经支气管淋巴结针吸活检164例结果分析

The results of transhronchial needle aspiration in 164 cases with enlarged mediastinal and/or hilar lymph nodes

目的评价经支气管淋巴结针吸活检（TBNA）在纵隔肺门肿大淋巴结诊断中的作用。方法选胸部CT检查发现纵隔肺门淋巴结肿大、估计支气管镜检查不能发现气道内新生物的患者，在支气管镜检查过程中完成TBNA操作。TBNA取出的每份标本分送呼吸科实验室和病理科细胞学室检查。结果（1）入选的164例患者中80例诊断肺癌，69例诊断肺部良性疾病，其他类型恶性肿瘤2例，13例最终无明确诊断。（2）164例患者共穿刺260个部位，463针，其中TBNA穿刺成功445针（96．1％）。（3）80例肺癌患者中，TBNA总结果阳性66例（82．5％），其中25例患者TBNA结果是惟一病理学证据。80例肺癌患者共穿刺122枚淋巴结，其中TBNA结果阳性80枚（65．6％）。（4）TBNA结果的阳性率在小细胞肺癌（SCLC）和直径≥3cm淋巴结中阳性率稍高，但差异无统计学意义。（5）2006年6月1日-2007年12月31日，64例（64／87，73．5％）患者可获得明确组织学标本。其中TBNA穿刺物病理诊断结节病阳性率为53．3％（8／15），诊断肺癌阳性率为78．6％（33／42）。（6）100例（61．0％）患者穿刺部位少量出血。结论TBNA安全性好，对肺癌的诊断和分期判定有很大帮助，对肺部良性疾病的诊断亦有一定帮助。

Objective To evaluate the role of transbrochial needle aspiration （TBNA） in the diagnosis of patients with enlarged mediastinal and/or hilar lymph node. Methods Patients with mediastinal and/or hilar lymphoadenopathy proven by CT scan were eligible for TBNA as reported. All specimens were directly and instantly smeared for pathological examination. Results From June 1 2004 to December 31 2007, 164 patients were examined： including 80 lung cancers, 69 lung bengin diseases, 2 other malignancy tumor, and 13 without definite diagnosis. Total 260 lymph nodes were punctured. TBNA procedures were successfully carried out in 445/463 （96. 1% ）. Sensitivity of TBNA was 82. 5% （66/80） in patients who had been proven to suffer from bronchogenic carcinoma. There were 25 patients that diagnosis of lung cancer was pathologically determined by TBNA only. A total of 122 lymph nodes in the 80 lung cancer patients were aspirated by TBNA with a positive rate of 65.6% （ 80/122 ）. Severe complications were rare except small amount of bleeding at the TBNA site （ 100/164, 61.0% ）. From June 1 2006 to December 31 2007, lymph node tissues able to make histology diagnosis were yield in 73.5% （64/87） patients. Through histology pathology, the sensitivities of TBNA were 53.3% （8/15） for sarcoidosis and 78. 6% （33/42） for lung cancer. Conclusion TBNA is quite safe and helpful in diagnosis and staging of bronchogenic carcinoma, and in diagnosis of benign lung diseases.