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The objective of the study: to evaluate and compare the predictors of effectiveness of navigation bronchobiopsy – radial endobronchial ultrasound with mini probes (rEBUS) in patients with peripheral pulmonary tumors of tuberculosis and oncological origin.Subjects and Methods. The effectiveness of rEBUS-guided bronchoscopic biopsies and predictors of this effectiveness were retrospectively analyzed in 152 patients (71 men and 81 women) with pulmonary tumors visualized by chest computed tomography (CT) as peripheral lung masses. All patients were divided into 2 groups according to the verified diagnoses: TB Group included 83 patients with pulmonary tuberculosis without bacterial excretion at the time of bronchological examination; NEO Group included 69 patients with pulmonary neoplasms.In all patients of both groups, a bronchological examination was performed for diagnostic purposes and included several types of biopsies (a set of biopsies): at least one of the liquid biopsies (bronchoalveolar lavage (BAL) or bronchial lavage) and one tissue biopsy (transbronchial lung biopsy (TBLB) or brush biopsy). Specimens of all types of bronchobiopsy were sent for microbiological and cytological tests, and the TBLB samples were additionally sent for histological examination.Results. The efficiency of diagnosing bronchobiopsy with rEBUS navigation in TB and NEO Groups was comparable – 81.9% (68/83) and 81.2% (56/69) (pχ2 > 0.05), respectively. The factors (predictors) that statistically significantly influenced on effectiveness of bronchobiopsy in both groups were the following: signs of draining bronchus on chest CT, visualization of the mass in general during rEBUS, central position of the ultrasound probe in the mass during navigation, localization of the mass in the upper lobe of the right lung versus the lower lobe (summarized in two groups).Additionally for TB Group, the predictor was the size of the mass exceeding 20 mm.The effectiveness of cytological and histological verification in NEO Group with brush biopsy and TBLB samples significantly surpassed the effectiveness in TB Group, but the microbiological diagnosis of M. tuberculosis in BAL/bronchial lavage specimens increased the effectiveness in TB Group and made it comparable to NEO Group.
The objective of the study: to evaluate and compare the predictors of effectiveness of navigation bronchobiopsy – radial endobronchial ultrasound with mini probes (rEBUS) in patients with peripheral pulmonary tumors of tuberculosis and oncological origin.Subjects and Methods. The effectiveness of rEBUS-guided bronchoscopic biopsies and predictors of this effectiveness were retrospectively analyzed in 152 patients (71 men and 81 women) with pulmonary tumors visualized by chest computed tomography (CT) as peripheral lung masses. All patients were divided into 2 groups according to the verified diagnoses: TB Group included 83 patients with pulmonary tuberculosis without bacterial excretion at the time of bronchological examination; NEO Group included 69 patients with pulmonary neoplasms.In all patients of both groups, a bronchological examination was performed for diagnostic purposes and included several types of biopsies (a set of biopsies): at least one of the liquid biopsies (bronchoalveolar lavage (BAL) or bronchial lavage) and one tissue biopsy (transbronchial lung biopsy (TBLB) or brush biopsy). Specimens of all types of bronchobiopsy were sent for microbiological and cytological tests, and the TBLB samples were additionally sent for histological examination.Results. The efficiency of diagnosing bronchobiopsy with rEBUS navigation in TB and NEO Groups was comparable – 81.9% (68/83) and 81.2% (56/69) (pχ2 > 0.05), respectively. The factors (predictors) that statistically significantly influenced on effectiveness of bronchobiopsy in both groups were the following: signs of draining bronchus on chest CT, visualization of the mass in general during rEBUS, central position of the ultrasound probe in the mass during navigation, localization of the mass in the upper lobe of the right lung versus the lower lobe (summarized in two groups).Additionally for TB Group, the predictor was the size of the mass exceeding 20 mm.The effectiveness of cytological and histological verification in NEO Group with brush biopsy and TBLB samples significantly surpassed the effectiveness in TB Group, but the microbiological diagnosis of M. tuberculosis in BAL/bronchial lavage specimens increased the effectiveness in TB Group and made it comparable to NEO Group.
Objective. To evaluate endosonographic images (EGI) for different peripheral lung lesions (PPLs) genesis, to identify patterns of malignancy in the differential diagnosis of tuberculosis (TB), mycobacteriosis (NTM), malignancy neoplasm, to compare the main combinations of variants of the echo characteristics of lung lesions visualized during rEBUS navigation with the data of a comprehensive microbiological, cytological and morphological studies. Methods. A cohort retrospective study included 145 patients (81 women (mean age 44.94±0.24 years) and 64 men (mean age 47.91±0.24)), with newly diagnosed PPLs and with negative sputum TB tests, who underwent diagnostic navigational bronchoscopy (rEBUS) and surgical diagnostics, and EGI of PPLs was visualized with rEBUS. Depending on the final verification, were endosonographic images divided into 2 groups: the Neo group (n=63), whose biopsy (during bronchoscopic or surgical diagnosis) verified the malignancy PPls, and the TB+NTM group (n=82) – infectious PPLs caused by mycobacterial infection (73 cases – pulmonary TB, 9 cases – mycobacteriosis). Results. It was established that differences were statistically significant in shape, contour/border, and the presence of inclusions (linear arcs, zones of hypo-anechogenesis) between the comparison groups. If there are echoic features of malignancy PPLs on EGI with rEBUS (irregular shape (found in 60,3%), lobulated shape (in 17,4%), visualized but blurred contour (in 57.2%), fuzzy/poorly visualized contour (in 25.4%), heteroechoic structure, with “linear arcs” (49.2%) with an air bronchogram (in 36,5%)), tissue bronchobiopsy (brush and TBBL) are priority for cytological and histological examination. If there are echoic features of delimited infectious inflammation on EGI of PPLs in rEBUS (round or oval shape (found in 34.1% of cases), definite, closed contour (in 78.0%), homoechoic structure (29,3%), heteroechoic structure with zones of hypo-anechoicity (in 32.9%) with an air bronchogram (in 23.2%)), bronchobiopsy is a priority, allowing to cover the largest area of the lungs (BAL) for microbiological examination (microscopy, PCR-RT, culture) in combination with tissue biopsy (cytological examination). A classification has been created that includes 3 types of EGI to determine rational approaches to bronchobiopsy for the purpose of differential diagnosis of TB, mycobacteriosis and neoplasia. Conclusions. The use of EGI of PPLs assessment during bronchoscopy with rEBUS navigation determines rational approaches to the complex of navigational bronchobiopsies in the differential diagnosis of TB, mycobacteriosis and malignant processes.
The objective: to analyze the effectiveness of etiological verification of pulmonary mycobacteriosis when using various biological materials at different diagnostic stages.Subjects and Methods. In Center for Diagnosis and Rehabilitation of Respiratory Diseases, CTRI, the results of stage-by-stage examinations of 142 patients (from 2018 to 2022) were analyzed. A retrospective, prospective, cohort, open study was conducted. Inclusion criteria: pulmonary mycobacteriosis etiologically verified by comprehensive microbiological examinations (molecular genetic and cultural tests) (with retrospective analysis after all stages of examination). Exclusion criteria: HIV infection. 115 women and 27 men were enrolled in the study, the age ranged from 21 to 86 years, the mean age was 57,9 years.All patients referred to CTRI for examination due to newly detected changes in the lungs (bronchiectasis, focal changes, and cavities). For etiological verification of the diagnosis, microbiological sputum testing was performed (Stage 1 of the examination); when negative results were obtained, bronchoscopy was prescribed and bronchobiopsies were used for microbiological and molecular genetic diagnostics – Stage 2. In case of negative results of Stage 2, the patient was recommended to undergo a diagnostic resection of the lung – Stage 3 of the examination. At all stages, specimens were sent for comprehensive microbiological testing: fluorescent microscopy to detect acid-fact mycobacteria, real-time polymerase chain reaction (PCR-RV) to detect NTBM DNA. Identification of NTBMB was carried out by molecular genetic methods (PCR for the presence of MTB DNA/NTBM (SYNTOL, Russia), and on DNA strips (GenoType Mycobacterium CM\AS Hain Livescience, Germany)). Specimens were cultured on a liquid medium in the ВАСТЕС MGIT960 (BD, USA).The diagnosis of mycobacteriosis was established in accordance with the diagnostic criteria proposed in the guidelines of the American Thoracic Society (ATS) and the Infectious Diseases Society of America (IDSA) (2020): detection of NTBM in 2 sputum samples or in 1 sample of bronchobiopsy specimens or in 1 surgical specimens [15].The studied data were entered to the Microsoft Office Excel sheet (Microsoft, USA) for statistical processing; the level of statistical significance of differences was taken as 0.05.Results. It was found that slow-growing NTBM were identified as etiologically significant in 93.0%, of which 78.1% was M. avium, fast-growing NTBM were represented only by M. abscessus, 7% of observations. During X-ray examination, the bronchiectatic form – 52.1% (74/142) was detected more often compared to the abdominal – 30.9% (44/142) and focal forms – 16.9% (24/142) (p<0.001). When verifying mycobacteriosis in patients with a negative sputum test – Stage 2 of the examination – the effectiveness was 91.0% (80/88). Regardless of the radiological form of the disease and dissemination of the disease, bronchoscopy revealed pathology of the tracheobronchial tree in 85.2% of cases, mainly in the form of bronchitis with purulent secretions.
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