经支气管纵隔淋巴结针吸活检112例结果分析

目的:探讨经支气管针吸活检（transbronchial needle aspiration，TBNA）对肿大纵隔淋巴结诊断的应用价值。方法:回顾性分析2011年8月至2013年12月间在宝鸡市中心医院呼吸内科112例行胸部CT检查发现纵隔淋巴结肿大的病例，均行TBNA检查，总结穿刺结果及评价该技术的诊断价值和安全性。结果: 112例患者经TBNA检查7个部位共197组淋巴结,TBNA穿刺共410针，其中成功394针（96.1%）。95例恶性肿瘤患者中，TBNA总结果阳性90例（94.74%），其中32例患者的TBNA结果是唯一病理学依据。32例患者行肺癌根治术，以术后淋巴结病理结果为参考，TBNA判断肺癌纵隔淋巴结分期诊断的敏感性、特异性、准确性、阳性预测值和阴性预测值分别是96.05%、100%、96.51%、100%、76.92%。22例TBNA阴性患者中，除6例经过TBNA确诊为结节病外，其余经开胸手术确诊，1例为淋巴瘤，4例为纵隔淋巴结转移癌，11例为阴性。在纵隔肿大淋巴结诊断中，敏感性、特异性和准确性分别为92.63%，100%和93.75%。小细胞肺癌TBNA的阳性率高于非小细胞肺癌，P＜0.01。直径≥3cm淋巴结TBNA的阳性率稍高，但差异无统计学意义。结论:TBNA对纵隔淋巴结诊断有很大帮助，且安全易行，值得基层医院临床推广应用。

The results of transbronchial needle aspiration in 112 cases with enlarged mediastinal lymph node

Objective:To evaluate the clinical value of transbronchial needle aspiration(TBNA) in the diagnosis of patients with enlarged mediastinal lymph node.Methods:The clinical data of patients with enlarged mediastinal lymph node proven by CT scan who were eligible for TBNA from August 2011 to December 2013 in our department were retrospectively analyzed.The diagnostic sensitivity,accuracy,specificity,positive predictive value and negative predictive value were evaluated.Results:All 112 patients with 197 lymph nodes were punctured.TBNA procedures were successfully carried out in 394/410(96.1%).The positive rate of TBNA was 94.74%(90/95) in patients who had been proven to suffer from carcinoma.There were 32 patients that diagnosis of cancer was pathologically determined by TBNA only.32 patients who were diagnosed NSCLC within Ⅲa period with 86 lymph nodes were punctured.Overall diagnostic sensitivity,specificity,accuracy,positive predictive value and negative predictive value of cytopathology for mediastinal staging in TBNA specimens were 96.05%,100%,96.51%,100% and 76.92%.16 patients were examined by surgery:including 1 lymphoma,4 mediastinal lymph node metastasis carcinoma,and 11 negative cases.The sensitivity,specificity and accuracy in diagnosing mediastinal enlarged lymph nodes were 92.63%,100% and 93.75%.The positive rate of TBNA in SCLC was higher than that in NSCLC,P＜0.01.The positive rate of TBNA in lymph node which diameter was not less than 3 cm was higher,but the difference was not statistically significant.Conclusion:TBNA is a safe and effective technique in diagnosing mediastinal lymph node.