EBUS-TBNA对纵膈及毗邻大气道肺部病变的诊断价值

Value of EBUS-TBNA in the diagnosis of mediastinal lesions and paratracheal/parabronchial masses

目的探讨支气管内超声引导针吸活检术(EBUS-TBNA)对纵膈及毗邻大气道的肺部病变的诊断价值。方法回顾性分析2017年5至2018年7月在我院行EBUS-TBNA检查的35例患者的临床资料及随访结果。结果 35例患者中,经EBUS-TBNA确诊的病例为30例,准确度为85.7%(30/35)。肺癌EBUS-TBNA诊断灵敏度为92.0%(23/25),特异度为100.0%(10/10),阳性预测值为100.0%(23/23),阴性预测值为83.3%(10/12)。35例患者,共穿刺49个部位,其中毗邻大气道肺部病灶确诊率为100.0%(16/16),4R淋巴结为78.6%(11/14),7组淋巴结为63.6%(7/11);各部位穿刺确诊率比较,差异无统计学意义(P>0.05)。25例肺癌患者EBUS-TBNA标本免疫组化病理阳性率为92.0%(23/25),显著高于TCT的44.0%(11/25)和穿刺涂片的28.0%(7/25),差异具有统计学意义(P<0.01)。结论 EBUS-TBNA适用于毗邻大气道的肺部病变及纵膈、肺门肿大淋巴结的诊断,尤其是恶性肿瘤的诊断效率高,标本免疫组化能提高诊断率,并能够提供病理分型。

Objective To investigate the value of endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA) in the diagnosis of mediastinal lesions and paratracheal/parabronchial masses. Methods The clinical data and follow-up results of 35 patients who underwent EBUS-TBNA in our hospital from May 2017 to July 2018 were retrospective analysis. Results The overall accuracy rate of EBUS-TBNA was 85.7%(30/35), with 30 cases confirmed by EBUS-TBNA in 35 patients. The sensitivity, specificity, positive predictive value and negative predictive value of EBUSTBNA in diagnosing lung cancer were 92.0%(23/25), 100.0%(10/10), 100.0%(23/23), 83.3%(10/12), respectively.EBUS-TBNA was successfully performed to obtain samples from 49 locations in 35 patients, the accuracy diagnosing rates of paratracheal/parabronchial lesions, 4 R and 7 lymph nodes were 100.0%(16/16), 78.6%(11/14) and 63.6%(7/11)respectively, and there were no statistically significant differences in the puncture accuracy among different sites(P>0.05).In 25 lung cancer samples with EBUS-TBNA, the positive rate of immunohistochemistry was 92.0%(23/25), which was significantly higher than 44.0%(11/25) of TCT and 28.0%(7/25) of direct smear cytopathological detection, the differences were statistically significant(P <0.01). Conclusion EBUS-TBNA is an effective tool in the diagnosis of paratracheal/parabronchial masses, mediastinal lesions and hilar Lymphadenopathy, especially in the malignant tumor. The pathological method of immunohistochemistry can improve the diagnostic efficacy and provide pathology type.