凸式超声支气管镜引导下的经支气管穿刺针吸活检术的临床应用

Clinical application of convex probe endobronchial ultrasound-guided transbronchial needle aspiration

目的研究凸式超声支气管镜引导下的经支气管穿刺针吸活检术(EBUS-TBNA)在纵隔淋巴结及肺门病变诊断中的应用价值。方法使用新型具有弹性成像功能的超声支气管镜系统,分析2016年11月-2018年2月期间70例行EBUS-TBNA检查的患者的穿刺部位、病理结果及并发症情况。结果 70例患者中61例诊断明确,确诊率为87.1%。恶性肿瘤者59例,对恶性肿瘤诊断的敏感度为94.9%、特异度100%、准确度94.3%。良性淋巴结5例,2例结节病,2例淋巴结核。直接+液基涂片明确诊断者48例,其中11例需细胞蜡块切片及免疫组化明确具体病理分型。13例患者直接+液基涂片法结果为阴性,细胞蜡块切片结果明确诊断。5例患者出现较显著的鼻出血,术中术后均未出现气胸、纵隔气肿和大血管破裂出血等严重并发症。结论 EBUS-TBNA对于纵隔/肺门淋巴结及病变具有较高的诊断价值,安全性高,加强病理科的沟通和科学的标本处理方法,可进一步提高诊断的敏感性和准确性。

Objective To study the diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration（ EBUS-TBNA） for mediastinal and hilar lymph node and focus. Methods The puncture site,pathological results and complications of 70 patients undergoing EBUS-TBNA examination used by ultrasonic bronchoscopy elastography were analyzed from December 2016 to February 2018. Results In the 70 patients,61 had a definite diagnosis,and the rate of diagnosis was 87. 1%. There were 59 cases of malignant tumor. The sensitivity to the diagnosis of malignant tumor was 94. 9%,the specificity was 100%,and the accuracy was 94. 3%. There were 5 cases of benign lymph nodes,2 cases of sarcoidosis and 2 cases of lymphatic tuberculosis. 48 cases were diagnosed by smear cytology,but 11 of them needed the paraffin imbedded cell blocks and immunohistochemistry to clear the pathological type. The results of smear cytology of 13 cases were negative,but the results of paraffin imbedded cell blocks were positive. Significant nasal bleeding occurred in 5 patients. No pneumothorax,mediastinal emphysema,or massive vascular rupture and bleeding were not found during the operation. Conclusion EBUS-TBNA has high diagnostic value and high safety for mediastinal/hilar lymph nodes and lesions. The good communication of the pathology department and the correct method of specimen processing can further improve the sensitivity and accuracy of the diagnosis.