快速现场评价在经气管镜超声引导针吸活检诊断纵隔病灶中的应用

Application of rapid on-site evaluation of endo-bronchial ultrasound-guided transbronchial needle aspirations for the diagnosis of mediastinal lesions

目的探讨快速现场评价(ROSE)在经气管镜超声引导针吸活检(EBUS-TBNA)诊断纵隔肿物中的价值。方法回顾性分析该院211例通过胸部CT显示纵隔/肺门病灶(包括肿大的淋巴结/肿块)的患者的临床资料,在有或无快速现场细胞学评价(C-ROSE)下行EBUS-TBNA检查。结果 C-ROSE组和未行C-ROSE组的敏感度分别为93.88%和92.45%,特异度分别为97.73%和93.85%,两组比较,差异均无统计学意义(P> 0.05)。由肺科医师担任解读的ROSE结果敏感度为87.76%(43/49)、特异度为88.64%(39/44),与专业细胞学病理人员结果高度一致(κ=0.806)。ROSE指导下率先肺癌3基因(EGFR、ALK和ROS1)检测完成率为65.52%(19/29),后续免疫组化完成率为31.03%(9/29)。结论在EBUS-TBNA过程中应用ROSE,临床医师与病理医师在诊断上具有高度的一致性,临床医生即刻知晓病理倾向,为后续诊疗方案提供了依据。

Objective To discuss the value of rapid on-site evaluation(ROSE)in diagnosis of mediastinal lesions by endobronchial ultrasound-guided transbronchial needle aspirations(EBUS-TBNA).Methods Clinical data of 211 patients underwent EBUS-TBNA with or without C-ROSE on chest computed tomography(CT)showed mediastinal/hilar lesions(including enlarged lymph nodes/masses)were retrospectively analyzed.Results The sensitivity of cytological ROSE(C-ROSE)group and No C-ROSE group were 93.88%and 92.45%,the specificity were 97.73%and 93.85%,respectively(P>0.05).The sensitivity of the ROSE results interpreted by pulmonologist was 87.76%(43/49)and the specificity was 88.64%(39/44),which were highly consistent with the results of professional cytopathologist(κ=0.806).Under the guidance of ROSE,the completion rate of the first detection of lung cancer 3 genes(EGFR,ALK and ROS1)was 65.52%(19/29),the subsequent immunohistochemical completion rate was 31.03%(9/29).Conclusion ROSE was applied in the EBUS-TBNA process,clinicians and pathologists had a high degree of consistency in diagnosis,and the pathological types could be immediately known,and provide guidance for the subsequent diagnosis and treatment plans.