支气管内超声引导针吸活检术(EBUS-TBNA)在肺癌纵隔淋巴结分期中的临床应用

The clinical application of endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA) for mediastinal staging of lung cancer

目的探讨支气管内超声引导针吸活检术(EBUS-TBNA)在肺癌纵隔淋巴结分期中的应用价值。方法回顾性总结2009年9月～2011年8月182例经EBUS-TBNA检查的肺癌患者的临床资料。术前所有患者胸部CT均发现纵隔淋巴结肿大(≥1.0cm)和(或)PET/CT提示纵隔淋巴结阳性。结果该组182例患者,经EBUS-TBNA检查证实纵隔淋巴结转移(阳性)者151例,未见纵隔淋巴结转移(阴性)者31例。阳性者放弃手术,予以化疗或新辅助治疗。阴性者接受胸腔镜或开胸手术,行肺叶切除或肺楔型切除加纵隔淋巴结清扫,术后病理证实26例纵隔淋巴结未见转移,5例纵隔淋巴结可见癌转移(EBUS-TBNA检查假阴性)。EBUS-TB-NA的敏感性、特异性、准确性、阳性预测价值及阴性预测价值分别为96.8%(151/156),100%(26/26),97.3%(177/182),100%(151/151)和83.9%(26/31)。所有患者检查耐受良好,无任何相关并发症发生。结论 E-BUS-TBNA是一种安全有效的肺癌纵隔淋巴结分期方法。

[Objective] To determine the value of endobronchial ultrasound-guided transbronchial needle aspiration（EBUS-TBNA） in the mediastinal staging of lung cancer.[Methods] 182 patients underwent EBUS-TBNA for known or suspected lung cancer were retrospectively reviewed.All the patients were detected enlarged mediastinal lymph nodes on radiographic examination of the chest（≥1.0 cm） and/or positron emission tomography（PET）-positive mediastinal lymph nodes.[Results] Of the 182 patients,151 patients were found with N2 or N3 disease on EBUS-TBNA.31 patients with negative EBUS-TBNA underwent thoracoscopy or thoracotomy for pulmonary resection and mediastinal lymph node dissection,26 were confirmed by surgical biopsy,metastatic node was diagnosed in 5 patients.The diagnostic sensitivity,specificity,accuracy,positive predictive value and negative predictive value of EBUS-TBNA for the mediastinal staging of lung cancer were 96.8%,100%,97.3%,100%,and 83.9%,respectively.The procedure was uneventful,and there were no complications.[Conclusions] EBUS-TBNA is an effective and safe technique for mediastinal staging in lung cancer patients.