摘要目的 探讨CT三维重建(CT-3DR)联合快速现场评价(ROSE)辅助径向超声支气管镜(R-EBUS)对肺外周孤立性结节(SPN)的诊断价值.方法 回顾性分析南京市胸科医院2016年3月至2017年3月收治的SPN共176例患者的临床资料,依据不同检查方式分为EG组[R-EBUS+引导鞘(GS)]、CTE组(CT-3DR+R-EBUS)、RE组(ROSE+R-EBUS)和三联组(CT-3DR+R-EBUS+ROSE),比较各组对SPN的诊断率、并发症、检查时间,探讨CT-3DR+ROSE+R-EBUS三联法对SPN的诊断效能及其影响因素,以及ROSE对SPN的诊断意义.结果 EG组、CTE组、RE组、三联组的SPN总体诊断率分别为70.5％、70.0％、69.0％、74.0％,各组间差异均无统计学意义(均P＞0.05);EG组、CTE组、RE组和三联组的检查时间分别是(34.0±6.3)、(26.6±6.8)、(27.2±7.8)和(19.4±5.4)min,CTE和RE组均显著短于EG组(均P＜0.001),三联组均显著短于其他三组(均P＜0.001).CTE组和三联组术前接受CT-3DR导航,其定位结果与镜下病灶所在目标支气管实际位置符合率分别是87.5％和90.0％(P＞0.05).各组病例中,SPN长径≥2 cm者诊断率均显著高于＜2 cm者(均P＜0.05);R-EBUS超声探头位于病灶内部者诊断率均显著高于探头位于病灶一侧或偏离病灶者(均P＜0.05);在EG组与RE组,SPN与胸膜之间距离≥2 cm者诊断率均显著高于＜2 cm者(均P＜0.05),但CTE组和三联组中未见类似现象;SPN病灶密度与诊断率无明显相关(均P＞0.05).RE组和三联组接受ROSE操作,ROSE读片结果与HE组织病理的诊断符合率为82.6％,Kappa值为0.608,ROSE的诊断灵敏度为0.818,特异度为0.846,阳性预测值为0.931,阴性预测值为0.647.结论 CT-3DR术前导航和术中ROSE有助于提升R-EBUS对SPN的诊断效能,CT-3DR+R-EBUS+ROSE的三联法对外周型SPN具有较好的诊断价值且能显著缩短检查时间.

abstractsObjective To evaluate the diagnostic efficiency of combination of CT multiplane 3D reconstruction (CT-3DR),radial endobronchial ultrasound (R-EBUS),and rapid on-site evaluation (ROSE) for peripheral solitary pulmonary nodules (SPN).Methods A total of 176 patients with peripheral solitary pulmonary nodule were included from the Nanjing Chest Hospital from March 2016 to March 2017.According to different methods,all the patients were divided into four groups:EG (i.e.R-EBUS+Guiding sheath (GS))group,CTE (i.e.CT-3DR+ R-EBUS) group,RE (i.e.ROSE+R-EBUS) group,and triad (i.e.CT-3DR+ ROSE + R-EBUS) group.Sampling was performed by transbronchial lung biopsy.The diagnostic yield and complications,procedure time and influencing factors in these four groups were retrospectively analyzed.The value of ROSE and combination of CT-3DR+ROSE+R-EBUS in diagnosis for SPN also was evaluated.Results The diagnostic yield for total SPNs among four groups were 70.5％ in EG group,70.0％ in CTE group,69.0％ in RE group and 74.0％ in triad group,respectively.There was no significant difference among four groups (all P＞0.05).The procedure time of EG group,CTE group,RE group and triad group were (34.0±6.3),(26.6±6.8),(27.2±7.8) and (19.4±5.4) min,respectively.The procedure time was the shortest in triad group compared with the other three groups (all P＜0.001) and the time of CTE and RE groups were significantly shorter than the EG group (both P＜0.001).The coincidence rates of CT-3DR navigation position with target bronchus were 87.5％ in CTE group and 90.0％ in triad group with no significant difference between these two groups (P＞0.05).The diagnostic yield was higher for SPNs with their major diameter ≥2 cm than those with their major diameter＜2 cm in all four groups (all P＜0.05).Thepositive diagnostic yield was higher with ultrasonic probe located within SPN lesion than the probe adjacent to or deviated the lesion in all four groups (all P＜0.05).In EG and RE groups,for those SPNs with the distance between the lesion and pleura≥2 cm,the diagnostic yield were higher than those withe thedistance＜2 cm (P＜0.05) but no similar phenomenon was observed in CTE and triad groups.No significantcorrelation was detected between the diagnostic yield and the density of SPN lesions among four groups (all P＞0.05).ROSE was used in RE and triad groups.The coincidence rate of ROSE with histopathology was 82.6％ and the value of Kappa was 0.608.The diagnostic sensitivity,specificity,positive predictive valueand negative predictive value of ROSE were 0.818,0.846,0.931 and 0.647,respectively.Conclusions CT-3DR navigation and ROSE help to improve the diagnostic efficiency of R-EBUS for SPN.Combination of CT-3DR,R-EBUS and ROSE is of diagnostic value for peripheral SPN and with significant shortening of procedure time.