支气管超声内镜引导下针吸活检结合液基细胞学检查对肺及纵隔淋巴结病变的诊断价值

Diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration combined with Surepath liquid-based cytology test for lung lesions and mediastinal lymphadenopathy

目的探讨支气管超声内镜引导下针吸活检（EBUS—TBNA）结合Surepath液基细胞学制片技术对肺及纵隔淋巴结病变的诊断价值。方法回顾性分析四川大学华西医院病理科2011年12月至2014年6月80例EBUS—TBNA病例，复习细胞学诊断结果并与组织学活检进行对照，同时对比观察液基细胞学制片与传统细胞学涂片，分析液基细胞学制片技术有无提高样本满意率和诊断准确性。结果80例EBUS-TBNA病例包括男性53例，女性27例，男女性别‘比为1．96：1．00，年龄17—79岁（平均54岁），每位患者穿刺1—4组淋巴结，总共穿刺109组淋巴结，包括气管旁淋巴结57组，隆突下淋巴结34组，气管支气管淋巴结3组，肺内淋巴结7组，肺门淋巴结4组，另有4组纵隔淋巴结具体部位不详。传统涂片标本满意率为90．0％，液基细胞学制片标本满意率为92．5％。该组病例包括恶性肿瘤37例，结核9例，结节病2例，原因不明的肉芽肿性炎11例，其他良性病变27例。EBUS—TBNA传统细胞学涂片对诊断肿瘤的敏感性、特异性和准确率分别为86．5％、97．7％和92．5％，阳性预测值和阴性预测值分别为97．0％和89．4％，液基细胞学制片诊断肿瘤的敏感性、特异性和准确率分别为89．2％、97．7％和93．8％，阳性预测值和阴性预测值分别为97．1％和91．3％，传统涂片联合液基细胞学制片诊断敏感性、特异性和准确率分别为91．9％、97．7％和95．0％，阳性预测值和阴性预测值分别为97．1％和93．3％，两种方法比较差异无统计学意义（P〉0．05）。结论EBUS．TBNA是诊断肺及纵隔淋巴结病变的有效手段，Surepath液基细胞学制片可提高样本满意率、诊断的敏感性及准确性，结合免疫细胞化学检测可以进一步区分肿瘤类型，是对组织学活检的有效补充。

Objective To explore the diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration （EBUS-TBNA） combined with Surepath liquid-based cytology test for lung and mediastinal lymphadenopathy. Methods Eighty EBUS-TBNA cases in West China Hospital of Sichuan University collected from December 2011 to June 2014 were retrospectively analyzed. The conventional smears and Surepath liquid based preparations were reviewed and compared with histological biopsy. Evaluated whether liquid based preparation could improve the satisfactory rate and diagnostic accuracy. Results This study included 53 men and 27 women, the male to female ratio was 1.96： 1.00; the age ranged from 17 to 79 （mean 54） years. One to four lymph node groups were aspirated in each patient, resulting in a total of 109 lymph node groups, including 57 paratracheal, 34 subcarinal, three tracheal bronchial, seven pulmonary and four hilar lymph node groups. The definite locations of four other mediastinal lymph node groups were not known. The overall satisfactory rate of conventional smears and liquid-based cytology test was 90. 0% and 92. 5%, respectively. By histology, there were 37 cases diagnosed as malignant tumors, nine as tuberculosis, two as sarcoidosis, 11 as unexplained granulomatous inflammation, and 27 as other benign lesions. The sensitivity, specificity and accuracy of conventional cytological smears for tumors were 86. 5% , 97. 7% and 92. 5% respectively; the positive and negative predictive values were 97.0% and 89.4% respectively. The sensitivity, specificity and accuracy of the liquid-based preparation were 89.2% , 97.7% and 93.8% respectively; the positive and negative predictive values were 97. 1% and 91.3% respectively. Combining the conventional cytological smears and liquid based preparation, the sensitivity, specificity and accuracy were 91.9% , 97.7% and 95.0% respectively; and the positive and negative predictive values were 97. 1% and 93.3% respectively. Conclusions EBUS-TBNA is a good method to diagnose lung and mediastinal lymphadenopathy. Surepath liquid based cytology test could improve the sample satisfactory rate, the diagnostic sensitivity and accuracy. If combined with immunoeytochemistry it could be useful for further tumor typing. EBUS-TBNA combined with Surepath liquid based preparation is an effective complement for the histologic biopsy.