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Lin CK, Ruan SY, Fan HJ, Chang HC, Lin YT, Ho CC. Using cryoprobes of different sizes combined with cone-beam computed tomography-derived augmented fluoroscopy and endobronchial ultrasound to diagnose peripheral pulmonary lesions: a propensity-matched study. Respir Res 2024; 25:65. [PMID: 38317222 PMCID: PMC10840252 DOI: 10.1186/s12931-024-02700-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 01/22/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Endobronchial ultrasound (EBUS) and cone-beam computed tomography-derived augmented fluoroscopy (CBCT-AF) are utilized for the diagnosis of peripheral pulmonary lesions (PPLs). Combining them with transbronchial cryobiopsy (TBC) can provide sufficient tissue for genetic analysis. However, cryoprobes of different sizes have varying degrees of flexibility, which can affect their ability to access the target bronchus and potentially impact the accuracy. The aim of this study was to compare the diagnostic efficacy of cryoprobes of varying sizes in CBCT-AF and EBUS for the diagnosis of PPLs. METHODS Patients who underwent endobronchial ultrasound-guided transbronchial biopsy (EBUS-TBB) and TBC combined with CBCT-AF for PPLs diagnosis between January 2021 and May 2022 were included. Propensity score matching and competing-risks regression were utilized for data analysis. Primary outcome was the diagnostic accuracy of TBC. RESULTS A total of 284 patients underwent TBC, with 172 using a 1.7-mm cryoprobe (1.7 group) and 112 using a 1.1-mm cryoprobe (1.1 group). Finally, we included 99 paired patients following propensity score matching. The diagnostic accuracy of TBC was higher in the 1.1 group (80.8% vs. 69.7%, P = 0.050), with a similar rate of complications. Subgroup analysis also revealed that the 1.1 group had better accuracy when PPLs were located in the upper lobe (85.2% vs. 66.1%, P = 0.020), when PPLs were smaller than 20 mm (78.8% vs. 48.8%, P = 0.008), and when intra-procedural CBCT was needed to be used (79.5% vs. 42.3%, P = 0.001). TBC obtained larger specimens than TBB in both groups. There is still a trend of larger sample size obtained in the 1.7 group, but there is no statistically different between our two study groups (40.8 mm2 vs. 22.0 mm2, P = 0.283). CONCLUSIONS The combination of TBC with CBCT-AF and EBUS is effective in diagnosing PPLs, and a thin cryoprobe is preferred when the PPLs located in difficult areas.
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Affiliation(s)
- Ching-Kai Lin
- Department of Medicine, National Taiwan University Cancer Center, Taipei, 106, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, 7, Chung-Shan South Road, Taipei, 100, Taiwan
- Department of Internal Medicine, National Taiwan University Hsin-Chu Hospital, Hsin-Chu 300, Taipei, Taiwan
| | - Sheng-Yuan Ruan
- Department of Internal Medicine, National Taiwan University Hospital, 7, Chung-Shan South Road, Taipei, 100, Taiwan
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, No.17 Xu-Zhou Road, Taipei, 10020, Taiwan
| | - Hung-Jen Fan
- Department of Medicine, National Taiwan University Cancer Center, Taipei, 106, Taiwan
- Department of Internal Medicine, National Taiwan University Biomedical Park Hospital, Hsin-Chu County 302, Taipei, Taiwan
| | - Hao-Chun Chang
- Department of Medicine, National Taiwan University Cancer Center, Taipei, 106, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, 7, Chung-Shan South Road, Taipei, 100, Taiwan
- Department of Internal Medicine, National Taiwan University Biomedical Park Hospital, Hsin-Chu County 302, Taipei, Taiwan
| | - Yen-Ting Lin
- Department of Medicine, National Taiwan University Cancer Center, Taipei, 106, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Chao-Chi Ho
- Department of Internal Medicine, National Taiwan University Hospital, 7, Chung-Shan South Road, Taipei, 100, Taiwan.
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Wu D, Liu YY, Wang T, Huang YY, Xia P. Computed tomography-guided lung biopsy with rapid on-site evaluation for diagnosis of lung lesions: a meta-analysis. J Cardiothorac Surg 2023; 18:122. [PMID: 37038189 PMCID: PMC10088145 DOI: 10.1186/s13019-023-02212-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 04/02/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Lung biopsy (LB) procedures performed with computed tomography (CT guidance can enable the reliable diagnosis of lung lesions. These diagnostic efforts can be further expedited through a rapid on-site evaluation (ROSE) approach, allowing for the rapid assessment of collected tissue samples to gauge the adequacy of these samples, their features, and associated cytomorphological characteristics. The present analysis was developed to examine the safety and efficacy of CT-guided LB with ROSE as a means of diagnosing lung lesions. METHODS Studies published as of July 31, 2022 in the PubMed, Embase, and Wanfang databases were identified for this meta-analysis. Diagnostic accuracy was the primary endpoint, while secondary endpoints included the operative duration, the number of punctures, and rates of lung hemorrhage, pneumothorax, and secondary LB. RESULTS This meta-analysis included 6 total studies. Relative to CT alone, CT with ROSE was associated with a significant increase in diagnostic accuracy (P < 0.00001). In contrast, there were no significant differences between these two groups with respect to the operative duration (P = 0.86), the number of punctures (P = 0.60), or the rates of pneumothorax (P = 0.82) or lung hemorrhage (P = 0.81). Pooled secondary LB rates were significantly lower for patients that underwent CT with ROSE relative to patients in the CT only group (P = 0.0008). Significant heterogeneity was detected for the operative duration (I2 = 94%) and number of punctures (I2 = 98%) endpoints, while no publication bias was detected for any study endpoints. CONCLUSIONS These results suggest that ROSE may contribute to significant improvements in the diagnostic accuracy of CT-guided LB without contributing to higher rates of complications.
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Affiliation(s)
- Di Wu
- Department of Pathology, Xuzhou Central Hospital, Xuzhou, China
| | - Yue-Yue Liu
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, China
| | - Tao Wang
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, China
| | - Ya-Yong Huang
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, China
| | - Ping Xia
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, China.
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Endoscopic Technologies for Peripheral Pulmonary Lesions: From Diagnosis to Therapy. Life (Basel) 2023; 13:life13020254. [PMID: 36836612 PMCID: PMC9959751 DOI: 10.3390/life13020254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/07/2023] [Accepted: 01/09/2023] [Indexed: 01/18/2023] Open
Abstract
Peripheral pulmonary lesions (PPLs) are frequent incidental findings in subjects when performing chest radiographs or chest computed tomography (CT) scans. When a PPL is identified, it is necessary to proceed with a risk stratification based on the patient profile and the characteristics found on chest CT. In order to proceed with a diagnostic procedure, the first-line examination is often a bronchoscopy with tissue sampling. Many guidance technologies have recently been developed to facilitate PPLs sampling. Through bronchoscopy, it is currently possible to ascertain the PPL's benign or malignant nature, delaying the therapy's second phase with radical, supportive, or palliative intent. In this review, we describe all the new tools available: from the innovation of bronchoscopic instrumentation (e.g., ultrathin bronchoscopy and robotic bronchoscopy) to the advances in navigation technology (e.g., radial-probe endobronchial ultrasound, virtual navigation, electromagnetic navigation, shape-sensing navigation, cone-beam computed tomography). In addition, we summarize all the PPLs ablation techniques currently under experimentation. Interventional pulmonology may be a discipline aiming at adopting increasingly innovative and disruptive technologies.
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Liang L, Duan H, Zhu H, Yang H, Li X, Wang C, Xie S. Value of transbronchial needle aspiration combined with a rapid on-site evaluation of cytology in the diagnosis of pulmonary lesions. Front Med (Lausanne) 2022; 9:922239. [PMID: 36275797 PMCID: PMC9579285 DOI: 10.3389/fmed.2022.922239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 09/21/2022] [Indexed: 12/03/2022] Open
Abstract
Background The diagnostic value of rapid on-site evaluation (ROSE) of cytology during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) remains controversial. The purpose of this study was to validate the value of ROSE during the EUBS-TBNA procedure in the diagnosis of pulmonary lesions (PLs). Methods Enrolled in this study were 260 patients with nodules, masses, cavities, or inflammatory lesions on pulmonary CT images. They were assigned to undergo EBUS-TBNA with ROSE (n = 134) or without ROSE (n = 126). The diagnostic results of ROSE during EBUS-TBNA and the final pathologic reports were analyzed and compared by utilizing SPSS21.0 software to evaluate the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). In addition, we further explored whether the ROSE method during EBUS-TBNA would improve the diagnostic yield and reduce the incidence of complications. Results The overall diagnostic yield of EBUS-TBNA for malignant diseases in the ROSE and the non-ROSE group were 29.9 and 11.1%, respectively. The sensitivity, specificity, PPV and NPV of the ROSE method during EBUS-TBNA were 97.4, 96.9, 92.5, and 98.90%, respectively. The result of the chi-square test effectively proved that ROSE operation during EBUS-TBNA contributes to the diagnosis of malignancy compared with the non-ROSE group (χ2 = 13.858, P < 0.001). The number of punctures in the ROSE group was significantly lower than that in the non-ROSE group (P < 0.001). Conclusion ROSE examination during EBUS-TBNA could effectively improve the diagnostic yield of malignant diseases compared with the non-ROSE group and reduce the number of intraoperative punctures, which is a clinical application worth popularizing.
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Affiliation(s)
- Long Liang
- Department of Respiratory Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hongxia Duan
- Department of Oncology, Affiliated Hospital of Nantong University, Nantong, China
| | - Huiyuan Zhu
- Department of Pathology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Huiqiong Yang
- Department of Pathology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xuan Li
- Department of Respiratory Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China,*Correspondence: Xuan Li,
| | - Changhui Wang
- Department of Respiratory Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China,Changhui Wang,
| | - Shuanshuan Xie
- Department of Respiratory Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China,Shuanshuan Xie,
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Clinical Utility of Rapid On-Site Evaluation of Touch Imprint Cytology during Cryobiopsy for Peripheral Pulmonary Lesions. Cancers (Basel) 2022; 14:cancers14184493. [PMID: 36139653 PMCID: PMC9496809 DOI: 10.3390/cancers14184493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/11/2022] [Accepted: 09/12/2022] [Indexed: 12/24/2022] Open
Abstract
Simple Summary With increasing interest in precision medicine for lung cancer, cryobiopsy is expected to improve the success rate not only for histological diagnosis, but also for next-generation sequencing. Rapid on-site evaluation (ROSE) is an immediate cytological evaluation performed during bronchoscopy. However, little is known about its clinical utility during cryobiopsy. We retrospectively reviewed the data of 63 consecutive patients who underwent cryobiopsy with ROSE of touch imprint cytology (ROSE-TIC) for solid peripheral pulmonary lesions. When the results of ROSE-TIC of each patient were compared directly with the histological findings of the corresponding specimen, the sensitivity, specificity, and positive and negative predictive values were 69.8%, 90.0%, 93.8%, and 58.1%, respectively. The concordance rate was 76.2%. Therefore, we believe that ROSE-TIC, due to its high specificity and positive predictive value, may be a potential tool in deciding whether cryobiopsy sampling could be finished during bronchoscopy. Abstract Cryobiopsy enables us to obtain larger specimens than conventional forceps biopsy despite the caution regarding complications. This study aimed to evaluate the clinical utility of rapid on-site evaluation of touch imprint cytology (ROSE-TIC) during cryobiopsy of peripheral pulmonary lesions (PPLs). We retrospectively reviewed the data of consecutive patients who underwent cryobiopsy for solid PPLs between June 2020 and December 2021. ROSE-TIC was performed on the first specimen obtained via cryobiopsy and assessed using Diff-Quik staining. The results of ROSE-TIC for each patient were compared with the histological findings of the first cryobiopsy specimen. Sixty-three patients were enrolled in this study. Overall, 57 (90.5%) lesions were ≤30 mm in size and 37 (58.7%) had positive bronchus signs. The radial endobronchial ultrasound findings were located within and adjacent to the lesion in 46.0% and 54.0% of the cases, respectively. The sensitivity, specificity, and positive and negative predictive values of the ROSE results for histological findings of the corresponding specimens were 69.8%, 90.0%, 93.8%, and 58.1%, respectively. The concordance rate was 76.2%. In conclusion, ROSE-TIC, due to its high specificity and positive predictive value, may be a potential tool in deciding whether cryobiopsy sampling could be finished during bronchoscopy.
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Zou X, Zhu Y, Hu Q, Qi Q, Hua H, Fei F, Cai Q. Diagnostic value of ultrasound‐guided transbronchial lung biopsy in peripheral tuberculous pulmonary lesions. Diagn Cytopathol 2022; 50:572-578. [DOI: 10.1002/dc.25041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/11/2022] [Accepted: 08/01/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Xingwu Zou
- Department of Tuberculosis, Affiliated Hangzhou Chest Hospital Zhejiang University School of Medicine Hangzhou People's Republic of China
| | - Yanling Zhu
- Department of Tuberculosis, Affiliated Hangzhou Chest Hospital Zhejiang University School of Medicine Hangzhou People's Republic of China
| | - Qin Hu
- Department of Tuberculosis, Affiliated Hangzhou Chest Hospital Zhejiang University School of Medicine Hangzhou People's Republic of China
| | - Qi Qi
- Department of Tuberculosis, Affiliated Hangzhou Chest Hospital Zhejiang University School of Medicine Hangzhou People's Republic of China
| | - Haibo Hua
- Department of Tuberculosis, Affiliated Hangzhou Chest Hospital Zhejiang University School of Medicine Hangzhou People's Republic of China
| | - Fan Fei
- Department of Tuberculosis, Affiliated Hangzhou Chest Hospital Zhejiang University School of Medicine Hangzhou People's Republic of China
| | - Qingshan Cai
- Department of Tuberculosis, Affiliated Hangzhou Chest Hospital Zhejiang University School of Medicine Hangzhou People's Republic of China
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Cone-Beam Computed Tomography-Derived Augmented Fluoroscopy Improves the Diagnostic Yield of Endobronchial Ultrasound-Guided Transbronchial Biopsy for Peripheral Pulmonary Lesions. Diagnostics (Basel) 2021; 12:diagnostics12010041. [PMID: 35054208 PMCID: PMC8774719 DOI: 10.3390/diagnostics12010041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/14/2021] [Accepted: 12/22/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Endobronchial ultrasound-guided transbronchial biopsy (EBUS-TBB) is used for the diagnosis of peripheral pulmonary lesions (PPLs), but the diagnostic yield is not adequate. Cone-beam computed tomography-derived augmented fluoroscopy (CBCT-AF) can be utilized to assess the location of PPLs and biopsy devices, and has the potential to improve the diagnostic accuracy of bronchoscopic techniques. The purpose of this study was to verify the contribution of CBCT-AF to EBUS-TBB. Methods: Patients who underwent EBUS-TBB for diagnosis of PPLs were enrolled. The navigation success rate and diagnostic yield were used to evaluate the effectiveness of CBCT-AF in EBUS-TBB. Results: In this study, 236 patients who underwent EBUS-TBB for PPL diagnosis were enrolled. One hundred fifteen patients were in CBCT-AF group and 121 were in non-AF group. The navigation success rate was significantly higher in the CBCT-AF group (96.5% vs. 86.8%, p = 0.006). The diagnostic yield was even better in the CBCT-AF group when the target lesion was small in size (68.8% vs. 0%, p = 0.026 for lesions ≤10 mm and 77.5% vs. 46.4%, p = 0.016 for lesions 10–20 mm, respectively). The diagnostic yield of the two study groups became similar when the procedures with a failure of navigation were excluded. The procedure-related complication rate was similar between the two study groups. Conclusion: CBCT-AF is safe, and effectively enhances the navigation success rate, thereby increasing the diagnostic yield of EBUS-TBB for PPLs.
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Lin C, Chang J, Huang C, Wen Y, Ho C, Cheng Y. Effectiveness of convolutional neural networks in the interpretation of pulmonary cytologic images in endobronchial ultrasound procedures. Cancer Med 2021; 10:9047-9057. [PMID: 34725953 PMCID: PMC8683546 DOI: 10.1002/cam4.4383] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/27/2021] [Accepted: 09/26/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Rapid on-site cytologic evaluation (ROSE) helps to improve the diagnostic accuracy in endobronchial ultrasound (EBUS) procedures. However, cytologists are seldom available to perform ROSE in many institutions. Recent studies have investigated the application of deep learning in cytologic image analysis. As such, the present study analyzed lung cytologic images obtained by EBUS procedures, and employed deep-learning methods to distinguish between benign and malignant cells and to semantically segment malignant cells. METHODS Ninety-seven patients who underwent 104 EBUS procedures were enrolled. Four hundred and ninety-nine lung cytologic images obtained via ROSE, including 425 malignant and 74 benign, and most malignant were lung adenocarcinoma (64.3%). All the images were used to train a residual network model with 101 layers (ResNet101), with suitable hyperparameters selected to classify benign and malignant lung cytologic images. An HRNet model was also employed to mark the area of malignant cells. Automatic patch-cropping was adopted to facilitate dataset preparation. RESULTS Malignant cells were successfully classified by ResNet101 with 98.8% classification accuracy, 98.8% sensitivity, and 98.8% specificity in patch-based classification; 95.5% classification accuracy in image-based classification; and 92.9% classification accuracy in patient-based classification. Malignant cell area was successfully marked by HRNet with a mean intersection over union of 89.2%. The automatic cropping method enabled the system to complete diagnosis within 1 s. CONCLUSIONS This is the first study to combine lung cytologic image deep-learning classification with semantic segmentation. The model was optimized for high accuracy and the automatic cropping facilitates the clinical application of our model. The success in both lung cytologic images classification and semantic segmentation on our dataset shows a promising result for clinical application in the future.
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Affiliation(s)
- Ching‐Kai Lin
- Department of Mechanical EngineeringCollege of EngineeringNational Yang Ming Chiao Tung UniversityHsin‐ChuTaiwan
- Department of MedicineNational Taiwan University Cancer CenterTaipeiTaiwan
- Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
- Department of Internal MedicineNational Taiwan University Hsin‐Chu HospitalHsin‐ChuTaiwan
| | - Jerry Chang
- Department of Mechanical EngineeringCollege of EngineeringNational Yang Ming Chiao Tung UniversityHsin‐ChuTaiwan
| | - Ching‐Chun Huang
- Department of Computer ScienceCollege of Computer ScienceNational Yang Ming Chiao Tung UniversityHsin‐ChuTaiwan
| | - Yueh‐Feng Wen
- Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
- Department of Internal MedicineNational Taiwan University Hsin‐Chu HospitalHsin‐ChuTaiwan
| | - Chao‐Chi Ho
- Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Yun‐Chien Cheng
- Department of Mechanical EngineeringCollege of EngineeringNational Yang Ming Chiao Tung UniversityHsin‐ChuTaiwan
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Fang X, Cui T, Qiu JQ, Zhang WL, Duan H. Rapid on-site cytologic evaluation during endobronchial ultrasound-guided transbronchial biopsy. J Formos Med Assoc 2020; 120:1412-1413. [PMID: 33342705 DOI: 10.1016/j.jfma.2020.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 12/03/2020] [Indexed: 02/05/2023] Open
Affiliation(s)
- Xiang Fang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Tao Cui
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, People's Republic of China
| | - Jian-Qing Qiu
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Wen-Li Zhang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
| | - Hong Duan
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
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Kao JH. Highlights. J Formos Med Assoc 2020. [DOI: 10.1016/j.jfma.2020.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Wu X, An Z, Zhao K, Yang S, Lin X, Dai X, Radisky D, Hu J. Integrated strategy combining endobronchial ultrasound with positron emission tomography to diagnose peripheral pulmonary lesions. Thorac Cancer 2020; 11:2094-2100. [PMID: 32543098 PMCID: PMC7396360 DOI: 10.1111/1759-7714.13484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 11/29/2022] Open
Abstract
Background Endobronchial ultrasound‐guided transbronchial lung biopsy (EBUS‐TBLB) and fluorodeoxyglucose positron emission tomography (FDG‐PET) have been widely used in the diagnosis of peripheral pulmonary lesions (PPLs). This study was conducted to determine the diagnostic value of EBUS‐TBLB combined with FDG‐PET in the assessment of PPLs. Methods The clinical data of 76 patients with PPLs who received both FDG‐PET and EBUS‐TBLB from January 2016 to February 2018 were retrospectively evaluated. Further subgroup analysis was performed according to lesion diameter (≤20 mm or >20 mm). Related diagnostic indices were calculated and compared between groups. Results When combining EBUS‐TBLB with FDG‐PET, the diagnostic accuracy rate, sensitivity, specificity, Youden's index, positive predictive value, and negative predictive value for PPLs were 86.8%, 90.2%, 73.3%, 63.5%, 93.2%, and 64.7%, respectively. In addition, the diagnostic accuracy rate of the combined approach was significantly higher than the single EBUS‐TBLB and FDG‐PET (P < 0.01 and P < 0.05, respectively), and its Youden's index was also at a higher level. When stratified by lesion diameter, the combined approach showed a significantly higher diagnostic accuracy rate (P < 0.05) and a higher Youden's index for PPLs >20 mm than PPLs ≤20 mm. In addition, we found that positive bronchus sign and probe within the probe were two important factors conducing to enhancing the diagnostic accuracy rate for EBUS‐TBLB. Conclusions An integrated approach combining EBUS‐TBLB with FDG‐PET is particularly useful for diagnosing PPLs, and the improved diagnostic yields were especially evident for PPLs >20 mm.
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Affiliation(s)
- Xiao Wu
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Zhou An
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Kui Zhao
- PET Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | | | - Xu Lin
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaona Dai
- Hospital Administration Office of Zhejiang University, Hangzhou, China
| | - Derek Radisky
- Department of Cancer Biology, Mayo Clinic Cancer Center, Jacksonville, Florida, USA
| | - Jian Hu
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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