支气管内超声引导针吸活检术在肺癌纵隔淋巴结分期和治疗中的价值

Values of endobronchial ultrasound-guided transbronchial needle aspiration( EBUS-TBNA ) in the mediastinal staging and proper therapy of lung cancer

目的探讨支气管内镜超声引导针吸活检术(EBUS-TBNA)在肺癌纵隔淋巴结分期和治疗中的价值。方法回顾分析我院呼吸内科和胸外科2003年5月至2014年5月期间收治的135例经胸部影像学检查(胸部CT或PET/CT)发现纵隔淋巴结肿大(≥1.0 cm)或提示淋巴结阳性的患者并经EBUS-TBNA检查的临床资料。结果 135例患者中,经EBUS-TBNA检查证实纵隔淋巴结转移者106例(阳性),无纵隔淋巴结转移者29例(阴性),阳性患者给以化疗、新辅助化疗或分子靶向治疗,阴性患者中2例放弃治疗自动出院,27例进行外科开胸手术,行肺叶切除术或肺楔形切除术并进行纵隔淋巴结清扫,术后病理证实22例纵隔淋巴结无转移,5例有淋巴结转移(假阴性)。本研究显示EBUS-TBNA的敏感性、特异性、准确性、阳性预测值、阴性预测值及假阴性值分别为95.9%(106/111)、100%(22/22)、96.2%(128/133)、100%(106/106)、81.5%(22/27)和4.5%(5/111)。所有患者检查过程中耐受性良好,无不良并发症。结论 EBUS-TBNA在肺癌纵隔淋巴结分期和治疗方案中有决定性意义。

Objective To determine the value of endobronchial ultrasound-guided transbronchial needle aspiration（ EBUS-TBNA） in the mediastinal staging and proper therapy of lung cancer. Methods 135 patients for known or suspected lung cancer underwent EBUS-TBNA were retrospectively reviewed. The 135 patients were detected enlarged mediastinal lymph nodes on radiographic examination of chest（ ≥1. 0 cm） and/ or positron emission tomograph（ PET） positive mediastinal lymph nodes. Results Of the 135 patients,106 patients were found with N3 or N3 disease on EBUS-TBNA. 29 patients with negative EBUS-TBNA underwent thoracoscopy or thoracotomy for pulmonary resection and mediastinal lymph node dissection,27 were confirmed by surgical biopsy,metastatic node was diagnosed in 5 patients. 2 patients were discharged. The diagnostic sensitivity,specificity,accuracy,positive predictive value and negative predictive value,false negative value of EBUS-TBNA for the mediastinal stsging of lung cancer were respectively 95. 9%（ 106 /111）,100%（ 22 /22）,96. 2%（ 128 /133）,100%（ 106 /106）,4. 5%（ 5 /111） and 18. 5%（ 2 /27）. The procedure was uneventful,and there were no complications. Conclusions EBUS-TBNA is an critical technique for mediastinal staging and proper therapy of lung cancer.