Usefulness of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Diagnosis of Sarcoidosis

Purpose

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an accurate and minimally invasive technique used routinely for investigation of mediastinal and hilar lymphadenopathy. However, few studies have addressed its role in comparison to the traditional diagnostic approaches of transbronchial lung biopsy (TBLB), endobronchial biopsy (EBB), and bronchoalveolar lavage (BAL) in the diagnosis of sarcoidosis. We evaluated the usefulness of EBUS-TBNA in the diagnosis of sarcoidosis compared to TBLB, EBB, and BAL.

Materials and Methods

Consecutive patients with suspected sarcoidosis (stage I and II) on chest radiography and chest computed tomography were included. All 33 patients underwent EBUS-TBNA, TBLB, EBB, and BAL during the same session between July 2009 and June 2011. EBUS-TBNA was performed at 71 lymph node stations.

Results

Twenty-nine of 33 patients, were diagnosed with histologically proven sarcoidosis; two patients were compatible with a clinical diagnosis of sarcoidosis during follow-up; and two patients were diagnosed with metastatic carcinoma and reactive lymphadenopathy, respectively. Among 29 patients with histologically proven sarcoidosis in combination with EBUS-TBNA, TBLB, and EBB, only EBUS-TBNA and TBLB revealed noncaseating granuloma in 18 patients and one patient, respectively. The overall diagnostic sensitivities of EBUS-TBNA, TBLB, EBB, and BAL (CD4/CD8 ≥3.5) were 90%, 35%, 6%, and 71%, respectively (p<0.001). The combined diagnostic sensitivity of EBUS-TBNA, TBLB, and EBB was 94%.

Conclusion

EBUS-TBNA was the most sensitive method for diagnosing stage I and II sarcoidosis compared with conventional bronchoscopic procedures. EBUS-TBNA should be considered first for the histopathologic diagnosis of stage I and II sarcoidosis.     

CT判断食管癌外侵程度与手术病理结果对比研究

目的：探讨CT判断食管癌外侵程度与手术病理结果的一致性。方法：经手术病理证实的食管癌患者226例，与术前CT资料进行对比分析。结果：CT判断食管癌外侵敏感性80．6％，特异性97．9％，阳性预测值86．2％，阴性预测值96．9％，准确性95．5％，假阴性6例，假阳性5例，食管壁厚度＞2cm时肿瘤外侵率达92．0％。结论：CT判断食管癌外侵基本可靠，对治疗方案的制订有价值，对手术的难度估计有帮助，术前CT检查是必要的。     

食管癌穿孔的手术治疗

目的:对33例食管癌穿孔的患者的手术治疗进行疗效分析。方法:其中食管癌切除同时纵隔穿孔区域周围组织切除26例;不同方式肺切除4例,支气管膜部楔形切除1例,单纯探查2例。结果:30例近期疗效满意,生存期均在6月以上,1例手术后33天死亡。结论:食管癌穿孔的患者应首先手术治疗且疗效肯定。     

CT判断食管癌外侵程度与手术病理结果对比研究

目的探讨CT判断食管癌外侵程度与手术病理结果的一致性. 方法经手术病理证实的食管癌患者226例,与术前CT资料进行对比分析. 结果 CT判断食管癌外侵敏感性80.6%,特异性97.9%,阳性预测值86.2%,阴性预测值96.9%,准确性95.5%,假阴性 6例,假阳性 5例,食管壁厚度>2cm时肿瘤外侵率达92.0%. 结论 CT判断食管癌外侵基本可靠,对治疗方案的制订有价值,对手术的难度估计有帮助,术前CT检查是必要的.     

肿瘤异常蛋白检测在食管癌诊断中的价值研究

目的 对食管癌、癌前病变、正常人群进行分析,探讨TAP检测在食管癌诊断中的价值,为临床应用提供依据.方法 选取2013年1月至2016年1月自贡市第四人民医院肿瘤科收治的经病理学检查确诊的50例食管癌患者、50例Barret食管患者及50例健康者进行分析,使用TAP检测技术对所有受试者进行检查,以病理诊断结果作为金标准,计算TAP检测系统的特异性、灵敏度、约登指数,评价TAP检测系统评价食管腺癌及Barrett食管的检测效力.结果 对50例食管癌患者进行筛选时,TAP的诊断灵敏度为88.00％,特异性为88.00％,约登指数为0.76;对50例Barrett食管患者进行筛选时,TAP的诊断灵敏度为80.00％,特异性为88.00％,约登指数为0.68.结论 检测TAP在食管癌的诊断中具有较高的临床应用价值,其在临床筛选具有很大的参考价值.     

RF和C4.5决策树在食管癌图像分类中的研究

目的 探讨RF和C4.5决策树对X线食管造影图像分型中的应用,以及验证分类器对特征的分类能力。方法 选取2018年1月~6月在新疆医科大学第一附属医院、第二附属医院和第三附属（肿瘤）医院的放射科选取溃疡性、缩窄型和蕈伞型食管癌X线图像各560张,提取灰度共生矩阵,灰度直方图和混合特征;采用RF和C4.5决策树通过调整参数进行分类研究。结果 RF和C4.5决策树对溃疡型和缩窄型食管癌进行分类,灰度共生矩阵的分类准确率分别为73.30%,67.76%;灰度直方图分类准确率分别为84.55%,76.16%。而混合特征算法的分类准确率分别为95.08%,86.87%;对溃疡型和蕈伞型食管癌进行分类,灰度共生矩阵的分类准确率分别为75.08%,66.96%;灰度直方图分类准确率分别为83.83%,77.23%。而混合特征算法的分类准确率分别为80.98%,73.66%。结论 灰度直方图特征的分类准确率比灰度共生矩阵特征的平均高10%,混合特征更适合于溃疡型,缩窄型食管癌的分类。而灰度直方图特征更适合于溃疡型,蕈伞型食管癌的分类;RF的分类能力比C4.5决策树高。此算法可为X线食管造影图像的分类提供参考。     

四维彩超与二维彩超在胎儿畸形诊断中的应用价值

目的 分析四维彩超与二维彩超在胎儿畸形诊断中的应用价值。方法 选取2018年1月~2019年1月在我院行产前胎儿畸形筛查的700例孕妇作为研究对象,分别采用二维彩超、四维彩超进行检查,以胎儿出生后的实际情况为标准,比较两种检查方法对胎儿畸形和具体畸形部位的诊断准确率。结果 胎儿出生后的实际诊断53例胎儿畸形,二维彩超正确诊断28例,四维彩超正确诊断49例,四维彩超对胎儿畸形诊断准确率（92.45%）高于二维彩超的（52.83%）,且四维彩超对面部畸形、躯干畸形、四肢畸形、心脏畸形、脊柱畸形的诊断准确率分别为86.67%、100.00%、100.00%、87.50%、83.33%,均高于二维彩超的53.33%、61.54%、66.64%、25.00%、50.00%,差异有统计学意义（P＜0.05）。结论 四维彩超与二维彩超在胎儿畸形诊断中均有一定的应用价值,但四维彩超对胎儿畸形的诊断准确率更高,临床可优先使用其行产前胎儿畸形筛查诊断。     

五项肿瘤标志物联合检测对食管癌诊治的临床评价

探讨肿瘤标志物癌胚抗原(CEA)、糖类抗原19-9(CA19-9)、CA724、细胞角蛋白19片断(CYFRA21-1)和鳞状上皮细胞癌抗原(SCC)联合检测对食管癌诊断、治疗及预后判断的临床价值.用电化学发光免疫分析法(ECLIA)和微粒子酶联免疫测定法(MEIA)检测102例食管癌患者术前和90例术后血清中CEA、CA19-9、CA724、CYFRA21-1和SCC含量.102例食管癌患者血清中5项肿瘤标志物含量均明显高于对照组,随病程增加,阳性率增高.检测90例食管癌患者,术前阳性指标与术后比较,有显著性差异(P＜0.01).五项肿瘤标志物联合检测阳性率为77.5%,高于单项指标检测阳性率,有显著性差异(P＜0.01).血清CEA、CA19-9、CA724、CYFRA21-1和SCC水平动态联合监测可用于食管癌辅助诊断、疗效观察、以及对病期及预后的判断.     

定量超声骨质疏松检测系统的研究与设计

设计开发一套定量超声骨质疏松检测系统,通过测量人体跟骨的超声传播速度（sound of speed,SOS）和超声带宽衰减系数（broadband ultrasound attenuation,BUA）,全面评价骨质疏松的状况,为骨质疏松的早期诊断和骨折的预防提供科学依据.定量超声骨质疏松检测系统硬件电路采用89c52单片机平台开发,实现超声信号的发射与接收、数据的高速采集与通信、步进电机的驱动与控制等功能;系统软件采用Visual C#和Matlab混合编程技术开发,完成用户添加与管理、超声数据采集与处理、检测结果存储与打印等功能.与Osteosys公司的SONOST-3000超声骨质疏松检测仪的比较研究结果显示,本文中研制的定量超声系统对骨质疏松的检测准确,达到了设计要求,具有良好的应用前景.     

输卵管间质部妊娠的经阴道三维超声与 二维超声诊断对比分析

目的 探讨经阴道三维超声与二维超声诊断输卵管间质部妊娠的临床价值。方法 选取2014年1月~2019年1月我院40例术前超声诊断输卵管间质部妊娠的患者,回顾性分析术前二维超声与经阴道三维超声的声像图特征,比较两种方式诊断该疾病的准确性。结果 经腹部二维超声及阴道二维超声检查诊断准确率为52.50%,经阴道三维超声检查诊断准确率为100.00%,差异有统计学意义（P＜0.05）。结论 经阴道三维超声诊断输卵管间质部妊娠的准确率高于二维超声。     

超声造影在子宫肿瘤诊治中的应用

目的：探讨超声造影在子宫肿瘤诊断及治疗中的应用进展。方法：查阅近年来关于超声造影在子宫肿瘤治疗和诊断中应用方面的有关文献,进行分析总结。结果：超声造影能够提高对子宫肿瘤的诊断和鉴别诊断,并能对子宫肿瘤进行治疗和治疗效果的评价。结论：超声造影现在已成为超声医学领域的研究热点,但对于妇科疾病的研究尚处于初级阶段。对其进一步研究有助．于临床更好地诊断和治疗子宫肿瘤。     

食管癌组织和细胞中表皮生长因子受体基因突变的筛选

目的 探讨食管癌组织和细胞中表皮生长因子受体(EGFR)基因突变情况.方法 提取30例食管癌配对组织和13株食管癌细胞系DNA,巢式PCR及DNA测序检测EGFR 18-21号外显子突变情况,采用CodonCode Aligner软件进行数据分析.结果 在30例食管癌组织中检测到4例EGFRV819V、E866V和L858R 3种突变.在KYSE450细胞中检测到EGFR 20号外显子S768I突变,KYSE510细胞中检测到18号外显子A702D突变,在KYSE180、KYSE680和EC9706细胞中检测到20号外显子Q787Q突变.结论 EGFR突变可能参与食管癌癌变机制,为进一步研究食管癌发生发展机理提供理论依据.     

食管癌及癌旁组织中端粒酶活性检测及其意义

目的探讨食管癌及癌旁组织中端粒酶活性检测的意义.方法采用PCR技术为基础的TRAP法检测了39例食管癌及癌旁组织端粒酶活性.结果39例食管癌组织中34例端粒酶活性阳性,阳性率为87.2%,癌旁组织中3例阳性,阳性率为7.7%,9例食管良性组织中1例阳性,阳性率为11.1%.食管癌与相应癌旁组织和良性食管组织端粒酶阳性检测率相比,差异有显著性意义(p<0.01).伴有淋巴结转移的25例食管癌端粒酶阳性检测率为96.0%,显著高于未伴有淋巴结转移的阳性率(71.4%),两者差异有显著性意义(p<0.05).结论端粒酶激活与食管癌发生发展有关,对端粒酶活性进行检测对食管癌的诊断和判断预后有重要价值.     

Clinical Value of Endobronchial Ultrasound Findings for Predicting Nodal Metastasis in Patients with Suspected Lymphadenopathy: A Prospective Study

We evaluated whether sonographic findings can provide additional diagnostic yield in endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), and can more accurately predict nodal metastasis than chest computed tomography (CT) or positron emission tomography (PET)/CT scans. EBUS-TBNA was performed in 146 prospectively recruited patients with suspected thoracic lymph node involvement on chest CT and PET/CT from June 2012 to January 2013. Diagnostic yields of EBUS finding categories as a prediction model for metastasis were evaluated and compared with findings of chest CT, PET/CT, and EBUS-TBNA. In total, 172 lymph nodes were included in the analysis: of them, 120 were malignant and 52 were benign. The following four EBUS findings were predictive of metastasis: nodal size ≥10 mm, round shape, heterogeneous echogenicity, and absence of central hilar structure. A single EBUS finding did not have sufficient diagnostic yield; however, when the lymph node had any one of the predictive factors on EBUS, the diagnostic yields for metastasis were higher than for chest CT and PET/CT, with a sensitivity of 99.1% and negative predictive value of 83.3%. When any one of predictive factors is observed on EBUS, subsequent TBNA should be considered, which may provide a higher diagnostic yield than chest CT or PET/CT.

Graphical Abstract

相似文献   

Diagnosis of nonprimary pancreatic neoplasms by endoscopic ultrasound-guided fine-needle aspiration

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a proven modality for the diagnosis of primary pancreatic neoplasms. We describe our experience in diagnosing nonprimary pancreatic tumors by EUS-FNA. Cytology files were searched for all EUS-FNA of the pancreas for the period 2000-2002. All cases diagnosed as neoplasms were selected and those diagnosed as nonprimary pancreatic tumors were reviewed and analyzed. One hundred ninety-one of 468 cases were diagnosed as neoplasms. Eleven of these cases were diagnosed as nonprimary pancreatic tumors (2.4% of all diagnoses and 5.7% of all neoplasms). The diagnoses were supported by clinical history (n = 7), cytological findings (n = 11), cell block histology (n = 11), cell block immunohistochemistry (n = 6), and flow cytometry (n = 1). EUS-FNA is a safe and minimally invasive method for the diagnosis of nonprimary pancreatic neoplasms. Evaluation of clinical history, cytomorphology, and ancillary techniques, especially those applied to cell block material, are essential for accurate diagnoses.     

连续顺序追踪超声法联合实时三维超声在胎儿手畸形诊断中的应用

目的探讨连续顺序追踪超声法联合实时三维超声在胎儿手畸形诊断中的应用价值。方法对5988例胎儿先后行胎儿产前常规超声和连续顺序追踪超声法超声检查,回顾性分析临床资料和结果。结果连续顺序追踪超声联合实时三维超声应用于胎儿手畸形诊断中的灵敏度、特异性、阳性预测值和阴性预测值分别为93.3%、99.9%、82.4%和100%,均显著优于常规超声46.7%、99.7%、26.0%和99.9%,差异显著,具有统计学意义(P0.05)。结论连续顺序追踪超声法联合实时三维超声在胎儿手畸形诊断中的应用,可有效降低漏诊和误诊的发生率,具有推广价值。     

胃肠道肿瘤诊断中彩色多普勒超声的应用价值

目的了解彩色多普勒超声在诊断胃肠道肿瘤中的应用价值，提高术前正确诊断率。方法临床彩色多普勒超声所见腹腔或盆腔占位，后经手术或超声引导下活检病理诊断进一步证实。结果临床彩超所见腹腔或盆腔占位，后经手术或超声引导下活检病理证实来源为胃、小肠或结肠良恶性肿瘤27例，其中小肠及胃平滑肌肉瘤各3例，空结肠恶性间质瘤5例，胃及结肠腺癌14例，胃淋巴瘤2例。27例病人中26例行纤维内窥镜检查，15例病理活检为恶性肿瘤（15／27），1例病理回报炎症（1／27），10例未见明显占位（10／27）。结论临床彩超在诊断腹腔或盆腔占位中的价值应得到临床医师的重视，在某些病例中甚至优于经典的纤维内窥镜和钡餐及气钡剂双重造影。     

Adaptation of a Quality of Life Questionnaire for Iranian Patients with Esophageal Cancer

Introduction:

Evaluation of quality of life is very important in cancer patients. Esophagus-specific quality of life questionnaire (QLQ-OES18) is a disease-specific questionnaire for assessing quality of life in esophageal cancer (EC). So we aimed to translate and evaluate the reliability and validity of the QLQ-OES18 when applied to Iranian patients.

Materials and Methods:

This study was designed as cross-sectional study on 62 newly confirmed EC in two referral hospital in Tehran, Iran. Reliability of the subscales was evaluated by intraclass correlation coefficients. Pearson''s correlations of an item with its own scale and other scales were calculated to assess convergent and discriminant validity. Clinical validity was also evaluated by known-group comparisons.

Results:

Cronbach''s alpha was higher than 0.7 in most subscales. All subscales met the standards of convergent and discriminant validity. Also QLQ-OES18 had discriminatory power for differentiation between patient''s groups with different clinical status.

Conclusion:

Our results provide evidences that Persian version of QLQ-OES18 is a valid and reliable questionnaire when applied to a sample of Iranian patients with EC and is recommended for use in clinical research.