高阳性率经支气管淋巴结针吸活检224例分析

Analysis of transbronchial needle aspiration in 224 cases with mediastinal lymphadenectasis

目的探讨经支气管针吸活检(TBNA)对肿大纵隔淋巴结诊断的应用价值。方法回顾性分析我院行胸部CT检查发现纵隔淋巴结肿大患者224例,均行TBNA检查,评价该技术的诊断价值和安全性。结果 1224例患者经TBNA穿刺394组淋巴结,共820针,穿刺成功788针,成功率96.1%(788/820)。2恶性肿瘤患者190例,TBNA结果阳性180例,其中64例患者TBNA结果是惟一病理学依据。364例确诊非小细胞癌患者接受了肺癌根治术,共穿刺172组淋巴结,以术后淋巴结病理结果为参考,判断TBNA在肺癌纵隔淋巴结分期诊断的敏感度、特异度、准确度分别是96.1%、100%、96.5%。4小细胞肺癌TBNA的阳性率高于非小细胞肺癌(P<0.01);直径≥3cm淋巴结TBNA的阳性率稍高,但差异无统计学意义。结论 TBNA对纵隔淋巴结诊断有很大帮助,且安全易行,值得基层医院临床推广应用。

Objective To investigate the value of transbronchial needle aspiration（TBNA）in the diagnosis of patients with mediastinal lymphadenectasis.Methods Retrospective analysis was performed in 224 cases of mediastinal lymphadenectasis diagnozed by CT scan who received TBNA in our hospital.The diagnostic sensitivity,accuracy,specificity,positive predictive value and negative predictive value were evaluated.Results 1 394 lymph nodes in 224 patients were punctured.788 needles were successfully carried out,success rate was 96.1%（788/820）.2The positive rate of TBNA was 94.74%（180/190）in patients who were diagnosed as carcinoma.There were 64 patients pathologically diagnosed as carcinoma by TBNA only.364 patients diagnosed NSCLC within ⅢA period with 172 lymph nodes were punctured.According to the postoperative pathological results of lymph node,the sensitivity,specificity,accuracy ofstaging diagnosis of mediastinal lymph node in TBNA specimens were 96.1%,100% and96.5%.4The positive rate of TBNA in SCLC was higher than that in NSCLC（P 0.01）.The positive rate of TBNA was higher in lymph node whose diameter was not less than 3cm,but there was no statistically significant difference.Conclusion As a safe and effective technique in diagnosing mediastinal lymph node,TBNA is fit for clinical application in primary hospital.