EBUS-TBNA在胸内淋巴结短径〈1cm的肺癌分期中的应用

目的 探讨标准化支气管腔内超声探查并行超声引导下经支气管针吸活检术（EBUS-TBNA）,对胸内淋巴结短径〈1cm的原发性肺癌行病理学评估并确定肺癌分期的应用价值.方法 收集2016年1月至2017年4月原发性肺癌并经增强CT检查发现伴有短径〈1cm的胸内淋巴结患者32例,行标准化支气管腔内超声探查并EBUS-TBNA获取淋巴结细胞或组织后送病理检查,分析患者的相关临床资料.结果 通过32例患者行EBUS-TBNA检查,共获得不同部位淋巴结样本54份.病理检查结果明确为恶性淋巴结病变7例,良性病变43例,4例淋巴结诊断不清.EBUS-TBNA对于短径〈1cm的胸内淋巴结评估的敏感性、特异性、准确率、阳性预测值及阴性预测值分别为87.5％、91.3％、90.7％、100％和97.7％.所有患者检查耐受性良好,无严重并发症发生.结论 在原发性肺癌患者中,无论胸内淋巴结短径是否〈1cm,排除禁忌后均建议行支气管腔内超声标准化探查并EBUS-TBNA取得病理结果以明确淋巴结分期.

Objective To evaluate the application value of standardized EBUS-TBNA （ endobronchial ultrasound-guided transbronchial needle aspiration biopsy ） in primary lung cancers with mediastinal lymph nodes diameter less than 1 cm. Method 32 patients with primary lung cancer were collected at department of respiration in Jiaxing First Hospital from January 2016 to April 2017. All the patients had the same feature of chest lymph nodes less than lcm which identified by enhanced CT. Lymph node cells or tissues were collected by Standardized EBUS-TBNA and sent for pathological test. Then all the clinical data were reviewed. Results 54 lymph nodes were obtained by EBUS-TBNA examination out of 32 patients. The pathological test showed 7 cases were malignant lymph node lesions, 43 cases were benign lesions and 4 cases were lymph nodes with unclear diagnosis. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of EBUS-TBNA for the evaluation of intrathoracic lymph nodes with longitudinal diameter smaller than lcm were 87.5%, 91.3%, 90.7%, 100% and 97.7% respectively. All patients were well tolerated without serious complications. Conclusion For patients with primary lung cancer, standardized EBUS-TBNA is recommended to get pathologic results for lymph node staging regardless of the diameters of the mediastinal lymph nodes when contraindications is excluded.