支气管镜超声引导下经支气管针吸活检术在纵膈肺门病变的临床应用价值

Clinical value of endobronchial ultrasonography guided transbronchial needle aspiration in the diagnosis of mediastinal pulmonary disease

目的探讨支气管镜超声引导下经支气管针吸活检术(EBUS-TBNA)在纵膈肺门病变的临床应用价值。方法选取苏州大学附属张家港医院2018年3月至2019年1月采用EBUS-TBNA诊断纵膈肺门病变患者36例,对于EBUS-TBNA未能明确诊断的患者,行胸腔镜或纵膈镜病理明确,并随访6个月以上,分析诊断结果。结果 EBUS-TBNA诊断准确率为94.4%,其中恶性肿瘤为92.6%,良性病变为100.0%。36例纵膈肺门病变患者经EBUS-TBNA确诊恶性肿瘤25例,其中肺腺癌11例,肺鳞癌6例,小细胞癌4例,神经内分泌癌2例,胃癌转移1例,肠癌转移1例;良性病变中,炎性增生7例,结核1例,结节病1例。EBUS-TBNA未确诊的2例患者中,经外院纵膈镜确诊为腺癌1例,鳞癌1例。EBUS-TBNA诊断灵敏度为92.6%,特异度为100.0%,阳性预测值为100.0%,阴性预测值为81.8%。EBUS-TBNA未出现严重并发症。结论 EBUS-TBNA结合细胞学及组织学(免疫组化)对纵膈肺门病变的准确性、灵敏度及特异性均较高,且安全性高,值得临床推广。

Objective To investigate the clinical value of endobronchial ultrasonography guided transbronchial needle aspiration in the diagnosis of mediastinal pulmonary disease.Methods 36 cases of patients diagnosed with mediastinal pulmonary disease by EBUS-TBNA from March 2018 to January 2019 in the Affiliated Zhangjiagang Hospital of Soochow University are reviewed.Patients who were not clearly diagnosed with EBUSTBNA were treated with thoracoscopic or mediastinal pathology and followed up for at least 6 months.Analysis of diagnosis results.Results The diagnostic accuracy of EBUS-TBNA was 94.4%,among which the accuracy of malignant tumors was 92.6%and that of benign lesions was 100.0%.Among 36 patients,25 patients were diagnosed with malignant tumor with EBUS-TBNA,including 11 cases of lung adenocarcinoma,6 cases of lung squamous cell carcinoma,4 cases of small cell lung cancer,2 cases of neuroendocrine tumor,1 case of gastric carcinoma metastasis,1 case of colorectal carcinoma metastasis.7 cases of inflammatory hyperplasia,1 case of tuberculosis,and 1 case of sarcoidosis.Among the 2 undiagnosed patients with EBUS-TBNA,adenocarcinoma and squamous cell carcinoma were confirmed by mediastinoscopy in another hospital.The diagnostic sensitivity,specificity,positive predictive value and negative predictive value of EUBS-TBNA were 92.6%,100.0%,100.0%and 81.8%respectively.No significant serious complications occurred.Conclusion EBUS-TBNA combined with cytology and histology(immunohistochemistry)has high accuracy,sensitivity and specificity in mediastinal pulmonary disease,and it is worthy of clinical application.