymphatic channels from a primary site and is often observed in advanced malignant tumors. This study aimed to evaluate the diagnostic yield of transbronchial lung cryobiopsy in PLC guided by radial endobronchial ultrasound and virtual bronchoscopic navigation (VBN).MethodsThis prospective study enrolled 40 patients with clinical and radiologic features indicating PLC. The radial endobronchial ultrasound probe was initially advanced to the region of interest of the desired lobe near the pleura with guidance by VBN. Transbronchial lung biopsy and transbronchial lung cryobiopsy were both performed in the same ROI of all patients with the obtained samples being sent to the pathology laboratory for diagnostic analysis. Procedural complications were recorded.ResultsThe average number of transbronchial lung biopsy and transbronchial lung cryobiopsy specimens were 4 (3 to 6) and 2 (1 to 3), respectively (t=10.43, P<0.01), with the corresponding mean diameters per biopsy being 3.7 and 8.7 mm (t=12.37, P<0.01). The diagnostic yields of transbronchial lung biopsy and transbronchial lung cryobiopsy were 70% (28/40) and 92.5% (37/40), respectively. The final positive predictive values of transbronchial lung cryobiopsy and transbronchial lung biopsy for PLC were 94.4% (34/36) and 77.8% (28/36), respectively (χ²=23.94, P<0.01). Further, 52.2% (12/23) and 81.5% (22/27) of the patients in the transbronchial lung biopsy and transbronchial lung cryobiopsy groups, respectively, were diagnosed with non-small lung cancer after further molecular analysis (χ²=19.56, P<0.01). Only 2 (5%) cases presented postoperative pneumothorax. Moreover, 0 (0%), 3 (7.5%), and 17 (42.5%) patients presented severe, moderate, and mild bleeding, respectively. There were no other adverse events or deaths.ConclusionsTransbronchial lung cryobiopsy with the guidance of radial endobronchial ultrasound and VBN without fluoroscopy has a good diagnostic yield for PLC; moreover, it allows one to obtain adequate and intact tissue samples for further molecular analysis.     

纤支镜与超声介入对肺癌检出率的比较

目的 探讨利用纤支镜与超声介入技术对肺癌检出率的比较。方法 选择肺部肿瘤患285例为受试，均先做纤支镜，第二日再做超声肺部肿瘤探查并行超声引导下肺肿块穿刺活检。上述二项检查标本做组织细胞学的病理检查。结果 纤支镜检出肺鳞癌99例、腺癌72例及未分化癌41例，而非肺癌73例。超声介入技术检出肺鳞癌97例、腺癌69例及未分化癌46例，而非肺癌73例。结论 纤支镜技术对中央型肺癌检出率方便准确，而超声介入技术对周围肺癌检出率高而方便。上述两项技术对肺癌检出具有叠加作用。     

Transbronchial versus transesophageal ultrasound-guided aspiration of enlarged mediastinal lymph nodes

RATIONALE: Transesophageal and transbronchial, ultrasound-guided, fine-needle aspiration of enlarged mediastinal lymph nodes have become popular, but have never been compared directly. OBJECTIVES: To compare the relative diagnostic yield and ability of the transesophageal and transbronchial approaches to reach abnormal mediastinal lymph nodes. METHODS: A total of 160 patients with enlarged lymph nodes in one of eight mediastinal lymph node stations underwent transbronchial and transesophageal biopsies in a crossover design. Each of the eight stations was allocated 20 patients. Two needle punctures were done with each approach. MEASUREMENTS: Percentage of successful biopsies, percentage of patients diagnosed, and biopsy time were measured from when the lymph node was identified with ultrasound. MAIN RESULTS: Among the 106 men and 54 women (mean age 53.2 years), transbronchial aspiration was successful in 85%, and transesophageal aspiration was successful in 78% (p = 0.2). For each station, the number of positive samples for the transbronchial/transesophageal approaches was: 2R: 19/13; 2L: 16/19; 3: 17/15; 4R: 19/12; 4L: 17/20; 7: 19/20; 10R: 18/9; and 10L: 17/18. Combining both approaches produced successful biopsies in 97% and diagnoses in 94% of patients. Mean biopsy times were 3.2 minutes for the transbronchial approach and 4.1 minutes for the transesophageal approach. The transbronchial approach was superior in nodes 2R, 4R, and 10R. No complications were encountered. CONCLUSIONS: In experienced hands, enlarged mediastinal lymph nodes may be aspirated with either the transbronchial or transesophageal approach. These nonsurgical approaches have similar diagnostic yields, although the transbronchial approach is superior for right-sided lymph nodes. Combining both approaches provides results similar those of mediastinoscopy.     

经气管镜超声引导针吸活检术在纵隔疾病诊断中的价值

目的探讨经纤维支气管镜超声引导针吸活检术（endobronchialultrasound—guidedtransbronchialneedleaspiration,EBUS—TBNA）在纵隔疾病诊断中的价值。方法2009年1月至2010年12月对326例经CT扫描发现有纵隔病变患者,在支气管镜检查过程中完成EBUS—TBNA操作,直接涂片送检。结果326例患者中,192例常规气管镜检查无黏膜及管腔改变,47例局部黏膜增厚肿胀或有小结节样改变,62例管腔呈轻度外压型改变,25例气管局部软骨环消失。326例患者共穿刺486个位点,获得阳性诊断304例,阳性率为93．25％（304／326）,其中恶性肿瘤260例（79．75％,260／326）,分别为肺鳞癌81例、肺腺癌78例、肺大细胞未分化癌8例、肺小细胞未分化癌74例、肺淋巴瘤7例、难以分类的恶性肿瘤12例;良性病变44例,分别为结节病32例、结核病7例、慢性淋巴结炎5例。486个位点共穿刺576针,482针（83．6％,482／576）经纤维支气管镜针吸活检术（transbronehialneedleaspiration,TBNA）涂片获得阳性诊断,其中恶性肿瘤421针（肺鳞癌137针、肺腺癌124针、肺大细胞未分化癌19针、肺小细胞未分化癌117针、肺淋巴瘤11针、难以分类的恶性肿瘤13针）,良性病变61针（分别为结节病43针、结核病11针、慢性淋巴结炎7针）;48针涂片中可见多个淋巴细胞团,认为穿刺成功,但无阳性发现;29针涂片可见较多纤毛柱状上皮细胞,未穿透气管壁,穿刺失败;17针涂片未见明显的细胞成分。TBNA并发症：31例患者穿刺部位少量出血,勿需特别处理;5例穿刺针误刺入血管内抽出新鲜血液,及时更换穿刺点顺利完成操作;未出现纵隔气肿、纵隔感染等不良反应。患者均能很好耐受操作。结论EBUS—TBNA创伤性小、安全性高,是诊断纵隔病变的有效方法。     

Flexible transbronchial needle aspiration biopsy for histologic specimens

Flexible transbronchial needle aspiration (TBNA) biopsy has been used to obtain cytologic specimens from mediastinal lymph nodes for the diagnosis and staging of bronchogenic carcinoma. The dependency on a sophisticated cytologic laboratory, the skill required to perform this procedure, and the inability to obtain enough tissue to diagnose noncarcinomatous processes in the mediastinum by smaller needles has limited its use. The application of TBNA would be greatly enhanced if a histologic specimen could be obtained from the mediastinal lymph node safely. For this reason, an 18-gauge needle was developed and used through a rigid bronchoscope. In ten patients, adequate tissue for histology was obtained in nine, and a specific diagnosis was made in eight patients without any complication. A similar technique was developed and is now reported using the flexible bronchoscope. We conclude that using a flexible transbronchial needle is an effective and safe way of obtaining histologic specimens from the mediastinum and can provide a diagnosis, both in malignant and benign mediastinal disease. Hopefully, this technique will further reduce the need for more invasive surgical procedures.     

Transbronchial lung cryobiopsy by twin bronchoscopes (kissing technique)

ObjectiveTo introduce a new & novel method of obtaining big lung tissue samples by transbronchial lung cryobiopsy by twin bronchoscopes (kissing technique) in an advanced interventional pulmonology suite.MethodsIn patients of diffuse parenchymal lung diseases, transbronchial lung cryobiopsy were taken using this novel approach using simultaneously two bronchoscopes under C- arm guidance under conscious sedation. First, a standard fibreoptic bronchoscope was inserted intranasally and fixed just above the area to be biopsied, then fogarty's catheter was introduced through FOB's suction channel and protruded it at the biopsy site. Second, another video bronchoscope was introduced orally by the side of FOB and cryobiopsy were taken using cryobiopsy forceps. Immediately, Fogarty's catheter was inflated and sealed the opening from where biopsy was taken to stop the bleeding. Third Video bronchoscope was also used which went up to larynx to take photograph of two bronchoscopes kissing each other and entering the vocal cords only, after which it was withdrawn.ResultsTransbronchial lung cryobiopsy in patients of diffuse parenchymal lung diseases were taken using this novel approach. This new technique called twin bronchoscopy (Kissing technique) has been practiced for the first time, it's a technique about which we want the world to be known.ConclusionThis new and novel two scope kissing bronchoscopy technique for TBLC under conscious sedation can be an alternative and fruitful method, especially the use of Fogarty's catheter to contain intra-bronchial bleeding. There is no deleterious effect on the patient and the patient can be discharged on the same day.     

Transbronchial needle aspiration: guidance with CT fluoroscopy

BACKGROUND: Bronchoscopy with transbronchial needle aspiration (TBNA) is valuable to diagnose lesions in the mediastinum and lung, but conventional fluoroscopic guidance may be suboptimal. We describe the use of CT fluoroscopy to provide real-time, transaxial TBNA localization, thus facilitating biopsy. METHODS: Patients were selected because of prior unsuccessful bronchoscopy or anticipated difficulty owing to small size or inaccessibility of the lesion. CT fluoroscopy consists of a spiral CT scanner adapted using a rapid-reconstruction algorithm and hardware that permits real-time in-room imaging. The bronchoscope was inserted on the CT scanner, which was used to guide TBNA instruments into the target lesion. RESULTS: Of 27 patients who underwent TBNA with CT fluoroscopic assistance, 15 had mediastinal nodes, and 12 had lung nodules or focal infiltrates. Mean lesion size was 1.7 cm in the mediastinum, 2. 2 cm in the lung. A correct diagnosis was established in 10 of 12 mediastinal lesions (83%) for which follow-up was available and in 8 lung lesions (67%). Diagnoses included small cell and non-small cell lung cancer and invasive aspergillosis. False-negative results were caused by sampling errors or inability to reach the lesion as documented by CT fluoroscopy. Postprocedure CT fluoroscopy revealed no complications. CONCLUSION: CT fluoroscopy provides effective, real-time guidance for TBNA and may be particularly valuable in patients with small or less accessible mediastinal or lung lesions.