The Influence Of VBN Assisted EBUS-GS TBLB On Pathological Results Of Peripheral Pulmonary Nodules

Objective:This study analyzed and compared the pathological results of TBLB under navigation bronchoscopy（VBN）assisted guided sheath-guided ultrasound bronchoscopy（EBUS-GS）and guided sheath-guided ultrasound bronchoscopy alone,to explore whether virtual navigation can improve the positive diagnosis rate of peripheral pulmonary nodules.Methods:This is a prospective study,including 41 patients who were admitted to our hospital（inpatient and outpatient）from November 2020 to November 2021 and underwent fiberoptic bronchoscopy with imaging manifestations of peripheral pulmonary nodules.All study patients were divided into navigation group（VBN group）and non-navigation group（NVBN group）according to whether VBN assisted e BUS-GS TBLB was performed.In the VBN group,EBUS-GS guided bronchoscopic lung biopsy（TBLB）was performed with VBN assisted,and in the NVBN group,TBLB was performed with e BUS-GS alone.In the VBN group,chest CT data were imported into the navigation system to construct the navigation path before surgery,and bronchoscopy was performed according to the guidance of the virtual path.In the NVBN group,the location of lesions was determined by reading the chest CT before surgery,and fiberoptic bronchoscopy was performed.Statistical analysis was performed on e BUS-GS lesion discovery,TBLB pathological results,total examination time and ultrasonic scanning time of patients in the two groups.SPSS 26.0 software was used for statistical analysis to analyze whether there was statistical significance between the two groups.Results:A total of 41 patients were enrolled in this study,and all patients were divided into navigation group（VBN group）and non-navigation group（NVBN group）according to whether VBN assisted e BUS-GS TBLB was performed.In the VBN group and NVBN group,the detection rate of lesion was 80.0%vs61.9%,P =0.306,and the difference was not statistically significant.The positive rate of pathological examination was 65.0% v S52.4 %,P =0.530,the difference was not statistically significant.For patients with diameter≤20mm,the detection rate of lesions between the two groups was 100.0%vs20.0%,P=0.048,and the difference was statistically significant.The positive rate was 80.0%vs0.00%,P=0.048,and the difference was statistically significant.For patients with diameter > 20 mm,the detection rate of lesions between the two groups was 73.3%vs75.0%,P =1.000,and the difference was not statistically significant.The positive rate was 53.3%vs68.8%（P=0.473）,and the difference was not statistically significant.The results of the two groups in the examination time,VBN group and NVBN group in the total examination time difference,VBN group 13.45±1.49,NVBN group 15.11±1.45,VBN group was significantly shorter than NVBN group,P =0.001 the difference was statistically significant;There was also a difference in ultrasonic positioning time between the VBN group and NVBN group,6.40±0.89 in the VBN group and 7.49±1.24 in the NVBN group,P =0.003,and the difference was statistically significant.We analyzed the results of alveolar lavage fluid in two groups,which were divided into group A: lesions were detected by ultrasound and pathological results were positive;Group B: Lesions were detected by ultrasound but pathological results were negative;Group C: no lesions were found by ultrasound.The results showed that the positive rate of VBN group was higher than NVBN group,P > 0.05,the difference was not statistically significant.Postoperative complications occurred in3 patients in both groups,all of which were small amounts of bleeding（≤10ml）,which could be stopped by suction with fiberoptic bronchoscopy.There was one5.0%（1/20）in the VBN group and two 9.5%（2/21）in the NVBN group.There was no significant difference between the two groups.Conclusion:1.For lesions with diameter ≤20mm,virtual navigation can improve the rate of lesion discovery and the positive rate of pathological results.2.Virtual navigation system can significantly shorten the total examination time and the time of lesion location,and does not increase the occurrence of complications of fiberoptic bronchoscopy.