支气管镜下UE技术在肺门纵隔淋巴结定性诊断中的应用研究

Application of UE technique under bronchoscope in qualitative diagnosis of hilar mediastinal lymph nodes

目的分析支气管镜下超声弹性成像(UE)技术在肺门纵隔淋巴结定性诊断中的应用价值。方法选取2019年6月至2021年10月梅州市人民医院经肺部增强CT检查确诊的肺门纵膈肿大患者123例,全部患者均接受支气管镜下常规超声和UE技术检查。并以经气管镜超声引导针吸活检术(EBUS-TBNA)病理结果为金标准,分析支气管镜下常规超声、UE技术定性诊断肺门纵隔淋巴结的价值。结果123例接受EBUS-TBNA检查的患者中,共穿刺139枚淋巴结,经EBUS-TBNA病理结果确诊恶性淋巴结90枚(64.75%),良性49枚(35.25%)。在EBUS-TBNA病理结果诊断为恶性的90枚淋巴结中,支气管镜下常规超声诊断为恶性69枚,良性21枚;UE技术诊断为恶性80枚,良性10枚。EBUS-TBNA病理结果诊断为良性的49枚淋巴结中,支气管镜下常规超声诊断为良性35枚,恶性14枚;UE技术诊断为良性42枚,恶性7枚。支气管镜下常规超声定性诊断肺门纵膈淋巴结与EBUS-TBNA病理结果的一致性一般(Kappa值=0.466);UE技术定性诊断肺门纵膈淋巴结与EBUS-TBNA病理结果的一致性较好(Kappa值=0.736)。支气管镜下UE评分在淋巴结良恶性组中的差异有统计学意义(P<0.05)。支气管镜下常规超声定性诊断肺门纵膈淋巴结的敏感度、准确度、特异度、阴性预测值、阳性预测值分别为76.67%、74.82%、71.43%、62.50%、83.13%;UE技术定性诊断肺门纵膈淋巴结的敏感度、准确度、特异度、阴性预测值、阳性预测值分别为88.89%、87.77%、85.71%、80.77%、91.95%;支气管镜下UE技术定性诊断肺门纵膈淋巴结的敏感度、准确度、阴性预测值均高于常规超声检查,差异有统计学意义(P<0.05)。结论支气管镜下UE技术定性诊断肺门纵隔淋巴结与EBUS-TBNA病理结果的一致性较好,有利于肺门纵隔淋巴结良恶性的鉴别诊断。

Objective To analyze the value of ultrasonic elastography(UE)technique under bronchoscope in the qualitative diagnosis of hilar mediastinal lymph nodes.Methods A total of 123 patients with hilar mediastinal enlargement diagnosed by enhanced CT in Meizhou People’s Hospital were selected from June 2019 to October 2021.All patients underwent routine ultrasound and UE examination under bronchoscope.Taking the pathological results of ultrasound-guided needle aspiration biopsy(EBUS-TBNA)under tracheoscopy as the gold standard,the value of routine ultrasound and UE technique under bronchoscope in qualitative diagnosis of hilar mediastinal lymph nodes was analyzed.Results Among 123 patients who underwent EBUS-TBNA examination,139 lymph nodes were punctured,90(64.75%)were malignant and 49(35.25%)were benign.Among the 90 lymph nodes diagnosed as malignant by EBUS-TBNA pathology,69 were diagnosed as malignant and 21 as benign by conventional ultrasound under bronchoscope;UE technology diagnosed 80 malignant and 10 benign.Among the 49 lymph nodes diagnosed as benign by EBUS-TBNA pathology,35 were benign and 14 were malignant by conventional ultrasound under bronchoscope;UE technology diagnosed 42 benign and 7 malignant.The qualitative diagnosis of hilar mediastinal lymph nodes by conventional ultrasound under bronchoscope was generally consistent with the pathological results of EBUS-TBNA(Kappa=0.466);the qualitative diagnosis of hilar mediastinal lymph nodes by UE technique was consistent with the pathological results of EBUS-TBNA(Kappa=0.736).There was a statistically significant difference in the UE scores under bronchoscope between benign and malignant lymph nodes(P<0.05).The sensitivity,accuracy,specificity,negative predictive value and positive predictive value of conventional ultrasound under bronchoscope for qualitative diagnosis of hilar and mediastinal lymph nodes were 76.67%,74.82%,71.43%,62.50%and 83.13%;the sensitivity,accuracy,specificity,negative predictive value and positive predictive value of UE in qualitative diagnosis of hilar and mediastinal lymph nodes were 88.89%,87.77%,85.71%,80.77%and 91.95%;the sensitivity,accuracy and negative predictive value of UE under bronchoscope in qualitative diagnosis of hilar and mediastinal lymph nodes were higher than those of conventional ultrasonography(P<0.05).Conclusion The qualitative diagnosis of hilar mediastinal lymph nodes by UE technique under bronchoscope is consistent with the pathological results of EBUS-TBNA,which is helpful for the differential diagnosis of benign and malignant hilar mediastinal lymph nodes.