Diagnostic Value Of Endobronchial Ultrasonography With A Guide Sheath For Peripheral Pulmonary Lesions

Background:With the development of CT technology and it's wide application in clinic,more and more Peripheral pulmonary lesions(PPLs)have been discovered.Currently,bronchoscopy is widely used to observe lesions in the bronchial lumen.Recently,there are meta analyses pointed out that with the new guiding technology,the diagnostic rate of PPLs by bronchoscopy is as high as 70%,such as endobronchial ultrasonography with a guide sheath(EBUS-GS).The technique can not only see the luminal lesions,but also directly observe the lesions,and then obtain a biopsy of the lung tissue.A large number of studies have shown that EBUS-GS significantly improves the diagnosis rate of peripheral lung lesions,especially the diagnosis rate of lung cancer.In recent years,pulmonary fungal diseases,as the most common deep mycosis,had increased.At present,due to the wide clinical application of EBUS-GS,its clinical role has been widely recognized,but its diagnostic value for pulmonary fungal disease is less studied.Objective: 1.This study was designed to analyze the diagnostic efficacy of EBUS-GS in the diagnosis of peripheral lung lesions,especially in lung cancer.2.To analyze the clinical features of pulmonary fungal diseases and the diagnostic value of EBUS-GS for pulmonary fungal disease.Methods: 1.This study used retrospective case analysis study.The patients with peripheral pulmonary disease who underwent EBUS-GS examination at Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine from January 2015 to December 2018 were collected and analyzed for the diagnosis rate of various diseases,especially the diagnosis rate of EBUS-GS in lung cancer.2.70 cases of patients were diagnosed as pulmonary fungal disease.All patients were from The Department of Respiratory,Xinhua Hospital,Shanghai Jiaotong University School of Medicine and they were selected from January 2015 to December 2018.They were classified into EBUS-GS group(EBUS-GS+BALF/PSB check+ blood GM/latex agglutination test)and non-EBUS-GS group(bronchoscope +BALF/PSB check + blood GM/latex agglutination test)according to the presence or absence of bronchoscopy.The patient's gender,age,underlying disease,clinical manifestations,imaging characteristics were analyzed,and the diagnostic value of EBUS-GS in pulmonary fungal disease was analyzed.3.This study used SPSS statistical software for analysis.The measurement data were described by the median(± standard deviation);the count data was described by the composition ratio n(%),and used the non-parametric test.Results: 1.With the 338 patients,205(60.7%)had malignant lesions,of which 189(92.2%)were non-small cell lung cancer.There were 133 cases of benign lesions.Among them,EBUS-GS clearly diagnosed 155 cases of malignant lesions,the diagnosis rate was 45.9%(155/338),and the final diagnosis of malignant lesions was 205 cases,the positive rate was 75.6%(155/205).2.Seventy patients were enrolled,with an age range of 22-86 years and a median age of 58.59±15.64 years.Among them,male: female = 1.06:1.Males have the highest incidence rate of 60-70 years old,and women have the highest incidence rate of 50-70 years old.In general,the incidence rate is the highest in 50-70 years old,accounting for 55.7% of the total.The age of onset of pulmonary cryptococcosis is lower than that of pulmonary aspergillosis.3.There were 14 patients with no underlying disease,and the other 56 patients had one or more underlying diseases.Among them,10 patients(14.3%)had diabetes,patients with chronic lung disease(chronic obstructive pulmonary disease,asthma,bronchus)had 16 cases(22.9%),14 patients(20%)with chronic diseases(tumor,chronic kidney disease,chronic bowel disease,chronic liver disease,etc.),patients who need long-term use of glucocorticoids due to chronic lung disease or rheumatoid connective tissue disease had 9 cases(16.1%).Compared with pulmonary cryptococcosis,pulmonary aspergillosis is more common in patients with underlying diseases.4.Twelve of the 70 patients with pulmonary fungal diseases did not have any clinical symptoms.58 cases(82.9%)of the other patients were admitted to the hospital as the main complaint due to fever(38.0%),cough(89.6%),cough(77.6%),and hemoptysis.12.1%).Pulmonary aspergillosis with clinically symptoms is more common than pulmonary cryptococcosis.CT Imaging showed that the right lung lesions(32.9%)were more than the left lung(28.6%),and the lower lobe lesions(35.7%)were more than the upper lobe lesions(22.8%).However,the involvement of both lungs is also more common(41.4%).5.There was significant difference in the diagnostic rate between the EBUS-GS group and the non-EBUS-GS group(P<0.05).Conclusion: 1.EBUS-GS plays an active diagnostic value in peripheral lung lesions,especially in lung cancer,and it contributes to the early diagnosis of lung cancer.2.EBUS-GS has diagnostic value in pulmonary fungal disease.Bronchoscopy combined with EBUS-GS examination can improve the diagnosis rate of pulmonary fungal disease.