폐주변부 병변의 진단시 기관지 초음파(Endobronchial Ultrasonogram)의 유용성

• Published in: Tuberculosis and respiratory diseases Vol. 67; no. 6; pp. 545 - 550
• Main Authors: 김성빈, Sung Bin Kim, 박진희, Jin Hee Park, 김예나, Ye Na Kim, 옥철호, Chul Ho Oak, 장태원, Tae Won Jang, 정만홍, Man Hong Jung, 천봉권, Bong Kwon Chun
• Format: Journal Article
• Language: Korean
• Published: 대한결핵 및 호흡기학회 30.12.2009; 대한결핵및호흡기학회
• Subjects: Bronchoscopy; Endosonography; Lung Neoplasms; Solitary Pulmonary Nodule; 내과학; Bronchoscopy; Solitary Pulmonary Nodule; Endosonography; Lung Neoplasms
• ISSN: 1738-3536; 2005-6184

Background: Endobronchial ultrasonogram (EBUS) has increased the diagnostic yield of a bronchoscopic biopsy of peripheral pulmonary lesions (PPL). This study evaluated the diagnostic yield of EBUS-guided transbronchial biopsy (TBB) and the visibility of EBUS PPL. Methods: Between August 2007 and November 2008, 50 patients (32 men and 18 women, median age, 61.1±10 yrs; range, 16 to 80 yrs) whose PPL lesions could not be detected with flexible bronchoscopy were enrolled in this study. Among the 50 patients, 40 cases were malignant lesions (adenocarcinoma 25, squamous cell carcinoma 10, small cell carcinoma 5) and 10 cases were benign lesions (tuberculoma 7, fungal ball 1, other inflammation 2). Results: The mean diameter of the target lesion was 35.4±4.3 mm. Of the 50 patients examined, the overall diagnostic yield by EBUS-TBLB was 46.0% (23/50). The visualization yield of EBUS was 66.0% (33/50). A definitive diagnosis of PPL localized by EBUS was established using EBUS-TBLB in 69.6% (23/33) of cases. The diagnostic yields from washing cytology and brushing cytology from a bronchus identified by EBUS were 27.0% and 45.4% respectively. The diagnostic yields reached 78.7% when the three tests (washing cytology, brushing cytology and EBUS-TBLB) were combined. The visualization yield of EBUS in lesions <20 mm was significantly lower than that in lesions ≥20 mm (p=0.04). The presence of a bronchus leading to a lesion (open bronchus sign) on the chest CT scan was associated with a high visualization yield on EBUS (p=0.001). There were no significant complications associated with EBUS-TBLB. Conclusion: EBUS-TBLB is a safe and effective method for diagnosing PPL. The lesion size and open bronchus signs are significant factors for predicting the visualization of EBUS.