EBUS-TBNA联合C-ROSE技术在肺及纵隔占位性病变中的诊断价值

Evaluation of the diagnostic potential of EBUS-TBNA combined with C-ROSE in the space-occupying lesions of the lung and mediastinum

目的观察超声引导下经支气管针吸活检(EBUS-TBNA)联合快速现场细胞学评估(C-ROSE)技术在肺及纵隔占位性病变中的诊断价值。方法本研究为观察性研究。选择2021年6月至2022年12月新疆维吾尔自治区人民医院收治的100例肺及纵隔占位性病变患者,采用随机数字表法分为EBUS-TBNA联合C-ROSE组和EBUS-TBNA组,各50例。比较2组患者的一般情况和穿刺情况(包括穿刺针数、穿刺部位数、穿刺深度、穿刺成功率)。以手术病理结果为金标准,采用Kappa检验和受试者操作特征曲线比较单独EBUS-TBNA、EBUS-TBNA联合C-ROSE技术诊断肺及纵隔占位性病变与金标准的一致性和诊断效能。比较2组患者不同性质病变肿块长径。记录2组EBUS-TBNA后并发症发生情况。结果2组患者性别、年龄、身体质量指数、民族、吸烟史和病灶最大径比较差异均无统计学意义(均P>0.05)。2组穿刺针数、穿刺部位数、穿刺深度比较差异均无统计学意义(均P>0.05)。与EBUS-TBNA组相比,EBUS-TBNA联合C-ROSE组穿刺成功率较高[100.00%(50/50)比88.00%(44/50);χ^(2)=4.43,P=0.035]。EBUS-TBNA诊断结果显示EBUS-TBNA组中有恶性肿瘤30例、良性病变20例,手术病理结果显示EBUS-TBNA组中有恶性肿瘤32例、良性病变18例;EBUS-TBNA联合C-ROSE诊断结果显示EBUS-TBNA联合C-ROSE组中有恶性肿瘤36例、良性病变14例,手术病理结果显示EBUS-TBNA联合C-ROSE组中有恶性肿瘤37例、良性病变13例。从两种方法与手术病理结果的一致性看,EBUS-TBNA联合C-ROSE的一致性较单独EBUS-TBNA好(Kappa值0.746比0.661)。经受试者操作特征曲线分析,EBUS-TBNA联合C-ROSE较单独EBUS-TBNA的诊断效能好,曲线下面积分别为0.919(95%CI:0.874~0.964)、0.826(95%CI:0.759~0.892)。EBUS-TBNA组与EBUS-TBNA联合C-ROSE组患者恶性肿瘤、良性病变的肿块长径比较差异均无统计学意义[(1.72±0.56)cm比(1.76±0.51)cm,(1.48±0.45)cm比(1.52±0.43)cm;t值分别为0.37、0.45,均P>0.05]。与EBUS-TBNA组相比,EBUS-TBNA联合C-ROSE组在EBUS-TBNA过程中并发症总发生率较低[4.00%(2/50)比16.00%(8/50);χ^(2)=4.00,P=0.046]。结论EBUS-TBNA联合C-ROSE技术用于肺及纵隔占位性病变诊断有利于提高穿刺成功率和诊断效能,降低并发症发生率。

ObjectiveTo observe the diagnostic potential of endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)combined with cytological rapid on-site evaluation(C-ROSE)in the space-occupying lesions of the lung and mediastinum.MethodsIt was an observational study.One hundred patients with space-occupying lesions of the lung and mediastinum admitted to Xinjiang Uiger Municipal People′s Hospital from June 2021 to December 2022 were enrolled.They were divided into the observation group(EBUS-TBNA combined with C-ROSE)and control group(EBUS-TBNA)by a random number table method,with 50 patients in each group.The general condition and puncture conditions(number of punctures,number of puncture sites,puncture depth and success rate of puncture)were compared between groups.The consistency of EBUS-TBNA and EBUS-TBNA combined with C-ROSE in diagnosing space-occupying lesions of the lung and mediastinum with the gold standard of postoperative pathology,and the diagnostic potential were assessed by the Kappa test and receiver operator characteristic(ROC)curves,respectively.The diameter of space-occupying lesions with different natures was compared.The complications after EBUS-TBNA were recorded.ResultsThere were no significant differences in gender,age,body mass index(BMI),ethnicity,smoking history and the maximum diameter of the space-occupying lesions between groups(all P>0.05).There were no significant differences in the number of punctures,number of puncture sites,puncture depth between groups(all P>0.05).Compared with that of the control group,the success rate of puncture was significantly higher in the observation group(100.00%[50/50]vs 88.00%[44/50];χ^(2)=4.43,P=0.035).The diagnostic results of EBUS-TBNA showed that there were 30 cases of malignant tumors and 20 cases of benign lesions in the control group,and the postoperative pathology showed 32 cases of malignant tumors and 18 cases of benign lesions in the control group.The diagnostic results of EBUS-TBNA combined with C-ROSE showed that there were 36 cases of malignant tumors and 14 cases of benign lesions in the observation group,and the postoperative pathology showed 37 cases of malignant tumors and 13 cases of benign lesions in the observation group.The diagnostic consistency of the observation group was significantly better than that of the control group(Kappa=0.746 vs 0.661).ROC curves revealed that the diagnostic performance of the observation group was significantly better than that of the control group,with the area under the curve(AUC)of 0.919(95%CI:0.874-0.964)and 0.826(95%CI:0.759-0.892),respectively.There were no significant differences in the diameter of malignant tumors([1.72±0.56]cm vs[1.76±0.51]cm,t=0.37)and benign lesions([1.48±0.45]cm vs[1.52±0.43]cm,t=0.45)between the control group and the observation group(P>0.05).Compared with that of the control group,the total incidence of complications in the observation group was significantly lower(4.00%[2/50]vs 16.00%[8/50];χ^(2)=4.00,P=0.046).ConclusionsEBUS-TBNA combined with C-ROSE for the diagnosis of space-occupying lesions in the lung and mediastinum is helpful to improve the success rate of puncture and diagnostic efficiency and reduce the incidence of complications.