经气管镜超声引导针吸活检术诊断纵隔病变的价值

目的 探讨经气管镜超声引导针吸活检术(EBUS-TBNA)用于纵隔病变定性诊断的价值及最佳应用范围.方法 对接受EBUS-TBNA检查的123例纵隔病变患者,以最终诊断为金标准,分析EBUS-TBNA诊断纵隔病变的准确率、灵敏度、特异度、阳性及阴性预测值,判断其对于不同纵隔病变的诊断价值,并深入分析EBUS-TBNA用于诊断纵隔病变的最佳范围.结果 全部患者共穿刺286组淋巴结,穿刺成功率为100％,无并发症.穿刺部位最终诊断阳性83例,其中EBUS-TBNA直接诊断79例.EBUS-TBNA诊断纵隔病变准确率为96.7％,灵敏度为95.2％,特异度为100％,阳性预测值为100％,阴性预测值为90.0％.针对上皮性癌患者,EBUS-TBNA的诊断准确率为98.8％,灵敏度为98.8％,特异度为100％,阳性预测值为100％,阴性预测值为100％.3例淋巴瘤患者EBUS-TBNA未能诊断.对于纵隔良性病变,EBUS-TBNA能够给出具有临床价值的疾病诊断率为47.2％.结论 对于上皮性癌,EBUS-TBNA有望取代纵隔镜检查成为首选的诊断方法;对于包括肉芽肿在内的纵隔良性病变,EBUS-TBNA的诊断价值尚受到诊断设备及技术的限制,存在较大提升空间.对于淋巴瘤等特殊病变,纵隔镜检查尚无法替代,但EBUS-TBNA有望成为一种较好的早期筛查方法.

Evaluation of the value of EBUS-TBNA in diagnosis of mediastinal lesions

Objective To evaluate the value of endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)in diagnosis of mediastinal lesions and to discuss its optimal indication.Methods One hundred and twenty three patients with mediastinal lesions who underwent EBUS-TBNA were included in this study.The accuracy,sensitivity,specificity,positive and negative predictive value of EBUS-TBNA in diagnosis of mediastinal lesions were analyzed according to the final diagnosis and evaluate its value and the optimal indication.Results In the 123 patients,EBUS-TBNA was successfully performed to obtain samples from 286 stations of lymph nodes(2.33 stations/per patient).The puncture success rate was 100％.The procedure was uneventful without complications.Final diagnosis indicated that there were 83 positive and 40 negative patients.EBUS-TBNA had a sensitivity of 95.2％,specificity of 100％,positive predictive value of 100％,negative predictive value of 90.0％,and overall accuracy of 96.8％.For diagnosis of the epithelial cancer,EBUS-TBNA had an accuracy of 98.8％,sensitivity of 98.8％,specificity of 100％,positive predictive value of 100％,and negative predictive value of 100％.EBUS-TBNA failed to reveal three lymphomas.For diagnosis of benign mediastinal diseases,EBUS-TBNA had a diagnosis rate of 47.2％ which had a confirmed clinical application value.Conclusions EBUS-TBNA may be expected to replace the mediastinoscopy as a superior choice for diagnosis of mediastinal epithelial cancers.EBUS-TBNA can not replace mediastinoscopy but being a promising tool for diagnosis of benign mediastinal lesions including granulornas.For certain special diseases such as lymphoma,mediastinoscopy cannot be replaced.However,EBUS-TBNA can be a potentially favorite choice for early stage screening.