支气管内超声引导针吸活检术在纵隔肿物及纵隔肿大淋巴结诊断中的临床应用

Clinical application of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of mediastinal lesions and mediastinal lymphadenopathy

目的探讨支气管内超声引导针吸活检术(endobronchial ultrasound-guided transbronchial needle aspiration,EBUS-TBNA)在明确纵隔肿物性质和纵隔或肺门肿大淋巴结定性诊断中的应用价值。方法 2012年4月至2013年12月期间,对胸部CT或PET/CT检查提示纵隔占位、纵隔或肺门淋巴结肿大≥1cm的患者行EBUSTBNA检查,阴性者进一步接受纵隔镜检查或胸腔镜、开胸手术明确病变性质。结果本组共203例病例,EBUS-TBNA明确诊断阳性者180例,其中诊断为小细胞肺癌54例,非小细胞肺癌119例,食管癌1例,贲门癌1例,鼻咽癌2例,淋巴瘤3例;EBUS-TBNA阴性者23例,其中5例最终证实为非小细胞肺癌的纵隔淋巴结转移,1例为小细胞肺癌,其余17例为良性病变。EBUS-TBNA在纵隔病变或纵隔淋巴结转移诊断中的灵敏度、特异性和准确性分别为96.8%、100%、97%。检查过程中,患者耐受性均较好,所有病人均无严重并发症发生。结论 EBUSTBNA是一种对纵隔病变及纵隔肿大淋巴结定性诊断安全、有效的方法。

Objective To assess the efficacy and safety of endobronchial uhrasound-guided transbronchial needle aspiration （ EBUS-TBNA ） in qualitative diagnosis of mediastinal lesions or mediastinal lymphadenopathy. Methods From April 2012 to December 2013, 203 patients with mediastinal lesions or mediastinal lymphadenopathy（ minmum diameter 〉 1 cm） diagnosed by chest computed tomography （CT） or PET-CT were included in this study. EBUS-TBNA was performed in all cases. All patients with negative EBUS-TBNA were confirmed by mediastinoscopy, thoracoscopy or open thoracotomy. Results All 203 patients underwent EBUS-TBNA. The results showed metastatic lymphnodes involvement in 180 patients, including 54 cases of small-cell lung cancer, 119 cases of non-small-cell lung cancer, 1 case of esophageal carcinoma, 1 case of cardia cancer, 2 cases of nasopharyngeal cancer and 3 cases of lymphoma. Twenty-three patients showed negative EBUS-TBNA, and 5 patients was diagnosed as metastatic node.The sensitivity, specificity, and accuracy of EBUS-TBNA in defining malignant lymph nodes were 96.8%, 100%, 97%, respectively. No patients presented with complications. Conclusions EBUS-TBNA is a safe and effective method for evaluating mediastinal lesions.