超声支气管镜引导经支气管针吸活检术在胸部疾病的诊断价值

The value of endobronchial ultrasound-guided transbronchial needle aspiration in the evaluation of thoracic diseases

目的评价超声支气管镜引导下经支气管针吸活检术(EBUS-TBNA)在胸部疾病诊断中的应用价值。方法回顾分析100例经胸部影像学检查(CT或PET-CT)诊断为胸内气管或支气管旁肿块及肺门和(或)纵隔淋巴结肿大的患者行EBUS-TBNA的资料,统计EBUS-TBNA诊断的特异性、准确率、敏感度以及阳性预测值和阴性预测值。结果 (1)已确诊或怀疑肺癌72例,经EBUS-TBNA检查证实纵隔淋巴结转移52例。EBUS-TBNA检查阴性者中,18例接受胸腔镜或开胸手术,其中有12例肺癌术后病理证实纵隔淋巴结未见转移,3例肺癌出现纵隔淋巴结转移,其余3例为肺良性病变;EBUS-TBNA在本研究中肺癌纵隔淋巴结分期中的特异性、敏感度和准确性分别为100%(12/12)、94.5%(52/55)和95.5%(64/67);阳性预测值及阴性预测值分别为100%(52/52)和80%(12/15)。(2)不明原因的纵隔和(或)肺门淋巴结肿大以及纵隔肿物16例,经EBUS-TBNA检查后明确恶性病变5例,良性病变11例;EBUS-TBNA在纵隔病变良恶性诊断方面的敏感性和准确性分别为83.3%(5/6)和93.8%(15/16)。(3)大气道旁肺内病变12例,经EBUS-TBNA检查后明确肺癌10例,EBUS-TBNA在大气道旁肺内病变中诊断的敏感性和准确率分别为90.9%(10/11)和91.7%(11/12)。所有患者检查耐受良好,无严重并发症出现。结论在胸部疾病诊断中EBUS-TBNA是一种安全、有效的诊断手段。

Objective To evaluate the value of endobronchial ultrasound-guided transbronchial needle aspiration（EBUS-TBNA）in the diagnosis of the thoracic diseases.Methods A total of 100 patients with mediastinal and/or hilar lymphadenopathy,and/or intrathoracic peritracheal masses previously detected by CT or PET-CT scan and who underwent EBUS-TBNA were retrospectively reviewed.The sensitivity,specificity,positive predictive value,negative predictive value,and diagnostic yield of this procedure were calculated.Results（1）72patients underwent EBUS-TBNA for proven or suspected lung cancer.Among them,52 patients were confirmed to have mediastinal lymph nodes metastasis on EBUS-TBNA 18 patients with negative EBUS-TBNA underwent thoracoscopy or thoracotomy for pulmonary resection and mediastinal lymph node dissection.Postoperative pathology confirmed that 12 patients did not have metastatic nodes,3patients had metastatic nodes and 3other patients had benign lesions within the lung.The diagnostic sensitivity,specificity,accuracy,positive predictive value and negative predictive value of EBUS-TBNA for the mediastinal staging of lung cancer were 94.5%（52/55）,100%（12/12）,95.5%（64/67）,100%（52/52）and 80%（12/15）,respectively.（2）16patients underwent EBUS-TBNA for the evaluation of mediastinal adenopathy or mass in the absence of any identifiable pulmonary lesion.Among them,5had malignancy,11 had benign diseases on EBUS-TBNA and The diagnostic sensitivity and accuracy of EBUS-TBNA in distinguishing malignant mediastinal diseases were 83.3%（5/6）and 93.8%（15/16）,respectively.（3）12patients with pulmonary mass located adjacent to the central airways were accessed by EBUS-TBNA,Definite diagnosis was achieved in 10 lung cancer patients.The sensitivity and the diagnostic accuracy of EBUS-TBNA for the diagnosis of unknown pulmonary mass were 90.9%（10/11）and 91.7%（11/12）,respectively.all the procedures were uneventful,and there were no complications.Conclusion EBUS-TBNA is both effective and safe in making a diagnosis of intrathoracic lesions.