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.

Value of endobronchial ultrasound-guided transbronchial needle aspiration in hilar and mediastinal lesions

Objective To evaluate the diagnostic yield of endobronchial ultrasound-guided transbronchiai needle aspiration(EBUS-TBNA)in cases of undiagnosed intrapulmonary lesions.Methods A total of 89 patients with intrathoracic lesions underwent EBUS-TBNA.including 56 pulmonary lesions,7 lymph node staging in lung cancer patients,21 unknown hilar and/or mediastinal lymphadenopathies and 5 mediastinal tumors.All samples were evaluated for cytological and pathological examinations.Results No complication of EBUS-TBNA was observed.Among 89 cases,76 had positive results,5 negative and 5 cases excluded as unsatisfied samples.In 56 patients with pulmonary lesions.EBUS-TBNA demonstrated 45 malignant tumors,5 benign diseases,3 suspicious cancers,1 negative and 2 unsatisfied samples.In 7 lung cancer patients staged by EBUS-TBNA.5 showed metastasis and 2 showed no metastasis.In 21 cases with mediastinal and/or hilar lymphadenopathy,EBUS-TBNA demonstrated 3 malignant tumors,13 benign diseases.2 negative and 3 unsatisfied samples.All 5 mediastinal lesions were malignant.Three suspicious cancers were confirmed.1 bv CT-guided percutaneous transthoracic needle biopsy and 2 by clinical followups.In 2 lung cancer patients EBUS-TBNA showed negative.1 surgical sample showed metastasis and another nometastasis by PET-CT.Three negative cases were diagnosed as benign by clinical follow-ups.The diagnostic sensitivity,specificity,positive predictive value and negative predictive value of EBUS-TBNA were 95%,100%,100%and 20%respectively.Conclusion EBUS-TBNA is both effective and safe in making a diagnosis of intrathoracic lesions.