EBUS-TBNA对纵隔及肺部疾病诊断的意义

目的 探讨支气管内超声引导针吸活检术(endobronchial ultrasound-guided transbronchial needle aspiration,EBUS-TBNA)在纵隔和(或)肺门淋巴结以及肺部病变诊断中的意义.方法 回顾性总结35例接受EBUSTBNA的患者的临床资料.单纯纵隔和(或)肺门淋巴结肿大11例,单纯肺部病变4例,纵隔和(或)肺门淋巴结肿大伴肺部病变20例.结果 通过对35例患者进行EBUS-TBNA检查,获得65份纵隔淋巴结或肺部病变组织.32例患者明确诊断,其中恶性病变27例,良性病变5例.3例患者诊断不清,后经纵隔镜活检2例诊断为淋巴瘤,1例诊断为慢性淋巴结炎.EBUS-TBNA的敏感性、特异性、准确率、阳性预测值及阴性预测值分别为98.3％、100.0％、92.3％、100.0％和83.3％.所有患者检查耐受良好,无任何相关并发症发生.结论 对于纵隔及肺部疾病的诊断,EBUS-TBNA是一种安全有效的微创活检方法.     

经支气管超声引导针吸活检在肺癌诊断及分期中的初步应用

背景与目的经支气管超声引导针吸活检(endobronchial ultrasound-guided transbronchial needle aspira-tion,EBUS-TBNA)是近年来新的纵隔淋巴结定性诊断方法。本研究旨在探讨其应用于肺癌诊断及分期中的价值。方法2009年4月1日-2010年2月8日,75例本院胸部增强CT提示肺内占位伴多发纵隔淋巴结肿大患者接受EBUS-TBNA检查。以最终病理诊断为金标准,检验EBUS-TBNA诊断肺癌纵隔淋巴结转移的准确性、敏感性、特异性、阳性及阴性预测值,并判断其用于非小细胞肺癌N分期的准确率。结果75例患者共计穿刺177组病灶区域,平均穿刺2.4组/例。75例患者,组织病理标本送检率为49.33%。以177组穿刺区域计算,组织病理标本送检率为28.81%。75例患者EBUS-TBNA诊断准确率为98.66%,敏感性为98.43%,特异性为100.00%,阳性预测值为100.00%,阴性预测值为91.67%。以177组穿刺区域计算EBUS-TBNA诊断准确率为96.05%,敏感性为95.10%,特异性为100.00%,阳性预测值为100.00%,阴性预测值为82.93%。上述指标除敏感性(P=0.435)外,均高于CT检查(P0.05)。73例可行N分期患者中,19例(26.03%)患者EBUS-TBNA检查后出现分期改变。结论EBUS-TBNA准确率较高,创伤小,是用于肺癌诊断及分期的较好方法。     

超声支气管镜引导下的经支气管针吸活检对肺癌的诊断价值

背景与目的本研究旨在评价超声支气管镜引导下的经支气管针吸活检(endobronchial ultrasound-guided transbronchial needle aspiration,EBUS-TBNA)对肺癌的诊断价值和安全性。方法于2009年7月-2010年2月,对95例胸部CT检查显示纵隔/肺门淋巴结肿大和/或胸内气管或支气管旁肿块患者进行EBUS-TBNA,并未采取现场细胞学方法进行检测。结果95例患者中,其中经病理学检查和临床随访验证新发肺癌患者60例。60例肺癌患者共穿刺112组淋巴结,肺内肿块11例。60例肺癌患者中通过EBUS-TBNA明确诊断58例,假阴性2例,敏感性为96.67%、特异性100%。EBUS-TBNA过程安全,全部病例无并发症发生。结论EBUS-TBNA是诊断肺癌安全、有效的方法。     

经支气管超声引导针吸活检(EBUS-TBNA)在肺癌诊断及分期中的应用

经支气管超声引导针吸活检(endobronchial ultrasound guided tranbronchial needle aspiration,EBUS-TBNA)支气管镜具有一置入的微型超声探头,以便实现实时的TBNA活检。在肺癌中,EBUS-TBNA的敏感性为88%-90%,特异性为100%。受试者工作特征曲线下面积低于0.99时,测试效果良好。其诊断率显著优于传统盲法TBNA。然而,其假阴性率仍然很高,大约为20%。因此,阴性针吸结果需经纵隔镜检查、外科取样或临床随访证实。新辅助化疗后纵隔的再分期并不十分乐观,据报道,EBUS-TBNA的敏感性仅为76%,阴性预测值仅为20%。该方法亦已被成功用于获取气管旁及支气管周围区域原发肿瘤的活检标本,敏感性为82%-94%。EBUS-TBNA的优势在于其可在门诊中实施,患者仅需中度镇静,且无需电离辐射消毒。尽管在多数研究机构中EBUS-TBNA目前仍仅用于肿大淋巴结的靶向取样,但也有可能实现影像学检查正常的纵隔的完全分期。因此,如果设备及专家条件具备,EBUS-TBNA可作为肺癌诊断及有创分期的一线方案之一。     

超声支气管镜引导下支气管针吸活检在肺癌及纵隔肺门病变诊断中的应用价值

目的探讨超声支气管镜引导下支气管针吸活检在肺癌及纵隔、肺门病变诊断中的应用价值。方法选择2012年8月至2014年10月间收治的140例肺部病变患者,计算机断层扫描(CT)检查均提示肺内病变伴纵隔和(或)肺门淋巴结肿大、不明原因的纵隔和(或)肺门淋巴结肿大以及纵隔占位病变,收集超声支气管镜引导下支气管针吸活检资料进行分析,并以手术病理证实结果作为诊断金标准,分析超声支气管镜引导下支气管针吸活检的准确率和超声结果以及并发症。结果 140例患者穿刺均为阳性,穿刺阳性率达到100.0%。126例取得阳性病理诊断,14例不确定,阳性诊断率为90.0%。肺内病变伴纵隔和(或)肺门淋巴结肿大87例,不明原因纵隔和(或)肺门淋巴结肿大45例,不明原因纵隔占位8例。140例穿刺患者未见大出血和气胸以及纵隔气肿等并发症。纵隔与肺门肿大淋巴结超声检查示圆形或椭圆形,多个病灶融合为不规则形状,病变内见低回声和局部回声加强以及回声不均匀,部分病变彩色多普勒超声显示血流信号;结节病超声检查发现上皮样细胞团、纤维丝样的改变;纵隔与肺门位置血管超声显示圆形或者管状,无回声区,彩色多普勒超声显示红色高能量信号。结论肺癌及纵隔、肺门病变患者应用超声支气管镜引导下支气管针吸活检检查具有较高诊断率,安全性高,是一种有效的诊断方法。     

非小细胞肺癌患者术前EBUS-TBNA淋巴结分期与术后病理分期一致性探讨

目的:探索术前超声引导下支气管镜针吸活检术(EBUS-TBNA)淋巴结活检结果与术后病理结果的一致性。方法:回顾性纳入本院2013年1月至2017年12月期间符合纳入标准的、不符合排除标准的非小细胞肺癌患者。以术后病理为金标准,分析术前EBUS-TBNA淋巴结活检的敏感性和特异性等。结果:研究纳入了80例符合纳入标准、不符合排除标准的患者,平均年龄61.1岁,男性占73.8%,病理类型包括腺癌、鳞癌、腺鳞癌等。EBUS-TBNA未见明显并发症,对于全部103枚EBUS-TBNA活检淋巴结,EBUS-TBNA检测的敏感性为96.15%、特异性为100.00%、阳性预测值为100.00%、阴性预测值为89.29%。结论:EBUS-TBNA纵隔淋巴结活检是安全的,对于转移淋巴结判断的敏感性、特异性、阳性预测值、阴性预测值均较高。     

经支气管纵隔淋巴结针吸活检112例结果分析

目的:探讨经支气管针吸活检（transbronchial needle aspiration,TBNA）对肿大纵隔淋巴结诊断的应用价值。方法:回顾性分析2011年8月至2013年12月间在宝鸡市中心医院呼吸内科112例行胸部CT检查发现纵隔淋巴结肿大的病例,均行TBNA检查,总结穿刺结果及评价该技术的诊断价值和安全性。结果: 112例患者经TBNA检查7个部位共197组淋巴结,TBNA穿刺共410针,其中成功394针（96.1%）。95例恶性肿瘤患者中,TBNA总结果阳性90例（94.74%）,其中32例患者的TBNA结果是唯一病理学依据。32例患者行肺癌根治术,以术后淋巴结病理结果为参考,TBNA判断肺癌纵隔淋巴结分期诊断的敏感性、特异性、准确性、阳性预测值和阴性预测值分别是96.05%、100%、96.51%、100%、76.92%。22例TBNA阴性患者中,除6例经过TBNA确诊为结节病外,其余经开胸手术确诊,1例为淋巴瘤,4例为纵隔淋巴结转移癌,11例为阴性。在纵隔肿大淋巴结诊断中,敏感性、特异性和准确性分别为92.63%,100%和93.75%。小细胞肺癌TBNA的阳性率高于非小细胞肺癌,P＜0.01。直径≥3cm淋巴结TBNA的阳性率稍高,但差异无统计学意义。结论:TBNA对纵隔淋巴结诊断有很大帮助,且安全易行,值得基层医院临床推广应用。     

针吸活检对肺癌伴肺门纵隔淋巴结转移的诊断价值

背景与目的经支气管针吸活检(transbronchial needle aspiration,TBNA)和经支气管超声引导针吸活检(endobronchial ultrasound-guided TBNA,EBUS-TBNA)是用于诊断纵隔淋巴结病变的最新检查方法。本研究旨在评价TBNA和EBUS-TBNA对肺癌伴肺门纵隔淋巴结转移的诊断价值及安全性。方法对CT检查疑似肺癌但管腔内无明显新生物且肺门纵隔淋巴结肿大的250例患者行TBNA后行活检或刷检,15例疑似肺癌患者行EBUS-TBNA。结果180例患者TBNA、刷检和活检确诊为肺癌,阳性率分别为82.86%、51.24%和45.45%。15例EBUS-TBNA的阳性率为91.67%。结论TBNA和EBUS-TBNA检查安全性好,准确率高,对肺癌伴肺门纵隔淋巴结转移的患者有较高的诊断价值。     

EBUS-TBNA和纵隔镜检查术在纵隔淋巴结诊断与分期中的对照研究

以影像学纵隔淋巴结异常的患者为研究对象,比较EBUS-TBNA和纵隔镜检查术诊断纵隔淋巴结转移和肺癌纵隔分期的价值。方法:对纵隔淋巴结异常的患者先行EBUS-TBNA,不管EBUS-TBNA的结果如何,再行纵隔镜检查术。以病理结果或临床随访为标准,比较两者在诊断纵隔淋巴结转移和肺癌纵隔分期中的价值。结果:2009年12月至2011年4月期间,共33例患者纳入分析,其中23例最后确诊为肺癌,10例为良性病变;EBUS-TBNA和纵隔镜检查术对肺癌纵隔淋巴结分期的敏感性、特异性和准确率相同,分别为90.0%、100%和91.3%;诊断肺癌纵隔淋巴结转移的敏感性、特异度和准确率分别为88.5%、100%、91.4%和80.8%、100%、85.7%,差异无统计学意义;3例开胸术的患者未发现新的纵隔淋巴结转移;EBUS-TBNA检出90%（18/20）的阳性患者,但其中仅5例诊断出癌细胞或非小细胞肺癌;5组纵隔镜检查术假阴性的淋巴结有2组位于隆突下淋巴结。结论:EBUS-TBNA在肺癌纵隔分期和纵隔淋巴结转移诊断中的价值与纵隔镜检查术相似,两者具有互补性。对EBUS-TBNA阴性或者病理不能具体分型的患者,需再行纵隔镜检查术。      

支气管超声弹性成像技术对肺门及纵隔淋巴结良恶性鉴别诊断的临床价值*

目的: 探讨支气管超声弹性成像技术在肺门及纵隔淋巴结良恶性鉴别诊断中的临床价值。 方法: 选取2015年3月至2017年6月就诊于兰州大学第二医院行胸部CT提示肺门或纵隔淋巴结肿大,常规行经支气管镜超声引导针吸活检术（endobronchial ultrasound-guided tansbronchial needle aspiration,EBUS-TBNA）检查的68例患者,共穿刺121枚淋巴结,分别对目标淋巴结行支气管镜下超声及弹性成像检查,记录常规超声和弹性成像的各个参数。以EBUS-TBNA穿刺的病理结果作为诊断的“金标准”,计算常规超声和弹性成像各个参数的诊断敏感度和特异性,运用Logistic回归分析,评价对肿大淋巴结良恶性鉴别诊断的临床价值。 结果: 采用超声弹性成像蓝色面积的比例,作为鉴别诊断良恶性淋巴结的最佳诊断界值为0.6,诊断的准确率为87.10%,敏感度为89.20%,特异性为79.33%,阳性预测值为89.23%,阴性预测值为72.31%,受试者工作特征（receiver operator characteristic,ROC）曲线下面积为0.902,诊断价值明显高于常规超声下各参数和弹性评分;Logistic回归分析显示肺门和纵隔肿大淋巴结中影响其良恶性的主要因素为超声下病变短径、边界、回声均匀、血供及弹性成像蓝色面积的比例。 结论: 超声弹性成像蓝色面积的比例对肺门和纵隔淋巴结良恶性的鉴别诊断以及精准引导EBUS-TBNA操作具有较高的临床价值。      

超声支气管镜引导下针吸活检术在非小细胞肺癌诊断及其淋巴结分期评估中的价值研究#br#

目的探讨超声支气管镜引导下针吸活检术（EBUS TBNA）在非小细胞肺癌（NSCLC）诊断及其淋巴结分期评估中的价值。方法选取新疆医科大学第八附属医院2019年8月至2020年8月收治的经胸部CT检查显示纵隔或肺门淋巴结肿大或肺内肿块疑似肺癌的患者118例,均行EBUS TBNA检查,以病理学诊断结果为最终诊断,分析EBUS TBNA对NSCLC的诊断价值,并探查所有可及的纵隔与肺门淋巴结,对淋巴结试行穿刺,分析穿刺部位分布、EBUS TBNA诊断分型、EBUS TBNA对NSCLC淋巴结分期评估价值及并发症。结果118例患者中有116例经临床病理学诊断确诊为NSCLC,经EBUS TBNA检查确诊111例,准确度为9407%（111/118）,灵敏度为9569%（111/116）,特异度为10000%（2/2）,阳性预测值为10000%（111/111）,阴性预测值为2857%（2/7）。116例患者经EBUS TBNA检查共获得来自不同部位的142个淋巴结样本,其中纵隔淋巴结108个,肺门淋巴结34个,4R、7、11R为最常累及的淋巴结。EBUS TBNA检查对纵隔淋巴结和肺门淋巴结评估的灵敏度分别为9485%、7917%,特异度分别为10000%、10000%,阳性预测值分别为10000%、10000%,阴性预测值分别为6875%、6667%,准确度分别为9537%、8529%,Kappa值分别为0789、0691,与病理诊断结果的一致性良好。EBUS TBNA评估NSCLC淋巴结N0、N1、N2、N3期的准确度分别为9500%、9444%、9792%、9167%。共有6例（517%）患者发生轻微并发症,经相关处理后均有所好转。结论EBUS TBNA对NSCLC及淋巴结分期均有较高的诊断价值。     

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in the Diagnosis of Lymphoma

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is highlyaccurate in diagnosing mediastinal lymphadenopathies of lung cancer and benign disorders. However, the utilityof EBUS-TBNA in the diagnosis of mediastinal lymphomas is unclear. The aim of this study was to determinethe diagnostic value of EBUS-TBNA in patients with suspected lymphoma. Materials and Methods: Sixty-eightpatients with isolated mediastinal lymphadenopathy and suspected of lymphoma were included in the study.EBUS-TBNA was performed on outpatients under moderate sedation. The sensitivity, specificity, negativepredictive value and diagnostic accuracy of EBUS-TBNA were calculated. Results: Sixty-four patients werediagnosed by EBUS-TBNA, but four patients with non-diagnostic EBUS-TBNA required surgical procedures.Thirty-five (51.5%) patients had sarcoidosis, six (8.8%) had reactive lymphadenopathy, nine (13.3%) hadtuberculosis, one (1.5%) had squamous cell carcinoma, two (2.9%) had sarcoma and fifteen (22%) had lymphoma(follicular center cell, large B-cell primary, and Hodgkin lymphomas in three, two, and ten, respectively). Of the15 lymphoma patients, thirteen were diagnosed by EBUS and two by thoracotomy and mediastinoscopy. Thesensitivity, specificity, negative predictive value, and diagnostic accuracy of EBUS-TBNA for the diagnosis oflymphoma were calculated as 86.7%, 100%, 96.4%, and 97%, respectively. Conclusions: EBUS-TBNA can beemployed in the diagnosis of mediastinal lymphoma, instead of more invasive surgical procedures.     

The role of Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) for qualitative diagnosis of mediastinal and hilar lymphadenopathy: a prospective analysis

Background  

Recently EBUS-TBNA, which has a sensitivity of 94.6%, specificity of 100% and diagnostic accuracy rate of 96.3% as previously reported, has been widely used for patients with mediastinal and hilar lymphadenopathy or suspected lung cancer to get accurate diagnosis. The purpose of the current study was to evaluate the usefulness of EBUS-TBNA in obtaining cytological and histological diagnosis of mediastinal and hilar lymph nodes compared to the results obtained with conventional mediastinoscopy as previously reported, and to assess the relationship of diagnostic accuracy and number of passes and size of lymph nodes.     

Endobronchial ultrasound guided transbronchial needle aspiration for staging of lung cancer

During the staging process of lung cancer, accurate mediastinal lymph node staging is one of the important factors which affect patient management. The purpose of the current study was to evaluate the usefulness of direct real-time endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) for staging and diagnosis of lung cancer in patients with mediastinal lymph nodes suspected of malignancy and to assess the impact of this method in patient management. One hundred and eight patients with mediastinal lymph nodes with known or suspected lung cancer were included. The convex probe EBUS integrated with a convex scanning probe on its tip was used in all cases. Final diagnosis was based on cytology, surgical results, and/or clinical follow-up.

In 105 patients, EBUS-TBNA was successfully performed to obtain samples from 163 lymph nodes. With respect to the correct prediction of lymph node stage, EBUS-TBNA had a sensitivity of 94.6%, specificity of 100%, positive predictive value of 100%, negative predictive value of 89.5%, and diagnostic accuracy rate of 96.3%. In the 20 suspected lung cancer cases, mediastinal lymph node was used for tissue diagnosis of malignancy as well as staging. As a result of EBUS-TBNA, 29 mediastinoscopies, 8 thoracotomies, 4 thoracoscopies, and 9 CT-guided PCNB were avoided. The procedure was uneventful without complications. EBUS-TBNA is a safe and sensitive method for lymph node staging in patients with lung cancer. It spares invasive staging procedures which has a major impact on patient management.     

Endobronchial ultrasound for diagnosis of synchronous primary lung cancers

Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) has recently been shown to be accurate in diagnosis and staging of mediastinal lymph node metastases. We report a case of squamous cell carcinoma diagnosed by endobronchial biopsy with concomitant contralateral hilar lymph node metastasis from small cell carcinoma being confirmed by EBUS-TBNA. The diagnosis of synchronous primary lung cancers in this case, which altered the treatment strategy, would not be made if pathological staging of intrathoracic lymph node was not pursued. The unique role of EBUS-TBNA in diagnosis of hilar lymphadenopathy was underscored. The potential pitfall of missing synchronous lung tumour if the diagnosis is based either on sampling from intrathoracic lymph node or from endobronchial lesion alone is discussed.     

Has mediastinoscopy still a role in suspected stage I sarcoidosis?

INTRODUCTION: Whether diagnostic mediastinoscopy is needed for confirmation of diagnosis in patients who present with clinical stage I sarcoidosis and no lung lesions on CT scan, is not known. METHODS: A retrospectively review of all mediastinoscopies performed from 1992 to 2003 at Health Sciences center, Winnipeg, Canada yielded 55 patients with hilar and mediastinal lymphadenopathy and normal lung parenchyma on thoracic computerized axial Scan. RESULTS: Out of a total of 1462 procedures, 55 patients with a presumptive diagnosis of Stage I sarcoidosis underwent mediastinoscopy. Median age at presentation was 47.4 +/- 12.8 years (range 24-77). The patients had mild symptoms of cough (30.9%), dyspnea (20.0%), chest pain (14.6%), malaise in (20.0%), erythema nodosum (3.6%) and uveitis (3.6%). Thoracic CT scan revealed bilateral hilar lymphadenopathy in 9 (16%), bilateral hilar lymphadenopathy plus right paratracheal lymphadenopathy in 35 (63%), right paratracheal lymphadenopathy in 7 (12%) and unilateral hilar lymphadenopathy in 4 (7.1%) subjects. Pathology revealed noncaseating granuloma, suggestive of sarcoidosis in 49 (89.1%), reactive lymph nodes in 5 (9.1%) and was nondiagnostic in 1 (1.8%). Only 2 out of these 6 non-sarcoid patients had bilateral hilar lymphadenopathy. Biopsy cultures were negative for fungus and mycobacterium in all patients. CONCLUSION: Clinical presentation of minimal symptoms, mediastinal lymphadenopathy (especially bilateral hilar and right paratracheal lymphadenopathy) with normal parenchyma on CT scan strongly suggests a diagnosis of sarcoidosis. In these cases, confirmation of the diagnosis by mediastinoscopy and lymph node biopsy is unwarranted.     

Endobronchial ultrasound-guided transbronchial needle biopsy for M1 staging of extrathoracic malignancies

Background: Extrathoracic malignancies metastasize to the mediastinum and/or pulmonary hilum. Mediastinoscopy and thoracoscopy are standard to obtain tissue proof of metastatic spread but are invasive. Endobronchial ultrasound with real-time-guided transbronchial fine-needle aspiration (EBUS-TBNA) is a minimally invasive alternative for surgical staging of lung cancer.Methods: We analysed the test characteristics of EBUS-TBNA in consecutive patients with a suspicion of mediastinal or hilar metastases of various extrathoracic malignancies.Results: Ninety-two patients with concurrent (n = 33) or previously diagnosed and treated (n = 59) extrathoracic malignancies were evaluated. EBUS-TBNA detected mediastinal or hilar metastatic spread in 52 patients (57%) [metastasis of extrathoracic tumour in 40 (44%) and second malignancies (lung cancer) in 12 (13%)]. Subsequent surgical staging showed malignancy in another nine patients. With EBUS-TBNA, an alternate diagnosis was found in four. Sensitivity and negative predictive value for mediastinal or hilar metastatic spread were 85% [95% confidence interval (CI) 73–93] and 76% (95% CI 59–88). EBUS-TBNA prevented an invasive surgical procedure in 61% of the patients. One patient had a respiratory arrest during EBUS-TBNA; abortion lead to full recovery without further intervention.Conclusions: EBUS-TBNA is a minimally invasive method for M staging of patients with extrathoracic malignancies to confirm mediastinal or hilar spread. EBUS-TBNA therefore may qualify as an alternative for surgical staging.