[超声引导下经支气管针吸活检作为肺癌和结节病的诊断工具]

[Ultrasound guided transbronchial needle aspiration as a diagnostic tool for lung cancer and sarcoidosis].

作者信息

Szlubowski Artur, Kuzdzał Jarosław, Pankowski Juliusz, Obrochta Anna, Soja Jerzy, Hauer Jolanta, Kołodziej Marcin, Zieliński Marcin

机构信息

Samodzielny Publiczny Specjalistyczny Szpital Chorób Pluc, ul. Gladkie 1, Zakopane.

出版信息

Pneumonol Alergol Pol. 2008;76(4):229-36.

PMID:18785127

Abstract

INTRODUCTION

The aim of the study was to assess the diagnostic yield of ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in mediastinal or hilar adenopathy in: 1) staging of non-small cell lung cancer (NSCLC) (97); 2) other malignant neoplasms including: small cell lung cancer (SCLC), metastatic neoplasms and Hodgkin's disease (16); 3) NSCLC recurrence (7); 4) sarcoidosis and other non-malignant diseases (29).

MATERIAL AND METHODS

Real time EBUS-TBNA was performed under local anaesthesia and sedation in 149 consecutive patients - 237 biopsies in groups of lymph nodes: subcarinal (7) - 107, all paratracheal (2R, 2L, 4R, 4L) - 86, hilar (10R, 10L) - 41 and interlobar (11R, 11L) - 3. A mean axis of punctured node was 15 mm (range: 7-42 mm). All negative results were verified by transcervical extended bilateral mediastinal lymphadenectomy (TEMLA), mediastinoscopy or thoracotomy.

RESULTS

Lymph node biopsy was technically successful in 92% and was diagnostic in 55% of lung cancer patients and in 85.7% of sarcoidosis patients. In NSCLC staging sensitivity of EBUS-TBNA was 88.7%, specificity 100%, accuracy 92.8% and NPV 83.3% (89.7%, 100%, 94.9% and 90.9% per biopsy), and in the whole group it was 91.5%, 98.7%, 94.6% and 87.3% respectively. In 7.2% of NSCLC staging patients with false negative results of EBUS-TBNA (mainly subcarinal) there was observed partial involvement of metastatic lymph nodes, mean 34.3% (range 10-50%), confirmed by TEMLA.

CONCLUSION

The diagnostic value of EBUS-TBNA is very high in lung cancer, NSCLC staging and sarcoidosis.

摘要

引言

本研究的目的是评估超声引导下经支气管针吸活检术（EBUS-TBNA）对以下情况纵隔或肺门淋巴结肿大的诊断效能：1）非小细胞肺癌（NSCLC）分期（97例）；2）其他恶性肿瘤，包括小细胞肺癌（SCLC）、转移性肿瘤和霍奇金病（16例）；3）NSCLC复发（7例）；4）结节病和其他非恶性疾病（29例）。

材料与方法

对149例连续患者在局部麻醉和镇静下进行实时EBUS-TBNA，共对多组淋巴结进行237次活检：隆突下（7组）-107次，所有气管旁（2R、2L、4R、4L）-86次，肺门（10R、10L）-41次，叶间（1R、1L）-3次。穿刺淋巴结的平均直径为15mm（范围：7-42mm）。所有阴性结果均通过经颈扩大双侧纵隔淋巴结清扫术（TEMLA）、纵隔镜检查或开胸手术进行验证。

结果

淋巴结活检技术成功率为92%，肺癌患者诊断率为55%，结节病患者诊断率为85.7%。在NSCLC分期中，EBUS-TBNA的敏感性为88.7%，特异性为100%，准确性为92.8%，阴性预测值为83.3%（每次活检分别为89.7%、100%、94.9%和90.9%），在整个研究组中分别为91.5%、98.7%、94.6%和87.3%。在7.2%的NSCLC分期患者中，EBUS-TBNA出现假阴性结果（主要为隆突下），经TEMLA证实存在转移性淋巴结部分受累，平均为34.3%（范围10-50%）。