| Objective:The widespread use of computed tomography(CT) particularly the introduction of lowdose helical CT,has increased the detection rate of peripheral pulmonary lesions(PPLs).Therefore it is still a challenging task for pulmonologists to obtain accurate samplings.Differential diagnoses can include both malignant causes and benign causes such as infection and inflammation. Although clinical data and imaging data, such as chest X-ray and chest CT may provide some clues for the diagnosis,but in some circumstances, definite diagnosis is required before deciding on the appropriate treatment.Therefore, respiratory specimens are needed to identify the etiology of the lesions.In order to solve this problem, a number of new assistive technology application to clinical, which further improved the diagnostic capabilities of PPLs,such as ultrathin bronchoscopy, virtual bronchoscopic navigation(VBN), endobronchial ultrasonography with a guide sheath(GS)(K201 / K203 system) and rapid on-site evaluation(ROSE).The aim of our study was to evaluate the diagnostic yield and safety of transbronchial lung biopsy(TBLB) under VBN, endobronchial ultrasonography with a GS and ROSE using an ultrathin bronchoscopy(UNRE) for infectious lesions which located in the peripheral third of the lung field.Methods:The medical records of 172 consecutive patients in which 2 patients were excluded from analysis as the final diagnosis could not be determined due to death(1 patient) or loss to follow-up(1 patient) with 172 infectious PPLs who underwent TBLB between March 1,2013 and February 1,2016 at General Hospital of Tianjin Medical University were retrospectively reviewed.The PPLs were determined by chest computed tomography. The mean age of the patients was 58 ± 13 years and 93 cases were male, 75 cases were females. According to whether combined ultrathin bronchoscope approach with endobronchial ultrasound with a GS,VBN and ROSE for PPLs,those lesions were divided into two groups,one is UNRE group(84 cases),the other is NUNRE group(88 cases). The diagnostic yield, safety and complication rate were compared between two groups.Moreover, the differences of autofluorescence intensity of alveolar macrophage in alveolar lavage fluid were compared between Low risk and medium risk/high risk of CURB 65 score.Results:1. The final diagnosis was bacterial pneumonia in 76 cases, giving an incidence of 42.44 %,Pulmonary tuberculosis/ nontuberculous mycobacteriosis in 68 cases, giving an incidence of 39.53 %, Pulmonary fungal infection in 23 cases, giving an incidence of 13.37 %. 2. The diagnostic yield was significantly higher in UNRE group than that of NUNRE group(80.95% vs 64.77%,χ2=5.665,P<0.05).From the subgroup analysis, the diagnostic yield in the UNRE group was significantly higher than that in the NUNRE group for lesions which final diagnosis were pulmonary tuberculosis/ nontuberculous mycobacteriosis.(70.23% vs 47.73%,χ2=8.984,P<0.05).Diagnostic yield did not differ significantly according to lung lobe containing the lesion,ultrasound probe location and lesions which final diagnosis were bacterial pneumonia between the two groups. 3. The sensitivity of the ROSE was significantly higher in UNRE group than that of NUNRE group(70.23% vs 47.73%,χ2=8.984,P<0.05).From the subgroup analysis, the sensitivity of the ROSE in the UNRE group was significantly higher than that in the NUNRE group for lesions which final diagnosis were pulmonary tuberculosis/ nontuberculous mycobacteriosis(72.22% vs 46.88%,χ2=4.546, P<0.05).The sensitivity did not differ significantly according to lesions which final diagnosis were bacterial pneumonia between the two groups(χ2=2.590,P>0.05). 4. The ultrathin bronchoscope in the UNRE group could reach more distal bronchi than the bronchoscope in the NUNRE group(5.00±1.14 vs 4.41±1.06, t=3.525,P<0.05).The ultrasound probe location did not differ significantly between the two groups(χ2=3.242,P>0.05). 5. Overall complication rate was 2.38 % in the UNRE group. Two patients(2.38%) had significant hemorrhage and there were no pneumothorax or other serious complications.While overall complication rate was 2.27% in the NUNRE group. One patient(1.14%) had significant hemorrhage and One patient(1.14%) suffered a pneumothorax that was managed conservatively without requiring chest drainage. No patient required escalation in the level of care and All complications were self-limited. 6. Of the 168 patients,the autofluorescence intensity of alveolar macrophage in medium risk/high risk risk group was significantly lower than that in the low group(t=2.481,P <0.05).Conclusions: This is the first study to examine the value of using VBN system combined with ultrathin bronchoscope and rapid on-site evaluation to assist GS-EBUS in infectious PPLs.The outcome was Satisfactory. 1.The diagnostic yield was significantly higher in UNRE group than that of NUNRE group,and the rate of complications were quite lower than that of TTNA.Considering the higher diagnostic yield and low complications rate, ultrathin bronchoscope combined with GS-EBUS, VBN and ROSE may be a viable option for diagnosing infectious PPLs,especially those PPLs which is suspected pulmonary tuberculosis/ nontuberculous mycobacteriosis. 2. UNRE group provided a more rapid diagnosis via ROSE in 80.95 percent of patients with infectious PPLs than that of NUNRE group.What’s more, the sensitivity of the ROSE in the UNRE group was significantly higher than that in the NUNRE group for lesions which final diagnosed were pulmonary tuberculosis/ nontuberculous mycobacteriosis. 3. The ultrathin bronchoscope in the UNRE group could reach more distal bronchi than the bronchoscope in the NUNRE group 4.The autofluorescence intensity of alveolar macrophage in alveolar lavage fluid indicates the severity of infection in patients. |
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