Gogia Pratibha, Insaf Tabassum Z, McNulty William, Boutou Afroditi, Nicholson Andrew G, Zoumot Zaid, Shah Pallav L
The NIHR Respiratory Biomedical Research Unit at the Royal Brompton and Harefield National Health Service (NHS) Foundation Trust and Imperial College, London, UK.
School of Public Health University at Albany, State University of New York, Rensselaer, NY, USA.
ERJ Open Res. 2016 Jan 20;2(1). doi: 10.1183/23120541.00053-2015. eCollection 2016 Jan.
The objective of this study was to assess the utility of endobronchial ultrasound (EBUS) morphology of lymph nodes in predicting benign cytology of transbronchial needle aspirates in a prospective observational study. Five ultrasonic morphological characteristics of mediastinal and hilar lymph nodes were recorded: size, shape, margins, echogenic appearance and the presence of a central blood vessel. These characteristics were correlated with the final diagnosis. A total of 402 consecutive patients (237 males and 165 females) undergoing EBUS were studied. The final diagnosis was malignant disease in 244 (60.6%) and benign disease in 153 (38.05%) subjects. Out of 740 sampled nodes, in 463 (62.6%) malignant cells were identified, whereas in 270 (36.5%) nodes, no malignant cells were identified. On univariate analysis small size, triangular shape and the presence of a central vessel were predictive of a benign aetiology. In the final multivariate model, a predictive probability of 0.811 (95% CI 0.72-0.91) for benign disease was found if lymph node size was <10 mm and a central vessel was present. Sonographic appearances of lymph nodes improve the predictive probability of EBUS for benign aetiologies, and may reduce the number of nodes requiring sampling and the need for further invasive investigations.
本研究的目的是在前瞻性观察研究中评估支气管内超声（EBUS）下淋巴结形态对预测经支气管针吸活检良性细胞学结果的效用。记录了纵隔和肺门淋巴结的五个超声形态学特征：大小、形状、边缘、回声表现及中央血管的存在情况。这些特征与最终诊断相关。共对402例连续接受EBUS检查的患者（237例男性和165例女性）进行了研究。最终诊断为恶性疾病的有244例（60.6%），良性疾病的有153例（38.05%）。在740个采样淋巴结中，463个（62.6%）发现了恶性细胞，而270个（36.5%）淋巴结未发现恶性细胞。单因素分析显示，小尺寸、三角形形状及中央血管的存在提示为良性病因。在最终的多变量模型中，如果淋巴结大小<10 mm且存在中央血管，则良性疾病的预测概率为0.811（95%CI 0.72 - 0.91）。淋巴结的超声表现提高了EBUS对良性病因的预测概率，并可能减少需要采样的淋巴结数量以及进一步进行侵入性检查的必要性。
