经支气管超声引导针吸活检术对肺内病变的诊断价值。

Diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration in intrapulmonary lesions.

机构信息

Department of Thoracic Surgery, Peking University People's Hospital, Beijing 100044, China.

出版信息

Chin Med J (Engl). 2013 Nov;126(22):4312-5.

Abstract

BACKGROUND

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is considered to have high value in the staging of mediastinal lymph nodes in lung cancer. The current study was conducted to investigate the diagnostic value of EBUS-TBNA in intrapulmonary lesions located near the central airway.

METHODS

From September 2009 to March 2013, 66 patients with pulmonary masses located close to the central airways suspected to be lung cancer were accessed by EBUS-TBNA. Conventional bronchoscopic biopsy before EBUS-TBNA was nondiagnostic in all cases. If EBUS-TBNA did not result in a formal pathological diagnosis of malignancy, patients were subsequently referred for a surgical procedure.

RESULTS

Among the 66 cases, 59 were confirmed as pulmonary malignancies by EBUS-TBNA, of which 48 cases were non-small cell lung cancer, nine were small cell lung cancer, and two were metastatic lung tumors. No evidence of malignancy was found by biopsy and histopathological examination in the other seven cases. Thoracoscopy or thoracotomy was subsequently undergone for them. Postoperative pathological examinations confirmed three cases of squamous cell carcinoma of the lung, one case of lymphoma, two cases of sclerosing hemangioma, and one case of pulmonary tuberculoma. The definitive diagnosis rate of EBUS-TBNA for intrapulmonary lesions near the central airway was 89.4%. The sensitivity, specificity, and accuracy of EBUS-TBNA in distinguishing benign from malignant intrapulmonary lesions were 93.7%, 100.0%, and 93.9%, respectively. The positive and negative predictive values were 100.0% and 42.9%, respectively. The EBUS-TBNA procedures were well-tolerated by all patients. No associated complications were observed.

CONCLUSIONS

For intrapulmonary lesions near the central airway highly suspected of cancer, EBUS-TBNA has satisfactory diagnostic value. However, the negative predictive value of this technique is low, so negative results obtained by EBUS-TBNA should be confirmed by other methods.

摘要

背景

经支气管超声引导针吸活检术（EBUS-TBNA）被认为在肺癌纵隔淋巴结分期中有很高的价值。本研究旨在探讨 EBUS-TBNA 在靠近中央气道的肺内病变中的诊断价值。

方法

从 2009 年 9 月至 2013 年 3 月，对 66 例怀疑肺癌的靠近中央气道的肺部肿块患者进行了 EBUS-TBNA 检查。所有患者在进行 EBUS-TBNA 检查之前的常规支气管镜活检均未作出明确诊断。如果 EBUS-TBNA 未能得出恶性肿瘤的正式病理诊断，患者随后将被转诊进行手术。

结果

在 66 例患者中，59 例通过 EBUS-TBNA 被确诊为肺部恶性肿瘤，其中 48 例为非小细胞肺癌，9 例为小细胞肺癌，2 例为转移性肺癌。其余 7 例活检和组织病理学检查未发现恶性证据。随后对他们进行了胸腔镜或开胸手术。术后病理检查证实 3 例为肺鳞癌，1 例为淋巴瘤，2 例为硬化性血管瘤，1 例为肺结核球。EBUS-TBNA 对靠近中央气道的肺内病变的明确诊断率为 89.4%。EBUS-TBNA 鉴别良恶性肺内病变的灵敏度、特异性和准确性分别为 93.7%、100.0%和 93.9%。阳性和阴性预测值分别为 100.0%和 42.9%。所有患者均能很好地耐受 EBUS-TBNA 检查。未观察到相关并发症。