灰阶超声声像特征对肺门纵隔恶性淋巴结的预测价值

The predictive value of gray scale sonographic features in malignant hilar and mediastinal lymph node

目的 分析肺门纵隔淋巴结灰阶超声声像特征与其良恶性的相关性,筛选出恶性淋巴结的超声声像特征并检验其预测价值.方法 回顾性分析2012年11月1日至2013年11月30日在广州医科大学附属第一医院支气管镜中心经超声光纤电子支气管镜检查并行经支气管针吸活检确诊的肺门纵隔淋巴结390枚,分为恶性淋巴结组和良性淋巴结组,分析其超声声像特征,包括短径长度、形态、边界、回声高低、回声是否均匀、凝固性坏死、钙化、融合和后方回声增强.结果 390枚肺门纵隔淋巴结中恶性淋巴结、良性淋巴结分别为207和183枚.短径长度（以10 mm为临界值）、形态、边界、回声高低、回声是否均匀、凝固性坏死、钙化、融合和后方回声增强评估良恶性淋巴结的准确率分别为61.0％ （238/390）、75.4％（294/390）、75.6％ （295/390）、73.8％ （288/390）、65.9％ （257/390）、68.2％（266/390）、51.8％（202/390）、55.1％（215/390）和67.4％（263/390）.二分类多因素Logistic回归分析结果表明,圆形、边界清晰、回声不均匀、低回声及后方回声增强差异有统计学意义（均P＜0.05）.仅有35.3％ （73/207）恶性淋巴结同时具有5个阳性声像图特征,诊断率为93.6％（73/78）;72.46％（150/207）恶性淋巴结符合5个阳性声像图特征的任意4个或4个以上,诊断率为85.2％（150/176）;85.0％（176/207）恶性淋巴结符合5个阳性声像图特征的任意3个或3个以上,诊断率为84.6％（176/208）.结论 联合肺门纵隔淋巴结多个灰阶超声声像特征有助于预测恶性淋巴结.

Objective To explore the sonographic features of malignant hilar and mediastinal lymph nodes and the predictive value.Methods We performed retrospective analysis of 390 lymph nodes under the endobronchial ultrasound-guided transbronchial needle aspiration for diagnosis in the bronchoscope center of the First Affiliated Hospital of Guangzhou Medical University from November 1 st,2012 to November 31st,2013.They were divided into malignant and benign groups,and sonographic features of lymph nodes were analyzed,including the length of short axis,shape,margin,echogenicity,homogenicity,coagulation necrosis,calcification,coalesence and posterior acoustic enhancement.Results A total of 390 lymph nodes were evaluated,including 207 malignant and 183 benign lymph nodes,respectively.The accuracy based on the length of short axis,shape,margin,echogenicity,homogenicity,coagulation necrosis,calcification,coalesence and posterior acoustic enhancement to predict the malignancy were 61.0% （238/390）,75.4% （294/390）,75.6% （295/390）,73.8% （288/390）,65.9% （257/390）,68.2% （266/390）,51.8% （202/390）,55.1% （215/390）,67.4% （263/390）,respectively.Binary muhivariable logistic regression analysis revealed that 5 parameters,including round,distinct margin and heterogeneous,hypoechoic,and posterior acoustic enhancement possessed a significant predictive value （P 〈 0.05）.We found that only 35.3% （73/207） malignant lymph nodes possessed these 5 ultrasonographic characteristics,and the diagnosis rate was 93.6% （73/78）.72.46% （150/207） malignant lymph nodes possessed any 4 or more positive sonographic features,and the diagnosis rate was 85.2% （150/176）.85.0% （176/207） malignant lymph nodes had any 3 or more positive sonographic features,and the diagnosis rate was 84.6% （176/ 208）.Conclusion The combination of gray scale sonographic features has a predictive value in the diagnosis of malignant hilar and mediastinal lymph nodes.