Application of endobronchial ultrasound transbronchial lung biopsy with guide sheath and rapid on-site evaluation in the diagnosis of bacteriologically-negative pulmonary tuberculosis

doi:10.3969/j.issn.1004-583X.2022.03.004

Abstract

Abstract:

Objective To evaluate the combination of endobronchial ultrasonography with guide sheath (EBUS-GS), transbronchial lung biopsy (TBLB), and rapid on-site evaluation (ROSE) for the diagnosis of bacteriologically-negative pulmonary tuberculosis (PTB).Methods A total of 70 patients with suspected PTB were enrolled from January 2020 to December 2020 based on clinical symptoms, abnormal radiographic findings, sputum bacteriological examination (smear and culture), and initial sputum molecular detection negative results. The patients randomly divided into two groups: group A underwent EBUS-GS-TBLB (n=34), and group B underwent EBUS-GS-TBLB+ROSE (n=36). The diagnostic rates and biopsy numbers were evaluated between the two groups.Results 16 patients with PTB were detected in group A, and 22 in group B. After the joint ROSE, The PTB diagnostic rate improved from 47.06% to 61.11%(P=0.238), and the mean numbers of biopsy decreased from 4.53±0.50 to 3.08±0.60(P<0.01). The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of ROSE for the diagnosis of PTB were 86.36%, 86.67%, 85.71%, 92.86%, and 75.00%, respectively, with no serious complications.Conclusion The combination of EBUS-GS-TBLB and ROSE can improve the diagnostic rate, and reduce the biopsy numbers, which is thought of an effective and safe novel diagnostic modality.

Key words: tuberculosis,pulmonary, endobronchial ultrasonography with guide sheath, rapid on-site evaluation, diagnosis

CLC Number:

R521

Xu Jingran, Li Feifei, Xie Chengxin, Gong Hui, Luan Qiyun, Li Li. Application of endobronchial ultrasound transbronchial lung biopsy with guide sheath and rapid on-site evaluation in the diagnosis of bacteriologically-negative pulmonary tuberculosis[J]. Clinical Focus, 2022, 37(3): 220-224.

Add to citation manager EndNote|Ris|BibTeX

URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2022.03.004

https://huicui.hebmu.edu.cn/EN/Y2022/V37/I3/220

Figures/Tables 4

References 20

[1]	李百远, 李元军, 高非凡. 肺结核与肺癌相关性研究进展[J]. 临床荟萃, 2020, 35(10):943-946.
[2]	Dhamija A, Ganga VB, Guliani A, et al. Endobronchial ultrasound for tubercular mediastinal adenopathy and its comparison with traditional tools[J]. Int J Tuberc Lung Dis, 2019, 23(8):907-912. doi: 10.5588/ijtld.18.0381 pmid: 31533880
[3]	Gu Y, Wu C, Yu F, et al. Application of endobronchial ultrasonography using a guide sheath and electromagnetic navigation bronchoscopy in the diagnosis of atypical bacteriologically-negative pulmonary tuberculosis[J]. Ann Transl Med, 2019, 7(20):567. doi: 10.21037/atm URL
[4]	Kunimasa K, Tachihara M, Tamura D, et al. Diagnostic utility of additional conventional techniques after endobronchial ultrasonography guidance during transbronchial biopsy[J]. Respirology, 2016, 21(6):1100-1105. doi: 10.1111/resp.12813 pmid: 27250823
[5]	Izumo T, Matsumoto Y, Sasada S, et al. Utility of rapid on-site cytologic evaluation during endobronchial ultrasound with a guide sheath for peripheral pulmonary lesions[J]. Jpn J Clin Oncol, 2017, 47(3):221-225. doi: 10.1093/jjco/hyw180 URL
[6]	Jain D, Allen TC, Aisner DL, et al. Rapid on-site evaluation of endobronchial ultrasound-guided transbronchial needle aspirations for the diagnosis of lung cancer: A perspective from members of the pulmonary pathology society[J]. Arch Pathol Lab Med, 2018, 142(2):253-262. doi: 10.5858/arpa.2017-0114-SA URL
[7]	Lee SC, Kim EY, Chang J, et al. Diagnostic value of the combined use of radial probe endobronchial ultrasound and transbronchial biopsy in lung cancer[J]. Thorac Cancer, 2020, 11(6):1533-1540. doi: 10.1111/tca.v11.6 URL
[8]	陈雪融, 陈效友. 经验医学向精准医学的转变——《肺结核诊断》(WS 288-2017)解读[J]. 华西医学, 2018, 33(8):950-952.
[9]	Xu C, Wang Y, Li L, et al. Diagnostic value of virtual bronchoscopic navigation combined with endobronchial ultrasound guided transbronchial lung biopsy for peripheral pulmonary lesions[J]. Technol Cancer Res Treat, 2021, 20:1533033821989992.
[10]	Inomata M, Kuse N, Awano N, et al. Utility of radial endobronchial ultrasonography combined with transbronchial lung cryobiopsy in patients with diffuse parenchymal lung diseases: A multicentre prospective study[J]. BMJ Open Respir Res, 2021, 8(1):1-8.
[11]	Hong KS, Jang JG, Ahn JH. Radial probe endobronchial ultrasound-guided transbronchial lung biopsy for the diagnosis of cavitary peripheral pulmonary lesions[J]. Thorac Cancer, 2021, 12(11):1735-1742. doi: 10.1111/tca.v12.11 URL
[12]	Iglesias-Garcia J, Dominguez-Munoz JE, Abdulkader I, et al. Influence of on-site cytopathology evaluation on the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of solid pancreatic masses[J]. Am J Gastroenterol, 2011, 106(9):1705-1710. doi: 10.1038/ajg.2011.119 pmid: 21483464
[13]	Liu Q, Ji Y, Martinez L, et al. Combined tests with Xpert MTB/RIF assay with bronchoalveolar lavage fluid increasing the diagnostic performance of smear-negative pulmonary tuberculosis in Eastern China[J]. Epidemiol Infect, 2020, 149(e5):1-6.
[14]	周林, 刘二勇. 结核病诊断标准解读[J]. 寄生虫病与感染性疾病, 2019, 17(1):7-9.
[15]	Soto A, Acurio V, Solari L, et al. Incremental yield of bronchial washing for diagnosing smear-negative pulmonary tuberculosis[J]. Rev Saude Publica, 2013, 47(4):813-816. doi: 10.1590/S0034-8910.2013047004548 URL
[16]	Yoo H, Song JU, Koh WJ, et al. Additional role of second washing specimen obtained during single bronchoscopy session in diagnosis of pulmonary tuberculosis[J]. BMC Infect Dis, 2013, 13:404. doi: 10.1186/1471-2334-13-404 URL
[17]	Sun J, Teng J, Yang H, et al. Endobronchial ultrasound-guided transbronchial needle aspiration in diagnosing intrathoracic tuberculosis[J]. Ann Thorac Surg, 2013, 96(6):2021-2027. doi: 10.1016/j.athoracsur.2013.07.005 URL
[18]	Yang F, Liu E, Sun S. Rapid on-site evaluation (ROSE) with EUS-FNA: The ROSE looks beautiful[J]. Endosc Ultrasound, 2019, 8(5):283-287. doi: 10.4103/eus.eus_65_19 pmid: 31603143
[19]	Xu C, Wang Y, Wang W, et al. Improved diagnostic yield of transbronchial lung biopsy in peripheral pulmonary lesions using a combination of endobronchial ultrasound and rapid on-site evaluation[J]. J Int Med Res, 2021, 49(3):1-5.
[20]	Hsu KY, Lee HC, Ou CC, et al. Value of video-assisted thoracoscopic surgery in the diagnosis and treatment of pulmonary tuberculoma: 53 cases analysis and review of literature[J]. J Zhejiang Univ Sci B, 2009, 10(5):375-379. doi: 10.1631/jzus.B0820368 URL

项目
年龄(岁)	64.06±9.03	63.47±12.37	0.226	0.822
性别[例(%)]
男女	15(44.12) 19(55.88)	19(52.78) 17(47.22)	0.526	0.469
BMI(kg/m²)	22.83±3.51	23.11±3.75	-0.336	0.747
吸烟情况[例(%)]
吸烟不吸烟	12(35.29) 22(64.71)	15(41.67) 21(58.33)	0.300	0.584
ESR(mm/1 h)[例(%)]
0<ESR≤15 ESR>15	10(29.41) 24(70.59)	14(38.89) 22(61.11)	0.697	0.404
T-spot[例(%)]
阳性阴性	18(52.94) 16(47.06)	16(44.44) 20(55.55)	0.505	0.477
临床表现[例(%)]
咳嗽	27(38.57)	24(34.29)	N/A
咳血	12(17.14)	10(14.29)
低热	15(21.43)	14(20.00)
检查时发现	7(10.00)	12(17.14)

项目
年龄(岁)	64.06±9.03	63.47±12.37	0.226	0.822
性别[例(%)]
男女	15(44.12) 19(55.88)	19(52.78) 17(47.22)	0.526	0.469
BMI(kg/m²)	22.83±3.51	23.11±3.75	-0.336	0.747
吸烟情况[例(%)]
吸烟不吸烟	12(35.29) 22(64.71)	15(41.67) 21(58.33)	0.300	0.584
ESR(mm/1 h)[例(%)]
0<ESR≤15 ESR>15	10(29.41) 24(70.59)	14(38.89) 22(61.11)	0.697	0.404
T-spot[例(%)]
阳性阴性	18(52.94) 16(47.06)	16(44.44) 20(55.55)	0.505	0.477
临床表现[例(%)]
咳嗽	27(38.57)	24(34.29)	N/A
咳血	12(17.14)	10(14.29)
低热	15(21.43)	14(20.00)
检查时发现	7(10.00)	12(17.14)

项目	A组 (n=34)	B组 (n=36)	t/χ²值	P值
肺结核人数[例(%)]	16(47.06)	22(61.11)	1.391	0.238
取材次数	4.53±0.51	3.08±0.60	10.348	<0.01
灌洗液的实验室检查[例(%)]
结核分枝杆菌荧光染色
阳性阴性	8(23.53) 26(76.47)	11(30.56) 25(69.44)	0.437	0.509
分子生物学检查
阳性阴性	13(38.24) 21(61.76)	13(36.11) 23(63.89)	0.034	0.854
结核分枝杆菌培养
阳性阴性	7(20.59) 27(79.41)	10(27.78) 26(72.22)	0.491	0.483

项目	A组 (n=34)	B组 (n=36)	t/χ²值	P值
肺结核人数[例(%)]	16(47.06)	22(61.11)	1.391	0.238
取材次数	4.53±0.51	3.08±0.60	10.348	<0.01
灌洗液的实验室检查[例(%)]
结核分枝杆菌荧光染色
阳性阴性	8(23.53) 26(76.47)	11(30.56) 25(69.44)	0.437	0.509
分子生物学检查
阳性阴性	13(38.24) 21(61.76)	13(36.11) 23(63.89)	0.034	0.854
结核分枝杆菌培养
阳性阴性	7(20.59) 27(79.41)	10(27.78) 26(72.22)	0.491	0.483

ROSE	病理		合计
ROSE	阳性	阴性	合计
阳性	13	1	14
阴性	2	6	8
合计	15	7	22