气管镜下超声影像特征对肺癌纵隔/肺门淋巴结转移的诊断价值

目的 探讨超声支气管镜引导下针吸活检术(EBUS-TBNA)超声影像特征对肺癌纵隔/肺门淋巴结的诊断价值.方法 回顾性分析2009年10月至2011年9月422例经EBUS-TBNA检查术前未经抗肿瘤治疗的肺癌患者,病理明确诊断为肺癌且术后6个月随访胸部增强CT.肺癌患者683个纵隔/肺门淋巴结入组研究,其中男335例,女87例;年龄24～82岁,中位61岁,EBUS淋巴结超声图像结果与最终病理、随访结果进行比较.结果 683个淋巴结短轴直径0.40～4.60 cm,平均直径(1.58±0.68) cm;其中恶性淋巴结短轴平均直径(1.75 ±0.63) cm,良性淋巴结短轴平均直径(0.92±0.40)cm.超声图像下异质性淋巴结527个,其中恶性淋巴结519/527(98.5％);均质性淋巴结156个,其中恶性淋巴结28/156(17.9％),两种超声图像差异有高度统计学意义(x2=489.5,P＜0.01).短轴直径＞1.0 cm异质性淋巴结是恶性的敏感性89.4％,特异性100％,准确性89.6％.结论 EBUS-TBNA是纵隔/肺门淋巴结活检的一种新手段,基于EBUS成像分类为基础的淋巴结超声图像特征,可用于指导淋巴结穿刺顺序,预测肺癌患者淋巴结的良恶性.     

应用支气管内超声引导针吸活检术诊断胸部结节病

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)诊断胸部结节病的价值.方法 回顾性分析2009年9月至2011年6月接受EBUS-TBNA检查的35例临床拟诊胸部结节病患者的临床资料,所有患者术前胸部CT检查均发现肺门和(或)纵隔淋巴结肿大(≥1.O cm).对于EBUS-TBNA未能明确诊断的患者,进一步接受外科手术活检或至少6个月以上的临床及影像学随访.结果 35例患者,经EBUS-TBNA活检87组淋巴结,其中纵隔淋巴结64组,肺门及叶间淋巴结23组.最终明确诊断胸部结节病28例(80％),其中经EBUS-TBNA明确诊断25例(89.3％).所有患者检查耐受良好,无任何相关并发症发生.结论 EBUS-TBNA 是一种安全有效的诊断方法,对于Ⅰ、Ⅱ期胸部结节病有较高的诊断率.     

支气管内超声引导针吸活检术诊断胸部疾病

目的 探讨EBUS-TBNA在诊断胸部疾病中的应用价值.方法 回顾性分析2009年9月至2011年8月343例经EBUS-TBNA术检查患者资料,男219例,女124例;年龄(59.4±13.6)岁.其中影像学可疑或已明确肺癌,并伴有纵隔或肺门淋巴结肿大208例;不伴有肺内占位的纵隔和(或)肺门淋巴结肿大或纵隔占位94例;邻近大气道的肺实质内占位41例.结果 患者胸部病变短径(1.94±1.01) cm,穿刺胸部病变(1.77±0.86)个/例,穿刺(4.71±2.69)次,每处病变平均穿刺2.66次.本组EBUS-TBNA诊断纵隔和(或)肺门良、恶性病变总的敏感性95.6％(238/249例)、特异性100％( 94/94例)、阳性预测值100％(238/238例)、阴性预测值89.5％(94/105例)、准确性96.8％(332/343例).208例明确或可疑肺癌患者中151例经EBUS-TBNA诊断纵隔淋巴结转移,4例为结核,2例为Ⅱ期结节病;51例EBUS-TBNA阴性患者中37例接受进一步手术,32例证实为真阴性.EBUS-TBNA对本组188例肺癌患者纵隔淋巴结分期的敏感性96.8％(151/156例)、特异性100.0％(32/32例)、准确性97.3％(183/188例),阳性预测值100.0％(151/151例)、阴性预测值86.5％(32/37例).94例纵隔和(或)肺门淋巴结肿大或纵隔占位患者中22例恶性病变,73例良性病变中有23例诊断为淋巴结反应性增生,其中有13例接受进一步手术,6例为假阴性.EBUS-TBNA诊断本组纵隔病变良、恶性的敏感性88.0％(22/25例)、特异性100％(73/73例)、阴性预测值95.9％(70/73例)准确性97.9％(92/94例).EBUSTBNA对本组纵隔恶性和良性病变诊断的准确率分别为88.0％(22/25例)和95.9％(70/73例).41例邻近大气道的肺实质内占位中恶性33例;8例EBUS-TBNA阴性,其中4例经进一步手术证实为假阴性.EBUS-TBNA诊断大气道旁肺实质内占位中的敏感性89.2％(33/37例)、准确性90.2％(37/41例).全组病例无穿刺相关并发症发生.结论 EBUS-TBNA术对于肺癌的病理分期可靠,诊断邻近大气道的肺门或纵隔占位等胸部疾病安全、有效.     

支气管内超声引导针吸活检术在纵隔淋巴结CT阳性肺癌分期中的价值

目的 评价支气管内超声引导下针吸活检术(EBUS-TBNA)在纵隔淋巴结CT阳性肺癌病例分期中的应用价值.方法 2009年9月至12月共对28例胸部CT纵隔淋巴结阳性(短径≥1 cm)的肺癌病人行EBUS-TBNA检查.总结穿刺结果,评价该方法的诊断价值和安全性.结果 28例共穿刺淋巴结40组,淋巴结穿刺取材满意率96.3%(27/28例),无任何相关并发症.EBUS-TBNA阳性(取得恶性细胞病理学证据)20例,阴性(未取得恶性细胞病理学证据)8例;阴性者接受进一步外科手术,术后证实纵隔淋巴结转移2例(EBUS-TBNA假阴性).EBUS-TBNA检查准确率92.9%(26/28例),灵敏度90.9%(20/22例),特异度100%(6/6例),阳性预测值100%(20/20例),阴性预测值75%(6/8例).结论 EBUS-TBNA是评价纵隔淋巴结CT阳性肺癌分期的安全有效方法.     

EBUS-TBNA在纵隔气管周围病变诊断中的应用

目的 探讨支气管内超声引导针吸活检术(EBUS-TBNA)在纵隔气管周围病变诊断中的应用价值。方法 回顾性总结2009年9月至2010年7月,34例不明原因的纵隔淋巴结肿大或纵隔肿物患者经EBUS-TBNA检查的临床资料。对EBUS-TBNA仍未能明确诊断者,进一步接受外科手术活检或至少6个月以上的临床及影像学随诊。结果 经EBUS-TBNA检查后28例获得明确诊断,其中恶性病变10例,良性病变18例,确诊率82.4％。EBUS-TBNA在纵隔病变良、恶性诊断和鉴别诊断方面的敏感性、特异性和准确性分别为90.9％、100％和97.1％。所有受检者耐受良好,无任何相关并发症发生。结论 对于纵隔气管周围病变,EBUS-TBNA是一种安全、有效的诊断方法。     

支气管内超声引导针吸活检术在肺癌分期中的应用

目的 探讨支气管内超声引导针吸活检术(EBUS-TBNA)在肺癌分期中的应用价值.方法 回顾性总结2009年9月至2010年2月,52例胸部CT均发现纵隔淋巴结肿大≥1.0 cm肺癌病人经EBUS-TBNA检查的临床资料.结果 经EBUS-TBNA检查证实纵隔淋巴结转移(阳性)者41例,未见纵隔淋巴结转移(阴性)者11例.阳性者放弃手术,予以化疗.阴性者接受胸腔镜或开胸手术,行肺叶切除或肺楔形切除加纵隔淋巴结清扫.术后病理证实,9例纵隔淋巴结确实末见转移,2例纵隔淋巴结可见癌转移,即EBUS-TBNA检查假阴性.EBUS-TBNA的敏感性、特异性、准确性、阳性预测价值及阴性预测价值分别为95.3%、100%、96.2%、100%及81.8%.该检查耐受良好,无任何相关并发症发生.结论 EBUS-TBNA是一种安全、有效的肺癌分期方法.

Abstract：

Objective To determine the value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for staging of lung cancer. Methods The study was retrospective, a total of 52 patients underwent EBUSTBNA for known or suspected lung cancer. All patients were detected enlarged mediastinal lymph nodes on CT scan ( ≥ 1.0cm). Results Of the 52 patients, 41 patients were found with N2 or N3 disease on EBUS-TBNA. 11 patients with negative EBUS-TBNA underwent thoracoscopy or thoracotomy for pulmonary resection and mediastinal lymph node dissection, 9 patients were confirmed N0 by pathology, whereas 2 patients had metastatic lymph node. The diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value of EBUS-TBNA for the mediastinal staging of lung cancer were 95.3%, 100%, 96.2%, 100%, and 81.8%, respectively. The procedure was uneventful, and there were no postoperative complications. Conclusion EBUS-TBNA is an effective and safe technique for mediastinal staging in lung cancer patients.     

支气管内超声引导针吸活检术在胸部疾病中的临床应用价值

目的介绍支气管内超声引导针吸活检术(Endobronchial ultrasound-guided transbronchial needleaspiration,EBUS-TBNA)用于肺癌分期及胸部疾病诊断的新方法,探讨EBUS-TBNA在胸部疾病中的临床应用价值。方法回顾性分析2009年9月至2010年5月106例患者经EBUS-TBNA检查的临床资料,其中男75例,女31例;平均年龄62.3岁。根据适应证的不同,将106例患者分为3种情况行EBUS-TBNA,以进一步明确诊断:(1)已明确诊断或怀疑肺癌(76例),胸部CT示:纵隔淋巴结肿大(≥1.0 cm);(2)不明原因的纵隔和(或)肺门淋巴结肿大以及纵隔肿物(22例);(3)大气道旁肺实质内占位(8例)。结果 (1)已明确诊断或怀疑肺癌76例,经EBUS-TBNA检查证实纵隔淋巴结转移58例,未见纵隔淋巴结转移18例。EBUS-TBNA检查阴性者中16例接受胸腔镜或开胸手术,行肺叶切除或肺楔形切除加纵隔淋巴结清扫,术后病理证实12例肺癌纵隔淋巴结未见转移,2例肺癌纵隔淋巴结可见癌转移(EBUS-TBNA检查假阴性),其余2例为肺内良性病变;EBUS-TBNA在肺癌纵隔淋巴结分期中的敏感性、特异性和准确性分别为96.66%(58/60),100.00%(12/12)和97.22%(70/72)。(2)不明原因的纵隔和(或)肺门淋巴结肿大以及纵隔肿物22例,经EBUS-TBNA检查后明确恶性病变7例,良性病变13例;EBUS-TBNA在纵隔病变良恶性诊断和鉴别诊断方面的敏感性为87.50%(7/8)。(3)大气道旁肺实质内占位8例,经EBUS-TBNA检查后7例明确诊断,其中6例肺癌;EBUS-TBNA在大气道旁肺实质内占位中诊断的敏感性和准确率分别为85.71%(6/7)和87.50%(7/8)。所有患者检查耐受良好,无任何相关并发症发生。结论 EBUS-TBNA是一种安全有效的诊断技术,应成为胸部疾病诊断和分期的常用方法。     

支气管内超声引导针吸活检术（EBUS-TBNA）临床应用的初步体会

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）在明确纵隔和肺门肿大淋巴结定性诊断中的应用价值。方法2009年9~11月,对25例胸部CT检查提示纵隔和（或）肺门淋巴结肿大（短径〉1 cm）进行EBUS-TBNA检查,阴性者进一步接受纵隔镜检查或胸腔镜、开胸手术加以确证。结果本组25例共穿刺32组淋巴结。EBUS-TBNA明确淋巴结恶性转移者15例;EBUS-TBNA阴性者10例,其中1例开胸术后证实隆突下淋巴结转移。EBUS-TBNA在纵隔和肺门肿大淋巴结良恶性鉴别诊断中的敏感性、特异性和准确性分别为94%（15/16）,100%（9/9）和96%（24/25）。所有患者检查耐受良好,无任何相关并发症发生。结论EBUS-TBNA是评价纵隔及肺门淋巴结安全有效的方法。     

超声支气管镜引导下的经支气管针吸活检术诊断菌阴肺结核

目的 探讨超声支气管镜引导下的经支气管针吸活检(EBUS-TBNA)诊断细菌培养阴肺结核的有效性.方法 对于3次常规结核杆菌痰检阴性、伴肺门和(或)纵隔淋巴结肿大临床疑似肺结核的患者随机分为2组,比较支气管肺泡灌洗组即BAL组(对照组)和EBUS+ BAL组(试验组)诊断菌阴肺结核的差异.结果筛选115例患者,其中82例患者进入该研究,对照组40例,试验组42例.对照组通过细菌学明确诊断8例,诊断性抗结核治疗后明确诊断27例,手术证实非结核诊断5例;试验组通过细菌学和病理学明确诊断28例,假阴性8例,其他诊断6例.EBUS+BAL组诊断敏感性为77.8％,显著高于BAL组的22.9％ (x2 =21.4,P＜0.01);EBUS+BAL组阴性预测值也显著高于BAL组(42.9％对15.6％,x2=3.97,P=0.046).两组间并发症相似,仅1例试验组穿刺点出血需要止血干预.结论 EBUS-TBNA对菌阴肺结核伴肺门和(或)纵隔淋巴结肿大的患者诊断敏感性和阴性预测值高,并发症少,将成为菌阴肺结核患者一种新的诊断方式.     

超声内镜引导下经支气管针吸活检术在胸外科的应用进展

超声内镜引导下经支气管针吸活检术(EBUS-TBNA)是近10年才发展起来的新技术,在美国早已被推荐为肺癌术前淋巴结分期的重要手段,成为肺癌纵隔分期的新标准。通过大量的临床资料分析,EBUS-TBNA是一种诊断准确性较高、手术安全性好的新方法 ,而且在某些胸部疾病诊断价值已得到公认。本文就EBUS-TBNA在肺癌的早期诊断、中晚期肺癌诊断和分期的应用,EBUS-TBNA与CT、PET、纵隔镜等传统检查之间的关系,以及在上腔静脉综合征的应用价值和近年来EBUS-TBNA技术在胸部良性病变中的应用进展予以综述。     

支气管内超声引导针吸活检术在非小细胞肺癌术前分期中的临床应用

目的探讨支气管内超声引导针吸活检术(EBUS-TBNA)在非小细胞肺癌纵隔淋巴结分期中的应用价值。 方法2010年9月至2012年9月,北京大学人民医院利用EBUS-TBNA对术前确诊或CT扫描高度怀疑非小细胞肺癌且伴有纵隔淋巴结肿大(N₂站淋巴结短径≥1.0cm,或N₁站淋巴结短径≥1.0cm且N₂多站短径≥0.5cm者),有手术切除可能,术前无放、化疗史的126例患者进行纵隔淋巴结分期。最终入组82例非小细胞肺癌患者。 结果该组82例患者,经EBUS-TBNA检查证实纵隔淋巴结转移(阳性)者54例,未见纵隔淋巴结转移(阴性)者28例。EBUS-TBNA在该组肺癌术前纵隔淋巴结分期中的敏感度、特异度和准确性分别为94.7%(54/57)、100.0%(25/25)和96.3%(79/82),阳性预测值及阴性预测值分别为100.0%(54/54)和89.3%(25/28)。而CT对于本组患者纵隔淋巴结分期中的敏感度、特异度和准确性分别为98.2%(55/56)、38.5%(10/26)和79.3%(65/82),阳性预测值及阴性预测值分别为77.5%(55/71)和90.9%(10/11)。CT在术前纵隔淋巴结分期中的假阳性率为22.5%(16/71)。全组中,16例(19.5%)肺癌患者因EBUS-TBNA病理结果改变了治疗策略。 结论EBUS-TBNA用于非小细胞肺癌纵隔淋巴结分期的敏感性、特异性和准确性较高。EBUS-TBNA可以作为非小细胞肺癌术前分期、指导治疗策略的检查手段。     

Current status and perspective of EBUS-TBNA

In 2002, a new bronchoscope equipped with a convex type ultrasound probe on the tip was introduced into clinical practice. This convex probe endobronchial ultrasound (CP-EBUS) provides a long axis image of surrounding structures of the major airway. The CP-EBUS combined with a dedicated biopsy needle allows real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of mediastinal and hilar lymph nodes. Samples obtained from EBUS-TBNA can be used for pathological diagnosis including immunohistochemistry. EBUS-TBNA is now being performed worldwide for several indications including mediastinal staging, mediastinal pathology and for benign diseases. For mediastinal staging in lung cancer, the diagnostic yield of EBUS-TBNA is comparable to surgical staging in patients with enlarged lymph nodes. In addition, EBUS-TBNA can be used for molecular analysis of tumor cells obtained during the procedure. DNA mutation testing using EBUS-TBNA samples was first reported in 2007 for a chondrosarcoma case. Also, isolated DNA from EBUS-TBNA samples was applied for epidermal growth factor receptor mutation testing and aberrant methylation analysis in patients with lung cancer. RNA was also isolated from properly stored EBUS-TBNA samples and used for gene expression research and aberrant fusion gene detection in lung cancer patients. Optimization of tissue banking methods of EBUS-TBNA specimens was also investigated. Currently, EBUS-TBNA samples can be used for comprehensive mRNA and miRNA expression analysis. EBUS-TBNA will become an important modality for bronchoscopists in the era of personalized medicine in lung cancer.     

Role of endobronchial ultrasound-guided transbronchial needle aspiration in the management of lung cancer

Endobronchial ultrasound (EBUS) is a promising new modality first introduced during the early 1990s. The radial probe EBUS was initially developed seeking for high-resolution imaging of processes in the airway wall and outside the airways. The structure of special importance was lymph nodes, walls of the central airways, and the mediastinum. After the development of miniaturized radial probes with flexible catheters having a balloon at the tip, it has been applied to aid bronchoscopists during biopsy of patients with respiratory diseases. In particular, the role of EBUS in transbronchial needle aspiration (TBNA) has been established. Radial probe EBUS-guided TBNA has increased the yield of TBNA of mediastinal lymph nodes, although it was still not a real-time procedure with target visualization. New convex probe EBUS (CP-EBUS) with the ability to perform real-time EBUS-guided TBNA (EBUS-TBNA) has emerged to overcome these problems. Indications for EBUS-TBNA are (1) lymph node staging in lung cancer patients; (2) diagnosis of intrapulmonary tumors; (3) diagnosis of unknown hilar and/or mediastinal lymphadenopathy; and (4) diagnosis of mediastinal tumors. Case series using EBUS-TBNA for mediastinal lymph node staging in lung cancer have reported a high yield, ranging from 89% to 98% (average 94.5%). To date, there are no reports of major complications related to EBUS-TBNA. EBUS-TBNA is a novel approach with a high diagnostic yield that is safe. The aim of this article was to review the current role of EBUS-TBNA for the management of lung cancer patients.     

Linear Endobronchial Ultrasound as the Initial Diagnostic Tool in Patients With Indications of Mediastinal Disease

IntroductionLinear endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has proven useful for sampling mediastinal masses and nodes and staging lung cancer. The aim of this study was to assess the usefulness of this diagnostic tool in patients with indications of mediastinal disease that could not be diagnosed by noninvasive methods or white light bronchoscopy.Patients and MethodsAll patients undergoing linear EBUS-TBNA for the diagnosis of mediastinal masses and/or adenopathy at our endoscopy unit were included in the study. Diagnoses obtained by linear EBUSTBNA or any surgical technique performed after a nondiagnostic EBUS-TBNA were considered as final.ResultsIn the study population of 128 patients with a mean (SD) age of 62.0 (11.2) years, a total of 294 TBNAs were performed on 12 masses and 282 nodes. Satisfactory samples were obtained in 11 cases (91.7%) from masses and in 233 cases (82.6%) from nodes. Linear EBUS-TBNA was diagnostic, obviating the need for mediastinoscopy in 115 patients (diagnostic sensitivity, 89.8%). The technique confirmed the diagnosis in 85 of the 94 patients with cancer (90.4%), in 8 of the 10 patients with tuberculosis (80.0%), and in the 5 with sarcoidosis.ConclusionsLinear EBUS-TBNA is a useful diagnostic tool in patients with mediastinal disease for whom a pathologic diagnosis is not achieved by noninvasive methods or white light bronchoscopy.     

Bronchogenic carcinoma: incidence of metastases to normal sized lymph nodes.

BACKGROUND--The incidence of metastases to mediastinal lymph nodes was evaluated in patients with normal sized mediastinal nodes on the computed tomographic (CT) scan who underwent thoracotomy. The use of hilar lymph nodes in predicting mediastinal lymph node metastases was also assessed. METHODS--Ninety patients with non-small cell lung cancer who later underwent thoracotomy wer prospectively examined by CT scanning. Lymph nodes with a short axis diameter of 10 mm or more were considered abnormal. RESULTS--Mediastinal lymph node metastases were present at thoracotomy in 19 patients (21%). In 14 these lymph node metastases were misdiagnosed because the nodes were normal in size on the CT scan. In only one of the 19 patients with N2 nodes was an N1 lymph node enlarged, and four of the 19 patients with N2 nodes had metastases to these mediastinal nodes without N1 disease ("skipping metastases"). CONCLUSIONS--Metastases in normal sized nodes seen on the CT scan are a major problem in staging. Hilar lymph nodes did not help to predict reliably the presence or absence of metastases to the mediastinal lymph nodes.     

Lung cancer staging: what is the actual role of mediastinoscopy?

Today several methods for invasive mediastinal staging of lung cancer are available. Whereas mediastinoscopy and anterior mediastinotomy had been the gold standard in every situation several years ago, today EBUS-TBNA has been developed as an alternative to mediastinoscopy concerning the status of lymph node positions?2 L?/?R, 4 L?/?R and 7. Actually mediastinoscopy is accepted as the gold standard only in special situations such as negative cytology of suspicious lymph nodes after EBUS-TBNA and mediastinal evaluation after neoadjuvant treatment.