超声支气管镜引导下经支气管针吸活检术136例临床应用分析

目的 评价超声支气管镜引导下经支气管针吸活检术（EBUS-TBNA）对纵隔和肺门淋巴结肿大或支气管腔外肿物的诊断价值和安全性.方法 回顾性分析2011年5月～2013年7月于我院行EBUS-TBNA检查的136例患者临床资料.结果 共穿刺纵隔或肺门淋巴结185例次,腔外肿物44例次.病理学检查诊断为恶性肿瘤81例（64.3％）,良性疾病22例（17.5％）,可疑恶性疾病9例（7.1％）,病理结果无诊断意义14例（11.1％）,穿刺失败10例（7.3％）.恶性肿瘤中小细胞肺癌36例（44.4％）,非小细胞肺癌32例（39.5％）,恶性淋巴瘤1例（1.2％）,转移癌4例（4.9％）,无法分型者8例（9.9％）.良性疾病中肉芽肿性疾病16例（72.7％）,普通炎症2例（9.1％）,经抗酸染色直接明确诊断结核4例（18.2％）,肉芽肿性疾病中诊断结核3例（18.8％）,结节病11例（68.8％）,曲霉菌感染2例（12.5％）.EBUS-TBNA诊断恶性疾病的敏感度为90.0％,特异度为100％;诊断良性疾病的敏感度为37.5％,特异度为100％.所有患者术中术后均未发生严重并发症.结论 EBUS-TBNA对不明原因纵隔-肺门淋巴结肿大或气管/支气管腔外病变的诊断具有重要价值.     

常规经支气管镜针吸活检与超声引导下经支气管镜针吸活检对纵隔病变诊断的比较

目的 比较常规经支气管镜针吸活检(TBNA)和超声引导下经支气管镜肺活检(EBUS-TBNA)在同等条件下对纵隔病变的诊断的准确率及并发症的发生率等.方法 收集2008年10月至2009年10月广东省顺德第一人民医院呼吸科因胸部CT提示纵隔病变进行活检的患者95例,其中男65例,女30例,年龄13～85岁,平均(56±16)岁.所有患者于局部麻醉下行支气管镜,对172组纵隔病变先进行常规TBNA,后进行EBUS-TBNA,比较两者穿刺活检的阳性率、组织标本获取率及血管损伤率.结果 95例中确诊为恶性病变者71例,其中常规TBNA确诊65例,诊断阳性率为92%;EBUS-TBNA确诊68例,诊断阳性率为96%.172组病灶中,常规TBNA穿刺阳性结果为108组,总阳性率为63%(108/172),而EBUS-TBNA阳性结果为112组,总阳性率为65%(112/172).常规TBNA和EBUS-TBNA对纵隔良、恶性病变的诊断无明显差异,但EBUS-TBNA获取组织标本的成功率(39/95)高于常规TBNA(22/95).常规TBNA误伤血管7例,略高于EBUS-TBNA(3例).但差异无统计学意义.结论 在熟练掌握操作技术和方法后,两种方法均可获得满意的穿刺结果,操作者可选择性应用两种方法,做到优势互补.

Abstract：

Objective To compare the diagnostical yields and complication of conventional transbronchial needle aspiration ( TBNA ) and endobronchial ultrasound guided transbronchial needle aspiration ( EBUS-TBNA ) for the mediastium lesions under the same condition. Method Ninty-five patients with mediastinal lesions on chest CT were included. Bronchoscopy was performed under the local anesthesia, TBNA, EBUS-TBNA performed sequentially as a single combined procedure. Results Of the71 patients comfirmed to be malignant, the positive rate of TBNA was 92% ( 65/71 ), and 96% ( 68/71 )by EBUS-TBNA. There was no difference in malignant and benign lesions between conventional TBNA and EBUS-TBNA, but the success rate for obtaining adequate samples was higher by EBUS-TBNA ( 39/95 ) as compared to TBNA( 22/95 ). Accidental injury of the blood vessels occurred in 7 cases by TBNA as compared to 3 cases by EBUS-TBNA, but the difference was not significant. Conclusion Satisfactory diagnostic yields can be obtained by either conventional TBNA or EBUS-TBNA in skilled hands.     

CT引导下经支气管镜针吸活检术诊断纵隔和肺门周围肿块的效果分析

目的 探讨CT引导下经支气管镜针吸活检术对纵隔和肺门周围肿块的诊断效果.方法 选择140例行CT检查发现纵隔和肺门周围肿块的患者,在患者知情同意的情况下,采用随机号码表法将所有患者分为观察组(70例)和对照组(70例).观察组在CT实时引导下行经支气管镜针吸活检术,对照组则采用盲探法行经支气管镜针吸活检术.记录两组的阳性例数、假阳性例数、阴性例数和假阴性例数,并计算两种方法的敏感度、特异度、阳性预测值和阴性预测值.记录两组患者不良反应发生率.计数资料采用x2检验;以P＜0.05为差异有统计学意义.结果 观察组检出恶性肿瘤40例,良性肿瘤1例,结核病13例,结节病2例,正常组织14例;而对照组则检出恶性肿瘤38例,良性肿瘤2例,结核病11例,结节病3例,正常组织16例;两组比较差异无统计学意义(x2值分别为0.029、0.000、0.050、0.000和0.042,P值分别为0.734、1.000、0.823、1.000和0.837).观察组假阴性患者(1例)较对照组的(7例)更少(x2=4.275,P=0.039);观察组的阳性患者(65例)与对照组(59例)相当(x2=1.764,P=0.184);观察组的阴性患者(3例)与对照组(2例)相当(x2=0.000,P=1.000);观察组的假阳性患者(1例)与对照组(2例)相当(x2=0.000,P=1.000).对照组的敏感度为89.39％、特异度为50.00％、阳性预测值为96.72％、阴性预测值为22.22％;观察组的敏感度为98.48％、特异度为75.00％、阳性预测值为98.48％、阴性预测值为75.00％.观察组发生纵隔气肿或气胸0例,而对照组发生纵隔气肿或气胸6例,两组比较差异有统计学意义(x2=4.353,P=0.037);观察组发生穿刺点出血1例,而对照组发生穿刺点出血8例,两组比较差异有统计学意义(x2=4.275,P=0.039).结论 CT实时引导下行纤维支气管镜针吸活检术诊断纵隔和肺门周围肿块效果更好,不良反应更少.     

气道内超声检查引导经支气管针吸活检的价值探讨

目的探讨支气管镜下气道内超声检查(EBU S)引导经支气管针吸活检(TBNA)的价值。方法EBU S采用不带球囊或带球囊超声微探头,探头直接与气道壁接触扫描或先球囊内注水使之膨胀,后与气道壁接触扫描。EBU S确定穿刺部位后退出微探头,插入穿刺针行TBNA。结果本组13例的超声操作时间为3~10m in。EBU S所见:10见气道壁外不规则低回声肿瘤病灶、其中3例见肿瘤组织破坏管壁,2例见气道壁局限性增厚,1例见气道壁外圆形淋巴结。13例中11例经支气管镜检查确诊,阳性率84.6%。TBNA阳性10例,阳性率76.9%。仅TBNA阳性9例,TBNA使诊断率提高了61.5%。13例均未出现严重并发症。结论EBU S能够对气道壁及邻近器官或病灶进行高清晰度成像,提高了TBNA的诊断阳性率及安全性。     

细支气管镜下超声引导联合测量技术诊断肺周围性病变

目的 评价使用细支气管镜行支气管内超声引导联合测量技术诊断肺周围病变的有效性、安全性和影响因素.方法 回顾性分析2013年10月至2014年9月在苏州大学附属第三医院进行支气管内超声引导联合测量技术经支气管活检的肺周围性病变117例患者临床资料.其中男67例,女50例,年龄(62.2±10.9)岁,病灶直径(22.9 ±9.5)mm.支气管内超声检查使用外径4 mm细支气管镜和外径1.4 mm超声小探头.测量技术是指超声发现病灶后测量病灶与目标支气管开口或者病灶与支气管镜活检通道入口的距离,根据所测距离在活检钳相应部位做标记,从而指导活检钳进入深度的方法.结果 支气管内超声小探头病灶发现率77.8％ (91/117),超声引导经支气管活检总诊断率65.0％ (76/117),恶性肿瘤诊断率75.0％(66/88),良性病变诊断率34.5％(10/29).直径＞2 cm的病灶诊断率(78.7％,48/61)高于直径≤2 cm者(50.0％,28/56),差异有统计学意义(x2=10.56,P=0.001).不同部位病灶诊断率分别为右上叶61.8％ (21/34),右中叶91.7％(11/12),右下叶59.1％ (13/22),左上固有支57.1％(12/21),左舌叶80％ (4/5),左下叶65.2％(15/23),差异无统计学意义(x2=5.31,P=0.38).贴近胸膜的病灶且直径≤2 cm者诊断率18.2％(2/11).超声探头能穿过的病灶诊断阳性率(63.0％,17/27)低于探头不能穿过者(92.2％,59/64),差异有统计学意义(x2=11.78,P=0.001).不良反应为出血和胸痛,无需特殊处理.结论 细支气管镜下超声引导联合测量技术经支气管活检可明确大部分肺周围病变的诊断,并发症少,费用低廉.病灶大小、是否贴近胸膜以及超声探头能否穿过病灶影响诊断率.     

超声支气管镜引导下针吸活检纵隔淋巴结诊断率影响因素分析

目的 分析超声支气管镜引导下针吸活检(Endobronchial ultrasound-guided transbronchial nee-dle aspiration,EBUS-TBNA)纵隔淋巴结诊断阳性率影响因素,以促进临床进一步提高EBUS-TBNA纵隔淋巴结的诊断阳性率.方法 回顾性分析2018年5月～ 20...     

超声支气管镜引导下的经支气管针吸活检术的临床应用分析

目的研究超声支气管镜引导下的经支气管针吸活检术(EBUS-TBNA)在肺恶性肿瘤及纵隔肿物中的诊断价值及安全性。方法分析我科2013年10月至2015年10月经胸部CT发现肺门、纵隔淋巴结肿大或气管支气管旁肿物的94例患者行EBUS-TBNA检查结果。结果 94例患者中确诊肺恶性肿瘤80例;共穿刺150组淋巴结,每组平均穿刺2.4针,对肺恶性肿瘤的诊断敏感性为93.02%,特异性为100%,准确性为93.62%;4例患者临床诊断结节病;4例患者临床诊断淋巴结炎。结论 EBUS-TBNA在纵隔、肺门淋巴结和气管支气管旁肿物的诊断和肺恶性肿瘤的分期上有较高的敏感性、特异性、准确性和安全性,是经济有效的诊断方法。     

支气管超声引导下经支气管针吸活检术研究进展

<正>支气管超声(EBUS)引导下经支气管针吸活检术(TBNA)自引入临床至今已有十年余,这项微创技术的使用从根本上影响了胸部疾病的诊断手段,尤其是在肺癌方面,在世界范围内得到了认可。起初,普通支气管镜用于诊断支气管内病变,后常规经支气管针吸活检(cTBNA)发明被用于诊断部分支气管腔外病变,但成功率较低,且盲法操作易损伤血管,EBUS-TBNA应运而生。EBUS不仅允许操作者观察支气管黏膜和其周围组织,近年来还发展了淋巴结弹性成像技术,可大     

Diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration in various lung diseases

Objective:

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a new method for the diagnosis and staging of lung disease, and its use is increasing worldwide. It has been used as a means of diagnosing lung cancer in its initial stages, and there are data supporting its use for the diagnosis of benign lung disease. The aim of this study was to share our experience with EBUS-TBNA and discuss its diagnostic value.

Methods:

We retrospectively analyzed the results related to 159 patients who underwent EBUS-TBNA at our pulmonary medicine clinic between 2010 and 2013. We recorded the location and size of lymph nodes seen during EBUS. Lymph nodes that appeared to be affected on EBUS were sampled at least twice. We recorded the diagnostic results of EBUS-TBNA and (for cases in which EBUS-TBNA yielded an inconclusive diagnosis) the final diagnoses after further investigation and follow-up.

Results:

We evaluated 159 patients, of whom 89 (56%) were male and 70 (44%) were female. The mean age was 54.6 ± 14.2 years among the male patients and 51.9 ± 11.3 years among the female patients. Of the 159 patients evaluated, 115 (84%) were correctly diagnosed by EBUS. The diagnostic accuracy of EBUS-TBNA was 83% for benign granulomatous diseases and 77% for malignant diseases.

Conclusions:

The diagnostic value of EBUS-TBNA is also high for benign pathologies, such as sarcoidosis and tuberculosis. In patients with mediastinal disorders, the use of EBUS-TBNA should be encouraged, primarily because it markedly reduces the need for mediastinoscopy.     

Diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration for mediastinal staging in lung cancer

OBJECTIVE:

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive diagnostic test with a high diagnostic yield for suspicious central pulmonary lesions and for mediastinal lymph node staging. The main objective of this study was to describe the diagnostic yield of EBUS-TBNA for mediastinal lymph node staging in patients with suspected lung cancer.

METHODS:

Prospective study of patients undergoing EBUS-TBNA for diagnosis. Patients ≥ 18 years of age were recruited between July of 2010 and August of 2013. We recorded demographic variables, radiological characteristics provided by axial CT of the chest, location of the lesion in the mediastinum as per the International Association for the Study of Lung Cancer classification, and definitive diagnostic result (EBUS with a diagnostic biopsy or a definitive diagnostic method).

RESULTS:

Our analysis included 354 biopsies, from 145 patients. Of those 145 patients, 54.48% were male. The mean age was 63.75 years. The mean lymph node size was 15.03 mm, and 90 lymph nodes were smaller than 10.0 mm. The EBUS-TBNA method showed a sensitivity of 91.17%, a specificity of 100.0%, and a negative predictive value of 92.9%. The most common histological diagnosis was adenocarcinoma.

CONCLUSIONS:

EBUS-TBNA is a diagnostic tool that yields satisfactory results in the staging of neoplastic mediastinal lesions.     

Current status and clinical applicability of endobronchial ultrasound-guided transbronchial needle aspiration

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has played a key role in the diagnosis of mediastinal, paratracheal, and peribronchial lesions, as well as in lymph node staging for lung cancer. Despite its minimally invasive character, EBUS-TBNA has demonstrated a diagnostic yield comparable with that of established surgical methods. It has therefore gained credibility and has become a routine procedure at various referral centers. A successful EBUS-TBNA procedure requires careful planning, which includes a thorough review of the radiological imaging and special care during specimen collection and preparation, as well as technical expertise, experience with the procedure itself, and knowledge of the potential complications inherent to the procedure. The most common indications for EBUS-TBNA include lymph node staging for lung cancer and the diagnostic investigation of mediastinal/hilar masses and lymph node enlargement. Recently, tumor biomarkers in malignant samples collected during the EBUS-TBNA procedure have begun to be identified, and this molecular analysis has proven to be absolutely feasible. The EBUS-TBNA procedure has yet to be included on the Brazilian Medical Association list of medical procedures approved for reimbursement. The EBUS-TBNA procedure has shown to be a safe and accurate tool for lung cancer staging/restaging, as well as for the diagnosis of mediastinal, paratracheal, and peribronchial lesions/lymph node enlargement     

EBUS-TBNA相关并发症及其处理方法的研究进展

超声引导下经支气管针吸活检术(EBUS-TBNA)是近年来发展的新技术,气管内实时超声引导可提高经支气管针吸术对纵隔和肺门病变的诊断率,且安全性高.EBUS-TBNA目前主要用于肺癌的诊断、临床分期以及纵隔病变如结节病、结核的诊断,尚有报道其用于纵隔病变如纵隔囊肿、纵隔脓肿等的治疗.随着其应用范围的推广,相关的并发症报道也逐渐增多.本文将对EBUS-TBNA相关的并发症发生率、类别、危险因素、预防与处理等进行介绍,对相关文献进行回顾.     

超声支气管镜下穿刺活检对成人纵隔淋巴结结核的早期诊断价值（附87例临床报告）

目的 探讨超声支气管镜下穿刺活检（EBUS-TBNA）对于纵隔淋巴结结核的早期诊断价值。方法 选取上海市肺科医院2010年1月至2012年12月期间,影像学及临床诊断为纵隔淋巴结结核但气管镜检查无异常的患者共87例;其中男51例,女36例,年龄21～70岁,平均（48.5±11.5）岁。所有患者行EBUS-TBNA,标本送检病理、抗酸杆菌涂片、培养和体外聚合酶链反应检测,根据检测结果进行诊断性治疗并随访3个月,治疗无效者进行纵隔镜检查,最终统计EBUS-TBNA在纵隔淋巴结结核诊断中的诊断率。应用统计软件SPSS 13.0进行数据分析和计算。 结果 66例患者通过EBUS-TBNA直接确诊结核病,1例确诊为非结核分枝杆菌（NTM）感染（菌型鉴定为鸟-胞内分枝杆菌,MAC）;5例确诊肺癌,2例确诊结节病,13例未得到任何阳性证据;13例中6例通过诊断性抗结核治疗确诊结核病,7例行纵隔镜检查,其中3例确诊淋巴瘤,3例肺癌,1例结核病。因此87例患者中最终确诊结核病73例,其中通过EBUS-TBNA确诊66例（90.41%,66/73）。经过EBUS-TBNA确诊结核病的66例中21例（31.82%,21/66）为结核分枝杆菌涂片和（或）培养阳性（3例结核分枝杆菌药敏试验提示耐药）;40例（60.61%,40/66）结核分枝杆菌聚合酶链反应检测阳性,38例（57.58%,38/66）病理检测结果为干酪样坏死或者结核性肉芽肿。 结论 EBUS-TBNA在纵隔淋巴结结核特别是耐药纵隔淋巴结结核的早期诊断上可能具有一定的价值。     

气道内超声实时引导下经支气管针吸活检术的临床应用

气道内超声技术于20世纪90年代初已应用于临床~([1]),早期的超卢探头为辐射探头(radial probe),丰要用于对气管肇及周围组织的微细结构进行观察,藉此可评价气管壁的情况,以及气管肿瘤或其他病变的影响程度~([2]).     

Histological diagnosis of spinal chondrosarcoma by endobronchial ultrasound-guided transbronchial needle aspiration

Rare neoplastic diseases including sarcomas can occur in the middle mediastinum. Obtaining a histological specimen is crucial for diagnosis and for establishing a treatment plan. Our research group has recently reported a minimal invasive method of tissue sampling of the mediastinum using direct real-time endobronchial ultrasound-guided transbronchial needle aspiration. By the use of this new modality, histological cores can be obtained for pathological diagnosis that can be used for immunohistochemistry as well as genetic analysis. A very rare case of spinal chondrosarcoma due to hereditary multiple exostoses successfully diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration and by immunohistochemistry with genetic analysis is reported.     

经支气管镜超声内镜针吸活检应用进展

气管镜超声引导针吸活检术是近年来出现的一项新的微创诊断技术,目前有关其在肺癌诊断和分期中的应用价值、诊断纵隔淋巴结等病变正日益引起人们的关注。本文就这一技术的临床应用现状作一综述。