目的探讨纤维支气管镜联合快速现场评价(ROSE)技术对肺部感染的诊断价值。方法选取某院2017年7月—2018年6月(纤支镜组:采用常规纤维支气管镜检查)和2018年7月—2019年6月(纤支镜+ROSE组:采用纤维支气管镜联合ROSE检查)就诊的肺部感染患...目的探讨纤维支气管镜联合快速现场评价(ROSE)技术对肺部感染的诊断价值。方法选取某院2017年7月—2018年6月(纤支镜组:采用常规纤维支气管镜检查)和2018年7月—2019年6月(纤支镜+ROSE组:采用纤维支气管镜联合ROSE检查)就诊的肺部感染患者,比较两组患者的检查结果,并将随访6个月的确诊结果分别与两组现场检查结果比较,计算Kappa值并绘制受试者工作特征(ROC)曲线,评价诊断效果。结果共纳入438例患者,其中纤支镜组207例,纤支镜+ROSE组231例。与纤支镜组相比,纤支镜+ROSE组的首次检查时间较长(χ^(2)=1.965,P<0.001),但首次检查未明确诊断需选择二次检查的患者比例更低(χ^(2)=24.533,P<0.001),纤支镜+ROSE组较纤支镜组具有更高的诊断效能(Kappa:0.411 VS 0.164;AUC:0.904 VS 0.759)。结论ROSE技术可提供明确的细胞学背景,利于肺部感染的病原学分类,与单纯纤维支气管镜技术相比,纤维支气管镜联合ROSE技术具有更高的诊断效能,可有效减少二次检查,值得在临床上广泛推广。展开更多
Endoscopic ultrasound (EUS) has become an essential tool for the study of pancreatic diseases. Specifically, EUS plays a pivotal role evaluating patients with a known or suspected pancreatic mass. In this setting, dif...Endoscopic ultrasound (EUS) has become an essential tool for the study of pancreatic diseases. Specifically, EUS plays a pivotal role evaluating patients with a known or suspected pancreatic mass. In this setting, differential diagnosis remains a clinical challenge. EUS-guided fine-needle aspiration (FNA) and fine-needle biopsy (FNB) have been proven to be safe and useful tools in this setting. EUS-guided FNA and FNB, by obtaining cytological and/or histological samples, are able to diagnose pancreatic lesions with high sensitivity and specificity. In this context, several methodological features, trying to increase the diagnostic yield of EUS-guided FNA and FNB, have been evaluated. In this review, we focus on the role of rapid on-site evaluation (ROSE). From data reported in the literature, ROSE may increase diagnostic yield of EUS-FNA specimens by 10%-30%, and thus, diagnostic accuracy. However, we should point out that many recent studies have reported adequacy rates of > 90% without ROSE, indicating that, perhaps, at high-volume centers, ROSE may not be indispensable to achieve excellent results. The use of ROSE can be considered important during the learning curve of EUS-FNA, and also in hospital with diagnostic accuracy rates < 90%.展开更多
文摘目的探讨纤维支气管镜联合快速现场评价(ROSE)技术对肺部感染的诊断价值。方法选取某院2017年7月—2018年6月(纤支镜组:采用常规纤维支气管镜检查)和2018年7月—2019年6月(纤支镜+ROSE组:采用纤维支气管镜联合ROSE检查)就诊的肺部感染患者,比较两组患者的检查结果,并将随访6个月的确诊结果分别与两组现场检查结果比较,计算Kappa值并绘制受试者工作特征(ROC)曲线,评价诊断效果。结果共纳入438例患者,其中纤支镜组207例,纤支镜+ROSE组231例。与纤支镜组相比,纤支镜+ROSE组的首次检查时间较长(χ^(2)=1.965,P<0.001),但首次检查未明确诊断需选择二次检查的患者比例更低(χ^(2)=24.533,P<0.001),纤支镜+ROSE组较纤支镜组具有更高的诊断效能(Kappa:0.411 VS 0.164;AUC:0.904 VS 0.759)。结论ROSE技术可提供明确的细胞学背景,利于肺部感染的病原学分类,与单纯纤维支气管镜技术相比,纤维支气管镜联合ROSE技术具有更高的诊断效能,可有效减少二次检查,值得在临床上广泛推广。
文摘Endoscopic ultrasound (EUS) has become an essential tool for the study of pancreatic diseases. Specifically, EUS plays a pivotal role evaluating patients with a known or suspected pancreatic mass. In this setting, differential diagnosis remains a clinical challenge. EUS-guided fine-needle aspiration (FNA) and fine-needle biopsy (FNB) have been proven to be safe and useful tools in this setting. EUS-guided FNA and FNB, by obtaining cytological and/or histological samples, are able to diagnose pancreatic lesions with high sensitivity and specificity. In this context, several methodological features, trying to increase the diagnostic yield of EUS-guided FNA and FNB, have been evaluated. In this review, we focus on the role of rapid on-site evaluation (ROSE). From data reported in the literature, ROSE may increase diagnostic yield of EUS-FNA specimens by 10%-30%, and thus, diagnostic accuracy. However, we should point out that many recent studies have reported adequacy rates of > 90% without ROSE, indicating that, perhaps, at high-volume centers, ROSE may not be indispensable to achieve excellent results. The use of ROSE can be considered important during the learning curve of EUS-FNA, and also in hospital with diagnostic accuracy rates < 90%.
