EUS-FNA和EBUS-TBNA联合诊断纵隔病变的应用探讨

Application of EUS-FNA plus EBUS-TBNA in the diagnosis of mediastinal lesions

目的探讨超声内镜引导下的细针吸活检术(EUS-FNA)和气管超声内镜引导针吸活检术(EBUS-TBNA)联合诊断纵隔病变的应用价值。方法对16例影像学检查提示纵隔病变的患者行EUS-FNA或EBUS-TBNA,穿刺标本均行病理和细胞学检查。结果 16例患者穿刺成功率100%,未发生明显并发症。联合应用EUS-FNA和EBUS-TBNA的诊断率为81.3%(13/16),其中行EUS-FNA2例,诊断率为100%(2/2);行EBUS-TBNA 14例,诊断率为78.6%(11/14)。16例通过穿刺诊断的患者中,有11例得到明确组织分型,细胞学和病理学诊断率分别为81.3%(13/16)和68.8%(11/16)。通过离心后细胞块免疫组化检查,可使组织分型诊断率提高38.5%(5/13)。结论联合应用EUS-FNA和EBUS-TBNA能扩大穿刺技术对纵隔病变的诊断范围,提高诊断水平。离心后的细胞块免疫组化检查可提高EUS-FNA和EBUS-TBNA的诊断率和组织分型的诊断率。

Objective To investigate the application value of endoscopic ultrasound guided fine needle aspiration（EUS-FNA） plus endobronchial ultrasound guided transbronchial needle aspiration （EBUS-TBNA） in the diagnosis of mediastinal lesions. Methods Sixteen cases of mediastinal lesions indicated by image exam were performed with EUS-FNA or EBUS-TBNA, followed by pathological and cytology examination. Results The success rate of puncture was 100%, and no significant complication occurred. Thirteen were diagnosed positive by the combination of EUS-FNA and EBUS-TBNA [ positive rate, 81.3% （ 13/16 ） ], among which, 2 were diagnosed positive by EUS-FNA （positive rate, 100% ）, and 11 by EBUS-TBNA [ positive rate ,78.6% （ 11/14 ） ]. Eleven cases got a clear tissue typing in 16 cases, and the cytology and pathology diagnosis rate was 81.3% （13/16） ,68.8% （11/16） ,respectively. The cell block was collected after centrifugation, and tissue type was determined by immunohistochemical method, with an improvement of 38.5% （5/13） in the tissue typing. Conclusions Combining EUS-FNA with EBUS-TBNA can expand the range of puncture technique for the diagnosis of mediastinal lesions, and improve the positive rate. Cells block examination with inununohistochemical method after centrifugation can increase the positive rate and tissue typing of diagnosis by EUS-FNA and EBUS-TBNA.