支气管内超声引导针吸活检术对纵隔淋巴结性质的预测价值

Value of endobronchial ultrasound-guided transbronchial needle aspiration in diagnosis of the mediastinal enlarged lymph nodes

目的探讨支气管内超声引导针吸活检术（EBUS－TBNA）对纵隔淋巴结性质的预测价值。方法对2014年7月至2015年12月郑州大学第一附属医院收诊治的210例伴纵隔及肺门淋巴结肿大患者行EBUS－TBNA检查，评价淋巴结短径、纵/横径比值，淋巴结血流、髓质形态在良恶性淋巴结中的差异以及各变量与恶性淋巴结发生率的关系。将单因素分析中有意义的变量纳入Logistic多因素回归分析恶性淋巴结的危险因素。应用受试者工作特征（ROC）曲线分析淋巴结短径预测良恶性的最佳截点。应用标准的计算公式分析EBUS－TBNA检测纵隔恶性淋巴结中的敏感度、特异度、准确率。结果EBUS－TBNA诊断肺癌及肺外肿瘤并纵隔肺门淋巴结转移的敏感度、特异度、准确率分别为91.2%、100%、93.8%。淋巴结短径≥1.0 cm、纵/横径比值〈1.5、血流分布Ⅱ～Ⅲ级、髓质形态破坏者的恶性率均显著大于短径〈1.0 cm、纵/横径比值≥1.5、血流分布0～Ⅰ级、髓质形态正常者（79.8%、77.8%、84.7%、76.7%比37.7%、44.6%、42.9%、42.9%），以上4种特征是恶性淋巴结的独立危险因素（均P〈0.001）。ROC曲线提示淋巴结短径预测良恶性的最佳截点为8.2 mm。短径≥1.0 cm、纵/横径比值〈1.5、血流分布Ⅱ～Ⅲ级、髓质形态破坏4种因素联合检测预测恶性淋巴结的准确率显著高于以上单以因素检测（89.3%比74.7%、67.9%、67.8%、67.5%）（均P〈0.001）。结论EBUS－TBNA对纵隔淋巴结性质有较好的预测价值。

ObjectiveTo investigate the value of the endobronchial ultrasound-guided transbronchial needle aspiration （EBUS-TBNA） in diagnosing mediastinal enlarged lymph nodes.MethodsA total of 210 patients with mediastinal enlarged lymph nodes from the First Affiliated Hospital of Zhengzhou University from 2014 July to 2015 October were enrolled for EBUS-TBNA. Endobronchial ultrasound （EBUS） imaging features, including lymph node short diameter, the ratio of longitudinal to transverse diameter, the blood flow and morphology destroy, in benign and malignant lymph nodes were evaluated separately and their relationships with the rate of malignant lymph nodes were also analyzed. The significant variables according to single factor analysis were brought into the Logistic multivariate analysis, which investigated the risk factors of malignant lymph nodes. The best cut-off point of the short diameter of lymph nodes was analyzed by receiver operating characteristic curve （ROC）. The sensitivity, specificity and accuracy of EBUS-TBNA in the diagnosis of malignant lymph nodes were analyzed by the standard calculation formula.ResultsThe sensitivity, specificity, accuracy rate of EBUS-TBNA diagnosing lung cancer and other tumor with mediastinal lymph node metastasis were 91.2%, 100%, 93.8%. The rates of malignant in lymph node with short diameter ≥1.0 cm, ratio of longitudinal to transverse diameter〈1.5, blood flow distribution Ⅱ-Ⅲ, morphology destroy by the EBUS measurement were higher than those in the lymph node with short diameter〈1.0 cm, ratio of longitudinal to transverse diameter ≥ 1.5, the blood flow distribution 0-Ⅰ, without morphology destroy （79.8%, 77.8%, 84.7%, 76.7% vs 37.7%, 44.6%, 42.9%, 42.9%）, and the four factors were independent risk factors for malignant lymph nodes （all P〈0.001）. The ROC curve indicated the optimal cut-off point of short diameter was 8.2 mm. The accuracy of diagnosis by the combination of the above 4 ultrasound features, those were the lymph node short diameter not less than 1 cm, the ratio of longitudinal to transverse diameter less than 1.5, the blood flow distribution Ⅱ-Ⅲ and morphology destroy, was higher than those of the single factor （89.3% vs 74.7%, 67.9%, 67.8%, 67.5%） （all P〈0.001）.ConclusionEBUS-TBNA has satisfying value in diagnosing malignant mediastinal enlarged lymph nodes.