超声内镜引导下经支气管针吸活检对肺部及纵隔病变的诊断价值

目的 探讨超声内镜引导下经支气管针吸活检(EBUS-TBNA)在胸内病变诊断中的应用价值.方法 对89例影像学检查提示胸内病变的患者[肺部病变者56例,确诊肺癌需进行N分期者7例,单纯纵隔和(或)肺门淋巴结肿大者21例,纵隔占位5例]行EBUS-TBNA,穿刺物行细胞及组织病理学检查.结果 89例患者均顺利完成EBUS-TBNA,无一例发生并发症.76例穿刺阳性;5例穿刺阴性;5例因穿刺标本不满意而无法统计.56例肺部病变者中诊断恶性肿瘤45例,良性疾病5例,可疑癌3例;穿刺阴性1例;标本不满意而无法统计2例.7例确诊肺癌需进行N分期者中穿刺结果提示转移5例;穿刺阴性2例.21例单纯纵隔和(或)肺门淋巴结肿大者中诊断恶性肿瘤3例,良性疾病13例;穿刺阴性2例;标本不满意而无法统计3例.5例纵隔占位者均诊断为恶性肿瘤.3例可疑癌患者中1例经CT引导下穿刺、2例经临床随访观察诊断为恶性肿瘤.确诊肺癌而穿刺阴性的2例患者中1例手术后病理证实有淋巴结转移;1例PET-CT检查未见淋巴结转移.另3例穿刺阴性者经临床随访观察均诊断为良性疾病.EBUS-TBNA的敏感性、特异性、阳性预测值及阴性预测值分别为95%、100%、100%及20%.结论 EBUS-TBNA是诊断胸内病变的一种安全、有效的方法.     

超声支气管镜引导下针吸活检术对孤立性纵隔/肺门淋巴结肿大的诊断价值

  目的  评估超声支气管镜引导下经支气管镜针吸活检(EBUS-TBNA)对孤立性纵隔/肺门淋巴结肿大(IMHL)的诊断价值，分析IMHL的病因分布。  方法  收集上海市肺科医院和宁波大学医学院附属医院2018年8月—2019年1月胸部CT显示孤立性纵隔/肺门淋巴结肿大并至少一次EBUS-TBNA检查的124例患者临床资料，回顾性分析EBUS-TBNA病理学、细胞学和微生物学检查结果，同期进行纵隔镜检查或随访，得到最终结果，分析IMHL的病因分布，并评估EBUS-TBNA的诊断价值。  结果  共穿刺208个淋巴结，平均每例1.68个，124例IMHL患者中118例获得病因诊断结果，诊断率为95.2%。其中结节病43例(占34.7%)，淋巴结结核23例(占18.5%)，肿瘤21例(占16.9%)。11例为肺恶性肿瘤术后复发，淋巴瘤3例(占2.4%)，淋巴结反应性增生28例(占22.7%)，6例诊断不明。EBUS-TBNA对肿瘤的诊断率最高，为95.2%，对结核的诊断率为82.6%，对结节病的诊断率为48.8%。EBUS-TBNA对IMHL的总体诊断率为72.6%，特异性为100.0%，阴性预测值为50.0%。  结论  孤立性纵隔/肺门淋巴结肿大的常见病因是结节病、淋巴结结核和肿瘤，EBUS-TBNA对孤立性纵隔肺门淋巴结肿大的病因诊断是一种敏感性高且安全的初步检查方法。      

经支气管针吸活检术在支气管管腔通畅的肺及纵隔病变中的诊断价值

目的 探讨经纤维支气管镜纵隔淋巴结针吸活检术在支气管管腔通畅的肺及纵隔病变诊断中的临床价值.方法 对33例常规纤维支气管镜检查支气管管腔内未见肿块及明显外压,但伴有纵隔淋巴结肿大患者进行纵隔淋巴结针吸活检,直接涂片后送检.经支气管针吸活检术(transbronchial needle aspiration,TBNA)完成后,再以毛刷在穿刺点处刷检,如果可见局部黏膜增厚或充血水肿需另行活检.比较TBNA与黏膜活检联合刷检的诊断率,评价TBNA的有效性及安全性,并分析其影响因素.结果 27例伴有肺内占位性病变的纵隔淋巴结肿大患者经TBNA确诊17例,诊断率为63.3％;6例单纯纵隔淋巴结肿大患者经TBNA确诊1例,诊断率为16.7％;全部33例患者的TBNA诊断率为54.5％,高于支气管黏膜活检联合刷检的诊断率(15.2％)(P＜0.01).TBNA诊断率受淋巴结大小影响,淋巴结直径大于2cm的患者TBNA诊断率高(P＜0.01);另外TBNA诊断 率还受淋巴结部位的影响,在伴有肺内占位性病变的患者中,7组淋巴结的TBNA阳性率高于非7组淋巴结(P＜0.05).TBNA并发症少,绝大多数患者仅穿刺点有少许出血.结论 TBNA是一项有效、安全的检查手段,对支气管管腔外病变或肺门、纵隔淋巴结肿大的确诊具有重要意义,尤其在纤维支气管镜检查支气管管腔通畅的情况下.     

经支气管针吸术在肺癌诊断中的作用

目的总结经支气管针吸术（TBNA）在肺癌诊断中的作用。方法分析61例支气管镜TBNA检查患者的临床资料。其中常规胸部CT检查提示有纵隔淋巴结肿大55例,支气管外压性狭窄6例。结果 61例中,确诊肺癌43例,结节病7例,结核3例,感染性淋巴结肿大8例。43例经TBNA获取标本病理确诊为肺癌36例（36/43,83.7%）。36例肺癌患者纵隔淋巴结穿刺62例次,穿刺成功50例次（50/62,80.6%）;气管右前、隆突前、右主支气管前淋巴结共穿刺49次（49/62,78%）。其中20例周围型肺癌TBNA诊断阳性率70%（14/20）,活检诊断阳性率14.3%（2/14）,刷检诊断阳性率25%（5/20）,肺泡灌洗诊断阳性率25%（2/8）。TBNA诊断准确率显著高于其他3种诊断方法（P〈0.01）。结论对于周围型肺癌伴有纵隔淋巴结肿大及支气管外压性狭窄的患者,TBNA为更好的诊断方法。     

气管内超声实时引导经支气管针吸术对肺癌纵隔肺门淋巴结的诊断价值

目的 研究气管内超声实时引导经支气管针吸术(EBUS-TBNA)对肺癌纵隔和肺门淋巴结的诊断价值及安全性.方法 2008年7-12月,对25例[男18例,女7例,年龄(68±9)岁]诊断为肺癌或疑为肺癌且CT检查显示纵隔或肺门淋巴结肿大患者的28组淋巴结行EBUS-TBNA(EBUS-TBNA组).以2008年1-月由同一操作者因相同适应证而进行常规经支气管针吸术(C-TBNA)的26例患者[男18例,女8例,年龄(66±8)岁)]的28组淋巴结为对照(C-TBNA组).以穿刺针抽吸物检查找到特异性细胞物质或淋巴细胞为阳性结果.比较2组的诊断阳性率及并发症发生情况.结果 EBUS-TBNA组诊断阳性率为92.9%(26/28),明显高于C-TBNA组(60.7%,17/28,χ2=8.114,P=0.004).2组均未发现气胸、气道撕裂、出血(>5 ml)等并发症.结论 气管内超声实时引导可显著提高经支气管针吸术对肺癌患者纵隔和肺门淋巴结的诊断阳性率,且安全性高,应进一步开展应用研究.     

气管内超声引导下经支气管针吸活检在胸部恶性疾病诊断和肺癌个体化治疗中的价值

目的 评价气管内超声引导下经支气管针吸活检(endobronchial ultrasound-guided transbronchial needle aspiration,EBUS-TBNA)在胸部恶性疾病诊断和指导肺癌个体化治疗中的应用价值。 方法 回顾性分析2012年5月—2015年12月期间91例纵隔或肺门淋巴结肿大或毗邻气道的肿块的胸部恶性疾病患者EBUS-TBNA的诊断结果和24例患者EBUS标本的EGFR突变检测结果。 结果 共对227个纵隔、肺门淋巴结和23个肿块实施TBNA。4R和7组是最常受累的纵隔淋巴结;经EBUS-TBNA确诊86例,诊断恶性胸部疾病总体敏感度为94.5%,特异度为100.0%,准确度为94.5%。确诊病例中肺腺癌、小细胞癌、鳞癌和无法分型的非小细胞肺癌分别占确诊总例数的55.8%(48/86)、26.7%(23/86)、7.0%(6/86)和5.8%(5/86)。宫颈癌、结肠癌和食管癌和肾癌纵隔淋巴结转移各1例;超声图像分析表明:类圆形淋巴结[长短径之比(L/S)<1.5]、不均质回声、边界清晰、中央淋巴门结构消失和不规则血供在恶性病变中是常见征象;EBUS-TBNA标本EGFR敏感突变率为70.8%,病理标本和液基细胞标本EGFR突变阳性率差异无统计学意义(χ2=0.509 1,P=0.47);本组共17例轻微不良反应,均对症治疗后缓解或自行缓解。 结论 EBUS-TBNA操作简单、安全性高,对胸部恶性疾病的诊断和指导肺癌的个体化治疗有重要应用价值。      

经气管镜超声引导针吸活检术的应用进展

经气管镜超声引导针吸活检术(EBUS-TBNA)是用于诊断纵隔淋巴结等病变的最新微创检查方法。利用电子支气管超声内镜头端固化搭载的超声探头可实现在超声图像实时监视下的穿刺活检,大大提高了经支气管针吸活检术的准确性和安全性。现主要介绍EBUS-TBNA的技术方法、适应证、禁忌证、敏感性、特异性、准确性以及并发症和处理方法。     

气管内超声引导下针吸活检术诊断肺门纵隔病变的临床分析

目的：分析气管内超声引导下针吸活检术诊断肺门纵隔病变的临床效果。方法选取经过CT或正电子发射体层摄影术（PET）-CT检查,提示存在肺门纵隔淋巴结肿大或位于气管或支气管周围肿大的患者50例,采用气管内超声引导下针吸活检术检查,观察气管内超声引导下针吸活检术诊断的准确性。结果50例患者共穿刺淋巴结124例次,平均2.48次/例,穿刺成功率达到100%。肺癌诊断率达到87.50%,结核病诊断率达到71.43%,结节病诊断率为62.50%。除穿刺部位出现少许血,无其它并发症。结论采用气管内超声引导下针吸活检术诊断肺门纵隔病变准确性高、风险低、操作简单,具有较高的临床应用价值。     

经支气管针吸活检与超声内镜引导下经支气管针吸活检对支气管肺癌患者肿大淋巴结性质的诊断价值比较研究

目的 对比经支气管针吸活检（TBNA）与超声内镜引导下经支气管针吸活检（EBUS-TBNA）对支气管肺癌患者肿大淋巴结性质的诊断价值。方法 选取2012年1月-2014年10月于河北大学附属医院支气管镜室接受TBNA或EBUS-TBNA的支气管肺癌患者113例为研究对象。按照患者接受活检方式将其分为TBNA组（66例）和EBUS-TBNA组（47例）。依据所选穿刺点,将TBNA组及EBUS-TBNA组患者再分别分为中央区组﹝美国胸科医师学会（ACCP）胸内淋巴结分区中的4R、4L、7﹞及周围区组（ACCP胸内淋巴结分区中的11R、11L）。TBNA组共穿刺87个部位,其中中央区组56个,周围区组31个;EBUS-TBNA组共穿刺63个部位,其中中央区组40个,周围区组23个。穿刺标本均于病理科行细胞学检查,细胞学涂片可见癌细胞并分型者为穿刺阳性,如未见癌细胞则定义为穿刺阴性。以手术或胸腔镜、纵隔镜淋巴结活检的病理结果作为金标准。分别计算各组诊断肿大淋巴结性质的灵敏度、特异度、正确率,并记录患者并发症发生情况。结果 TBNA中央区组穿刺诊断肿大淋巴结性质的灵敏度、特异度、正确率（80.8%、100.0%、82.1%）与EBUS-TBNA中央区组（91.9%、100.0%、92.5%）比较,差异无统计学意义（P＞0.05）。TBNA周围区组穿刺诊断肿大淋巴结性质的灵敏度、正确率（55.2%、58.1%）低于EBUS-TBNA周围区组（85.0%、87.0%）（P＜0.05）;TBNA周围区组穿刺诊断肿大淋巴结性质的特异度（100.0%）与EBUS-TBNA周围区组（100.0%）比较,差异无统计学意义（P＞0.05）。患者均可良好地耐受检查。TBNA组与EBUS-TBNA组咯血发生率比较,差异无统计学意义（P＞0.05）。结论 TBNA及EBUS-TBNA均可有效诊断ACCP胸内淋巴结分区中的4R、4L、7处肿大淋巴结性质;EBUS-TBNA诊断ACCP胸内淋巴结分区中的11R、11L处肿大淋巴结性质的价值要优于TBNA。     

WHO告诫：改善家居通风降低氡水平

三、肺癌的诊断与治疗肺癌患者入院以后,可以经纤维支气管镜行支气管内组织活检或肺活检;经纵隔镜行纵隔淋巴结活检;对肿大的淋巴结、软组织肿块、溶骨损害、骨髓或胸膜损害行经皮活检。如果取得标本合适,病理学家大多能够对上皮性恶性肿瘤作出明确的诊断并且区分细胞类型。肺癌的确定诊断,需要进行组织细胞学的检查。反复进行痰的脱落细胞检查,也有利于肺癌的早期诊断。同时必须进行小细胞肺癌与非小细胞肺癌的鉴别诊断,以决定治疗方针。     

支气管内超声引导针吸活检术对肺门、纵隔淋巴结肿瘤和结核的诊断价值

目的探讨支气管内超声引导针吸活检术（EBUS-TBNA）在肺门、纵膈淋巴结恶性肿瘤和结核诊断中的应用价值。方法回顾性分析2013年1月至2016年9月在四川大学华西医院呼吸内镜中心接受EBUS-TBNA检查的553例患者的临床及病理资料,统计EBUS-TBNA对肺门、纵膈淋巴结肿瘤和结核的诊断敏感性、特异性和准确率。结果EBUS-TBNA诊断肺门、纵膈淋巴结恶性肿瘤的敏感性、特异性和准确率分别为89.2%（263/295）、100.0%（247/247）和94.1%（510/542）。针吸活检组织查见肉芽肿诊断结核的敏感性、特异性和准确率分别为65.0%（76/117）、97.2%（385/396）和89.9%（461/513）。标本组织行抗酸染色和TB-PCR的102例中,查见抗酸杆菌或TB-PCR任一项阳性诊断结核的敏感性、特异性和诊断准确率为63.7%（58/91）、90.9%（10/11）和66.7%（68/102）。结论EBUS-TBNA诊断肺门和纵膈肿瘤具有较高的敏感性和特异性,并可联合抗酸染色和TB-PCR联合诊断肺门和纵膈淋巴结结核。     

First 30 endobronchial ultrasound-guided transbronchial needle aspirations: a single institution’s early experience

Background  A new technique developed in 2002, real time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), has been one of the most important tools in lymph nodes (LNs) staging before lung cancer surgery. EBUS-TBNA was introduced into China in 2008.

Methods  Between June 2009 and October 2009, 30 patients with mediastinal/hilar lymphadenopathy and thoracic masses previously detected with CT scan underwent EBUS-TBNA without rapid onsite cytological examination.

Results  From 30 patients, 33 samples were obtained from LNs and seven samples from intrapulmonary lesions. Twenty out of the 23 lung cancer diagnoses were clarified through the procedure, with sensitivity, specificity, positive predictive value, negative predictive value and accuracy being 87%, 100%, 100%, 70% and 90%, respectively. All three false negative cases were found in the first five procedures. Additionally, among the 33 LNs examined, three specimens that had no lymphocytes were also found within the first five procedures. There were no major complications, and the procedures were uneventful.

Conclusions  EBUS-TBNA seems a safe and effective technique in making diagnosis for mediastinal/hilar LNs and intrapulmonary masses. For pulmonologists experienced in bronchoscopy, the sensitivity of the procedure for diagnosing lung cancer should be no less than 90% after the initial five procedures .

     

EBUS-TBNA明确诊断纵隔结核的CT影像学表现

目的 研究增强CT 联合超声内镜引导下经支气管针吸活检(EBUS-TBNA) 明确诊断的纵隔结核病例的临床及影像学特点,提高确诊率.方法 对10 例影像学表现以肺门、纵隔病变为主,临床疑诊为结核病的患者,行EBUS-TBNA 检查,分析其临床特点及影像学特点.结果 10 例经增强CT 联合EBUS-TBNA 以及试验性抗结核治疗,9 例明确纵隔结核诊断,1 例诊断为结节病.患者年龄17-71 岁,平均(39±16.82) 岁.发热、咳嗽为常见症状,咳痰症状少见.纵隔结核好发部位为4R 区、7 区及2R 区淋巴结,增强CT 常表现为不均匀强化、环形强化.结论 纵隔结核临床及影像学表现有其特点,增强CT 结合EBUS-TBNA 有助于诊断.     

气道内超声定位下经支气管针吸术对肺癌的诊断价值

目的:探讨气道内超声定位下经支气管针吸术(TBNA)在肺癌诊断中的应用价值。方法:对33例支气管镜检查呈外压性隆起,和/或有纵隔或肺门淋巴结转移的可疑肺癌患者行气道内超声检查,在超声定位下行TB-NA。术前常规支气管镜均未能确诊,且不能通过经皮肺穿刺获取病变组织。结果:33例患者中,1例支气管镜示外压性隆起,超声显示为血管,未行穿刺,32例行TBNA,诊断肺癌敏感性、特异性和准确性分别为96.3%、100%和96.9%,其中诊断肺癌26例(81.3%)、淋巴结结核3例(9.4%)、结节病1例(3.1%)、2例未能明确诊断(1例外科手术后病检证实为结核)。全部患者未出现任何与穿刺相关严重并发症。结论:气道内超声是一项安全、有效的新型内镜检查辅助工具,它能帮助定位支气管腔外病灶和纵隔、肺门淋巴结,引导TBNA,为肺癌诊断和分期提供了一种新的方法,具有微创、准确、安全的特点。     

Endobronchial ultrasound-guided transbronchial needle aspiration of undiagnosed mediastinal lymphadenopathy

Background Endobronchial ultrasound-guided transbronchial needle aspiration （EBUS-TBNA） can sample the enlarged mediastinal lymph nodes which are unreachable by conventional bronchoscopy.It is a relatively simple and safe method to see beyond the bronchial tree.We describe and discuss its initial application and our experience.Methods From July 2009 to December 2009, 52 patients with undiagnosed enlarged mediastinal lymph nodes were accessed with EBUS-TBNA in the People＇s Liberation Army General Hospital.Conventional bronchoscopy was performed before EBUS-TBNA, and patients with endobronchial lesions were excluded from this study.Smears fixed in 95% alcohol and histological specimens fixed in formalin were sent to Department of Pathology.Results EBUS-TBNA was diagnostic in 33 （63%） patients, with diagnosis of lung cancer in 23 patients （14 patients of small cell lung cancer, eight patients with adenocarcinoma, and one patient of squamous carcinoma）.Four patients, who had negative EBUS-TBNA results, were later diagnosed with malignancy at thoracotomy.One patient with negative EBUS-TBNA results died of cancer cachexia.The sensitivity, specificity, and positive and negative predictive value of EBUS-TBNA for the diagnosis of neoplastic disease were 85%, 100%, 100%, and 50% respectively.Among the 16sarcoidosis patients, who were diagnosed by a combination of the clinical and radiological information as well as pathological results obtained by EBUS-TBNA, nine of them had granulomas and benign lymphoid cells detected by EBUS-TBNA.The sensitivity, specificity, and positive and negative predictive value of EBUS-TBNA for the diagnosis of sarcoidosis were 56%, 100%, 100%, and 13%, respectively.Five patients with no definite diagnosis from EBUS-TNBA examination are under close follow-up.Conclusions EBUS-TBNA can provide a safe and effective method to sample mediastinal leisions suspected of malignancy.It also adds pathological information needed to make the diagnosis of sarcoidosis.     

Accuracy of 18F-FDG PET/CT for lymph node staging in non-small-cell lung cancers

Background This retrospective study evaluated the diagnostic accuracy of 2-（F18）-fluoro-2-deoxy-D-glucose-positron emission tomography （^18F-FDG-PET）/computed tomography （PET/CT） in the preoperative diagnosis of metastatic mediastinal and hilar lymph node in patients with non-small-cell lung cancer （NSCLC）. Methods A total of 39 patients received preoperative ^18F-FDG PET/CT and the postoperative biopsy. We compared preoperative PET/CT scan results with corresponding intraoperative histopathalogic findings in 39 NSCLC patients. The sensitivity, specificity, accuracy, positive and negative predictive value of ^18F-FDG PET/CT were assessed. Results Histopathologic examination confirmed metastasis in 57 out of the 208 excised lymph nodes; 23 of the 57 nodes were mediastinal and hilar lymph nodes. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of PET/CT in the preoperative diagnosis of mediastinal lymph node metastasis in NSCLC patients were 65%, 96.8%, 92%, 78.5% and 90%, respectively. Conclusions PET/CT scan showed good accuracy in the preoperative diagnosis of mediastinal and hilar lymph node metastasis in the patients with NSCLC. We recommend that PET/CT scanning be used as a first-line evaluation tool for tumor diagnosis, therapy evaluation and follow-up.     

Endobronchial Ultrasound Elastography for Diagnosing Mediastinal and Hilar Lymph Nodes

Background:

Pathophysiological processes, such as malignancy, can lead to the formation of stiffer tissue in lung cancers. Endobronchial ultrasound (EBUS) elastography is a novel technique for measuring tissue stiffness during EBUS-guided transbronchial needle aspiration (EBUS-TBNA). The current study was conducted to investigate the diagnostic value of EBUS elastography for mediastinal and hilar lymph node metastasis in lung cancers.

Methods:

From January 2014 to January 2015, 40 patients suspected of lung cancer were enrolled, and a total of 68 lymph nodes were evaluated by EBUS-TBNA. EBUS-guided elastography of lymph nodes was performed prior to EBUS-TBNA. Standard EBUS characteristics were also described. Pathological determination of malignant or benign lymph nodes was used as the gold standard for this study. If EBUS-TBNA did not result in a formal pathological diagnosis of malignancy, patients were referred for a surgical procedure. Comparisons of elastography and standard EBUS characteristics were made between benign and malignant lymph nodes.

Results:

Elastography grading scores and strain ratios showed significant differences between benign and malignant lymph nodes (P = 0.000). The elastography strain ratio was more sensitive and specific for determining malignant lymph nodes than elastography grading score or standard EBUS criteria. The receiver operating characteristic curve for the elastography strain ratio showed an area under the curve of 0.933. The best cut-off point of the strain ratio for differentiating malignant from benign lymph nodes was 32.07. The elastography strain ratio had a sensitivity of 88.1%, the specificity of 80.8%, positive predictive value of 88.1%, and negative predictive value of 80.8% for distinguishing malignant from benign nodes. The overall accuracy of elastography strain ratio was 85.3%. The strain ratio of malignant and benign lymph nodes positively correlated with the elastography grading score (r = 0.561, P = 0.000).

Conclusions:

EBUS elastography can be effectively used to predict mediastinal and hilar lymph node metastases in lung cancer. This noninvasive technique may thus complement standard EBUS and help guide EBUS-TBNA procedures.