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[经支气管针吸活检术在支气管内恶性病变诊断中的价值]

[Value of transbronchial needle aspiration in the diagnosis of endobronchial malignant lesions].

作者信息

Uskül Bahadir Taha, Türker Hatice, Melikoğlu Alkin, Yilmaz Adnan, Boğa Sibel, Ulman Can

机构信息

Süreyyapaşa Thoracic and Cardiovascular Diseases Training and Research Hospital, Istanbul, Turkey.

出版信息

Tuberk Toraks. 2007;55(3):259-65.

Abstract

Aim of our study was to investigate the sensitivity of transbronchial needle aspiration (TBNA) and its contributions to conventional diagnostic methods (CDM) in the endobronchial lesions of the patients who underwent TBNA during fiberoptic bronchoscopy (FOB) and had final diagnosis of lung cancer. Bronchoscopy records of 1194 patients, who underwent FOB for uncertain lung cancer in our clinic, were reviewed retrospectively. Eighty-one patients with final histopathological diagnosis of primary lung cancer who underwent TBNA, were included to study. Endobronchial lesions were divided into three groups as endobronchial mass, submucosal lesions and peribronchial diseases. Other CDMs performed during bronchoscopy such as forceps biopsy, bronchial brushing and bronchial lavage were also recorded. Sixty-six (82%) of 81 patients were diagnosed by means of FOB. Remaining 15 (18%) patients were diagnosed by means of other methods than FOB. The diagnostic successes of TBNA and CDMs alone and together, were compared according to the types, locations and histopathological types of the lesions. By the addition of TBNA to CDMs, histopathological diagnosis was made in 17 (21%) additional patients and diagnostic sensitivity of bronchoscopy was increased from 60% to 82% (p= 0.001). By the addition of TBNA to CDMs, a statistically significant increase in the sensitivity in the submucosal lesion group was observed (p= 0.008). By the addition of TBNA to CDMs, diagnostic success was increased from 52% to 76% in the non-small cell lung cancer group and from 81% to 95% in the small cell lung cancer group (p= 0.001 and p= 0.250, respectively). Although the diagnostic success was increased in all localizations by the addition of TBNA to CDMs, statistically significant increase was observed only for the lesions located at trachea and the main bronchi (p= 0.008). Joining TBNA to CDMs, especially for the submucosal lesions, may improve the diagnostic success of bronchoscopy.

摘要

我们研究的目的是调查经支气管针吸活检术(TBNA)的敏感性及其对在纤维支气管镜检查(FOB)期间接受TBNA且最终诊断为肺癌的患者支气管内病变的传统诊断方法(CDM)的贡献。回顾性分析了在我们诊所因肺癌诊断不明确而接受FOB的1194例患者的支气管镜检查记录。纳入81例最终经组织病理学诊断为原发性肺癌且接受了TBNA的患者进行研究。支气管内病变分为支气管内肿块、黏膜下病变和支气管周围疾病三组。还记录了在支气管镜检查期间进行的其他CDM,如钳取活检、支气管刷检和支气管灌洗。81例患者中有66例(82%)通过FOB确诊。其余15例(18%)患者通过FOB以外的其他方法确诊。根据病变的类型、位置和组织病理学类型,比较了单独及联合使用TBNA和CDM的诊断成功率。在CDM中加入TBNA后,另外17例(21%)患者获得了组织病理学诊断,支气管镜检查的诊断敏感性从60%提高到了82%(p=0.001)。在CDM中加入TBNA后,黏膜下病变组的敏感性有统计学意义的增加(p=0.008)。在CDM中加入TBNA后,非小细胞肺癌组的诊断成功率从52%提高到了76%,小细胞肺癌组从81%提高到了95%(分别为p=0.001和p=0.250)。虽然在CDM中加入TBNA后所有部位的诊断成功率均有所提高,但仅在气管和主支气管部位的病变中观察到有统计学意义的增加(p=0.008)。将TBNA加入CDM,尤其是对于黏膜下病变,可能会提高支气管镜检查的诊断成功率。

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