超声支气管镜引导下针吸活检淋巴结不同部位的对照研究

A comparative study of different sites of lymph nodes in endobronchial ultrasound-guided transbronchial needle aspiration

目的探讨超声支气管镜引导下针吸活检(EBUS-TBNA)细针穿刺病变淋巴结不同部位(包膜下部位或中心部位)对其阳性诊断率及标本质量的影响。方法对确诊或疑诊肺癌伴纵隔和(或)肺门淋巴结病变的78例患者,共96例淋巴结行EBUS-TBNA。每个淋巴结包膜下和中心部位各穿刺1针,共192份标本。分别从肿瘤细胞数、细胞退化程度、适当结构和组织的保留、背景血凝块4个方面评估标本质量。结果 96例淋巴结中,EBUS-TBNA病理诊断恶性病变79例,良性病变17例,经进一步检查良性病变中7例确诊为恶性,10例确诊为良性;排除良性病变,EBUS-TBNA阳性诊断率为91.9%(79/86),其中包膜下穿刺组阳性诊断率为83.7%(72/86),中心穿刺组为68.6%(59/86),P=0.019。标本质量评分中,包膜下穿刺组肿瘤细胞数评分为(1.36±0.75)分,明显高于中心穿刺组评分(1.06±0.83)分,差异有统计学意义(P=0.013);细胞退化程度评分,包膜下穿刺组标本评分为(1.56±0.59)分,明显高于中心穿刺组标本评分(1.36±0.65)分,差异有统计学意义(P=0.038)。适当结构和组织的保留、背景血凝块评分差异无统计学意义。结论 EBUS-TBNA在肺癌诊断及分期的过程中,选择淋巴结包膜下穿刺较中心部位穿刺将会取得更高的阳性诊断率。

Objective To compare the positive diagnostic yield and specimen quality of different sites of lymph nodes(subcapsular or central region)in endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA).Methods 78 patients diagnosed or suspected lung cancer with mediastinal and/or hilar lymph node lesions,with a total of 96 lymph nodes,underwent EBUS-TBNA and were punctured with one needle in the subcapsular or central region of lymph node.A total of 192 specimens were collected.Specimens were scored cytologically using 4 parameters:number of tumor cells,degree of cellular degeneration,retention of appropriate structure and tissues,background blood clot.Results Among 96 cases of lymph nodes,79 cases of malignant lesions and 17 cases of benign lesions were diagnosed by EBUS-TBNA,and 7 cases of benign lesions and 10 cases of benign lesions were diagnosed by further examination.The positive diagnostic yield of EBUS-TBNA was 91.9%(79/86),which from the subcapsular and central region was 83.7%(72/86)and68.6%(59/86),respectively,P=0.019.In quality score,the number of tumor cells score in the subcapsular region was(1.36±0.75),which was significantly higher than that in the central region(1.06±0.83,P=0.013).And the degree of cellular degeneration score was(1.56±0.59)in the subcapsular region which was higher significantly than(1.36±0.65)in the central region(P=0.038).There was no statistical difference in the retention of appropriate structure and tissues,background blood clot.Conclusion In the diagnosis and staging of lung cancer,subcapsular lymph node puncture will achieve a higher positive diagnostic yield than the central region.