EBUS-TBNA与PET/CT在不明原因纵隔淋巴结肿大诊断中的价值

Application of EBUS-TBNA and PET/CT in diagnosing enlarged mediastinal lymph nodes caused by unknown reasons

目的比较支气管超声引导针吸活检术(endobronchial ultrasound guided transbronchial needle aspiration,EBUS-TBNA)和电子发射断层显像/X线计算机体层成像(positron-emission tomography and computed tomography,PET/CT)用于不明原因纵隔淋巴结肿大诊断的价值,并探讨EBUS-TBNA和PET/CT联合应用的意义。方法回顾性分析解放军总医院呼吸科自2010年12月至2011年8月采用EBUS-TBNA诊断前已采用PET/CT检查的45例不明原因纵隔淋巴结肿大患者的临床资料。所有患者在进行EBUS-TBNA检查前接受普通白光支气管镜检查,均未发现支气管内病变。对于EBUS-TBNA未能明确诊断的患者,可行外科手术切除,并经至少6个月以上的临床和影像学随访。结果 EBUS-TBNA诊断恶性纵隔淋巴结的敏感性为81.48%(22/27)、特异性100%(18/18)、阳性预测值100%(22/22)、阴性预测值78.26%(18/23)、准确性88.89%(40/45);PET/CT诊断恶性纵隔淋巴结的敏感性为92.59%(25/27)、特异性55.56%(10/18)、阳性预测值75.76%(25/33)、阴性预测值83.33%(10/12)、准确性77.78%(34/45),EBUS-TBNA在诊断的特异性(P=0.003)和阳性预测值(P=0.016)方面优于PET/CT。结论 EBUS-TBNA在不明原因纵隔淋巴结肿大的诊断方面有较高的价值;与PET/CT联合应用,可使EBUS-TBNA诊断恶性纵隔淋巴结出现假阴性结果的状况得到改善。

Objective To compare the values of endobronchial ultrasound guided transbronchial needle aspiration（EBUS-TBNA） and positron-emission tomography and computed tomography（PET/CT） in diagnosis of enlarged mediastinal lymph nodes caused by unknown reasons,and to study the diagnostic value of the combination of EBUS-TBNA and PET/CT.Methods A retrospective study was carried out in our hospital.From December 2010 to August 2011,a total of 45 patients with enlarged mediastinal lymph nodes received EBUS-TBNA following PET/CT examination.Conventional bronchoscopy was performed before EBUS-TBNA.The patients with endobronchial lesions were excluded from this study.Patients with negative EBUS-TBNA results underwent surgical biopsies or a minimum of 6 months＇ clinical and radiological follow-up.Results Sensitivities of EBUS-TBNA and PET/CT in diagnosis of enlarged mediastinal lymph nodes were 81.48%（22/27） and 92.59%（25/27）,the specificities were 100%（18/18） and 55.56%（10/18）,the positive predictive values（PPV） were 100%（22/22） and 75.76%（25/33）,the negative predictive values（NPV） were 78.26%（18/23） and 83.33%（10/12）,the accuracies were 88.89%（40/45） and 77.78%（34/45）,respectively.EBUS-TBNA had a significantly better specificity（P=0.003） and PPV（P=0.016） than PET/CT for diagnosis of enlarge mediastinal lymph nodes.Conclusion EBUS-TBNA is valuable for diagnosing enlarged mediastinal lymph nodes caused by unknown reasons.EBUS-TBNA combined with PET/CT can reduce the false negative results in diagnosis of malignant mediastinal lymph nodes.