气道内超声定位下经支气管针吸术对肺癌的诊断价值

The Value of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration in Diagnosis of Lung Cancer

目的:探讨气道内超声定位下经支气管针吸术(TBNA)在肺癌诊断中的应用价值。方法:对33例支气管镜检查呈外压性隆起,和/或有纵隔或肺门淋巴结转移的可疑肺癌患者行气道内超声检查,在超声定位下行TB-NA。术前常规支气管镜均未能确诊,且不能通过经皮肺穿刺获取病变组织。结果:33例患者中,1例支气管镜示外压性隆起,超声显示为血管,未行穿刺,32例行TBNA,诊断肺癌敏感性、特异性和准确性分别为96.3%、100%和96.9%,其中诊断肺癌26例(81.3%)、淋巴结结核3例(9.4%)、结节病1例(3.1%)、2例未能明确诊断(1例外科手术后病检证实为结核)。全部患者未出现任何与穿刺相关严重并发症。结论:气道内超声是一项安全、有效的新型内镜检查辅助工具,它能帮助定位支气管腔外病灶和纵隔、肺门淋巴结,引导TBNA,为肺癌诊断和分期提供了一种新的方法,具有微创、准确、安全的特点。

Objective To explore the clinical value of endobronchial ultrasound-guided transbronchial needle aspiration(TBNA) in the diagnosis of lung cancer.Methods The endobronchial ultrasound-guided TBNA were underwent in 33 suspected lung cancer patients with external compression uplift examed by bronchoscopy,and/or mediastinal or hilar lymph node metastasis detected by chest CT,that could not confirm by conventional bronchoscopy and obtain pathological tissue through percutaneous lung biopsy.Results In all 33 patients,the result of endobronchial ultrasound was vascular in one case with external compression uplift examed by electronic bronchoscopy.The sensitivity,specificity and diagnostic accuracy of TBNA in the diagnosis of another 32 cases were 96.3%,100% and 96.9%,respectively,in which 26 cases(81.3%) were diagnosed as lung cancer,3 cases(9.1%) were diagnosed as lymph node tuberculosis,one case(3.0%) was diagnosed as sarcoidosis and two cases could not be diagnosed(one case was confirmed as tuberculosis by surgical operation finally).No severe complication associated with aspiration was happened.Conclusion Endobronchial ultrasound may be a safe,effective endoscopy auxiliary tool,which could help locate the lesion outside bronchial lumen and mediastinal and/or hilar lymph nodes,and guide TBNA,it would provide a new method for diagnosis and staging of lung cancer by its features of minimally invasive,accurate and safety.