| Introduction:Peripheral lung cancer(PLC)refers to lung cancer that originates below the lung bronchi and above the respiratory bronchiole.In recent years,with the promotion of computer tomography(CT)technology,more peripheral pulmonary lesions(PPLs)are found,which is attracting people's attention.Studies have shown that thin-layer CT screening can greatly reduce the mortality of lung cancer.PPL can be discovered early on CT images,but pathological evidence is required to determine the benign or malignant lesions.A series of methods are required to obtain samples of the diseased tissue to assess the nature of the tissue.Because PPL usually occurs at the distal end of the lung lobe or lung segment of the bronchus,it is difficult for conventional bronchoscopy to see the lesion in each bronchial branch.To obtain a tissue specimen of PPL,endobronchial ultrasound-guided transbronchial biopsy with a guided sheath(EBUS-GS-TBLB),image-guided percutaneous biopsy and surgical resection are the main methods currently used.Surgical resection is only used by some people due to big trauma,high risk and costs.Percutaneous biopsy has the advantages of extremely high diagnostic rate and low trauma,especially CT-guided percutaneous biopsy is the most widely used in clinical practice.EBUS-GS and MR-guided percutaneous lung biopsy(MR-PTLB)are relatively new technologies,which have been gradually promoted and applied clinically in recent decades.Each of the two technologies has different application category.There have been some studies comparing EBUS-GS and CT-guided transthoracic needle aspiration(CT-TTNA)to evaluate the pros and cons of the two for the diagnosis of PPLs.However,the comparison of the diagnostic value and safety of EBUS-GS and MR-PTLB technology for PLC has not been studied.We retrospectively studied inpatients diagnosed with PLC by EBUS-GS-TBLB in the bronchoscopy room of Shandong Provincial Hospital and percutaneous lung biopsy in the MR room.Our study compared the accuracy of EBUS-GS and MR-PTLB in the diagnosis of PLC,the incidence of complications and their influencing factors,to explore the diagnostic value and safety of the two techniques for PLCPurpose:Our study explored the diagnostic value and safety of EBUS-GS and MR-PTLB technologies for PLC,by analyzing and comparing the baseline data,CT characteristics,diagnostic accuracy of PLC,incidence of postoperative complications and factors affecting the diagnosis rate and complicationsMethods:This study is a retrospective case-control study.According to strict case inclusion and exclusion criteria,we retrospectively analyzed these cases undergoing EBUS-GS-TBLB and MR-guided percutaneous puncture from November 2018 to November 2019,which were diagnosed as PLC by follow-up or other testing methods(such as surgical resection).They were divided into EBUS-GS group(n=36)and MR-PTLB group(n=67).The clinical information such as gender,age,smoking history,CT imaging characteristics,pathological diagnosis,final diagnosis,and surgery-related complications were collected in the two groups.Through the SPSS software,we compared the diagnostic rate and safety of the two technologies for PLCs and the factors affecting the incidence of complications in the MR-PTLB group.We use subgroup analysis to summarize the indications of the two operations,and comprehensively evaluate the diagnostic value and safety of the EBUS-GS and MR-PTLB techniques for patients with PLC.Results:1.Comparison of baseline information between EBUS-GS and MR-PTLB groupIn this study,a total of 103 cases with final diagnosis of PLC were included,with an average age of 61.86±10.17 years,ranging from 28 to 84 years old,including 60 males(58.3%)and 43 females(41.7%);51 patients(49.5%)who smoked before or now There were 36 cases in the EBUS-GS group and 67 cases in the MR-PTLB group.There was no statistically significant difference in age,gender and smoking history between the two groups(p>0.05).There was no significant difference between the two groups in the distribution of lung segments and the distance from the pleura to the lesions(p>0.05).2.Comparison of diagnosis rate between EBUS-GS group and MR-PTLB groupThe diagnosis rate of PLC in the EBUS-GS group was 75.0%,and the diagnostic positive rate in the MR-PTLB group was 95.5%.The diagnosis rate in the MR-PTLB group was higher and the difference was statistically significant(p=0.006).Among the two groups of confirmed cases,adenocarcinoma is the most common(41.7%vs 73.1%),followed by squamous cell carcinoma(4 cases vs 7 cases).The diagnostic sensitivity of MR-PTLB for lesions close to the chest wall or located in the lower lobe of the lung is significantly higher than that of EBUS-GS(p<0.05).When the diameter of the lesion is?30 mm,there is no obvious specific difference in the diagnosis rate of peripheral lung cancer between the two methods(p=0.063);while when the diameter is greater than 30 mm,the diagnosis rate of MR-PTLB group is significantly higher than that of EBUS-GS group(78.6%vs 100%,p=0.008).The size of the lesion,the distance from the lesion to the chest wall,and the location of the lesion had no significant statistical significance in two groups(p>0.05).3.Comparison of complications in EBUS-GS and MR-PTLB group97.2%of the patients in the EBUS-GS group had no complications,and only 1 patient(2.8%)had more bleeding(>20ml)during the operation.There was no obvious bleeding after thrombin was used to stop bleeding during the operation.The incidence of complications in the MR-PTLB group was 22.4%,which was significantly higher than that in the EBUS-GS group(p=0.009).Postoperative pulmonary hemorrhage occurred in 9 cases(13.4%),pneumothorax in 6 cases(9.0%),and 3.0%(2/67)of patients had mild chest pain.Whether it is close to the pleura is a related risk factor for complications.4.The diagnostic value of pathology and cytology for PLCThe combined application of pathology and cytology in the EBUS-GS group can increase the diagnostic proportion of lung cancer by 13.9%compared with the pathological diagnosis alone;in the MR-PTLB group,the combined diagnosis rate of lung cancer increased by 1.5%;The combined diagnostic value of pathology and cytology is superior to the pathological diagnosis alone.Conclusions:1.Both EBUS-GS and MR-PTLB can effectively diagnose PLC,but each has operational limitations.2.Compared with EBUS-GS group,MR-PTLB has higher diagnostic value for PLC.3.The incidence of EBUS-GS complications is significantly lower than that of MR-PTLB,and it has better safety.4.For lesions?30mm in diameter,in the upper/middle lobe or not close to the pleura,we recommend using EBUS-GS;for lesions>30mm in diameter,located in the lower lobe or close to the pleura,we recommend using MR-PTLB.5.During the operation of EBUS-GS and MR-PTLB,sending cytology and pathology at the same time can improve the diagnosis rate of PLC than pathology alone. |
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