支气管内超声引导针吸活检术在非小细胞肺癌术前分期中的临床应用

Clinical application of endobronchial ultrasound-guided transbronchial needle aspiration in preoperative staging of non-small cell lung cancer

目的探讨支气管内超声引导针吸活检术(EBUS-TBNA)在非小细胞肺癌纵隔淋巴结分期中的应用价值。方法 2010年9月至2012年9月,北京大学人民医院利用EBUS-TBNA对术前确诊或CT扫描高度怀疑非小细胞肺癌且伴有纵隔淋巴结肿大(N_2站淋巴结短径≥1.0cm,或N_1站淋巴结短径≥1.0cm且N_2多站短径≥0.5cm者),有手术切除可能,术前无放、化疗史的126例患者进行纵隔淋巴结分期。最终入组82例非小细胞肺癌患者。结果该组82例患者,经EBUS-TBNA检查证实纵隔淋巴结转移(阳性)者54例,未见纵隔淋巴结转移(阴性)者28例。EBUS-TBNA在该组肺癌术前纵隔淋巴结分期中的敏感度、特异度和准确性分别为94.7%(54/57)、100.0%(25/25)和96.3%(79/82),阳性预测值及阴性预测值分别为100.0%(54/54)和89.3%(25/28)。而CT对于本组患者纵隔淋巴结分期中的敏感度、特异度和准确性分别为98.2%(55/56)、38.5%(10/26)和79.3%(65/82),阳性预测值及阴性预测值分别为77.5%(55/71)和90.9%(10/11)。CT在术前纵隔淋巴结分期中的假阳性率为22.5%(16/71)。全组中,16例(19.5%)肺癌患者因EBUS-TBNA病理结果改变了治疗策略。结论 EBUS-TBNA用于非小细胞肺癌纵隔淋巴结分期的敏感性、特异性和准确性较高。EBUSTBNA可以作为非小细胞肺癌术前分期、指导治疗策略的检查手段。

Objective To determine the value of endobronchial ultrasound-guided transbronchial needle aspiration （EBUS-TBNA） in staging of mediastinal lymph nodes of lung cancer. Methods From September 2010 to September 2012, mediastinal lymph node staging was conducted by EBUS-TBNA among patients in People＇s Hospital, Peking University with confirmed or suspicious non-small cell lung cancer and detected enlarged mediastinal lymph nodes （short diameter of lymph node at N2 ≥1.0 cm, or short diameter of lymph node at Nl ≥1.0 cm with short diameter of lymph node at N2 ≥0. 5 cm） who had the chance of surgical resection and no history of radiotherapy and chemotherapy before operation. A total of 82 patients with non-small cell lung caneer were involved. Results Of the 82 patients, mediastinal lymph node metastasis （positive finding） was confirmed by EBUS-TBNA in 54 patients, and no mediastinal lymph node metastasis （negative finding） was detected in the other 28 patients. The diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value of EBU-TBNA for the preoperative staging of mediastinal lymph nodes of lung cancer were 94. 70/00 （54/ 57）, 100. 0K（25/25）, 96.3%（79/82）, 100. 0%（54/54） and 89. 3%（25/28）, respectively. The diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CT scans for the preoperative staging of mediastinal lymph nodes of lung cancer were 98. 2%（55/56）, 38. 5%（10/26）, 79. 3%（65/82）, 77.5%（55/71） and 90. 9%（10/11）, respectively. The false positive rate of CT scans for the preoperative staging of mediastinal lymph nodes was 22. 5% （16/71）. EBUS-TBNA resulted in the alteration of individual treatment strategies in 16 patients （19. 5%）. Conclusion EBUS- TBNA has the high diagnostic sensitivity, specificity and accuracy for the staging of mediastinal lymph nodes of non-small cell lung cancer, which may serve as an effective technique for preoperative staging and treatment guiding.