Jeebun Vandana, Harrison Richard Neil
Department of Respiratory Medicine, North Tees and Hartlepool NHS Foundation Trust, Cleveland, UK.
J Thorac Dis. 2017 May;9(Suppl 5):S350-S362. doi: 10.21037/jtd.2017.05.18.
We reviewed the diagnostic performance of endobronchial ultrasound transbronchial aspiration (EBUS-TBNA) on an unselected large cohort of patients who underwent the procedure in our institution in the past 3 years and to compare against published standards and existing literature.
All consecutive patients who underwent EBUS from January 2013 to December 2015 were included in the retrospective analysis, with a minimum of 6 months of clinico-radiological follow up. For assessing EBUS-TBNA performance, patients were analysed in three subgroups based on the indication for the EBUS-TBNA: in investigation of isolated mediastinal and/or hilar lymphadenopathy (IMHL), in staging of suspected or confirmed non-small cell lung cancer (NSCLC) and in making a tissue diagnosis in suspected thoracic or extrathoracic cancer. For patients subjected to EBUS-TBNA for staging in suspected lung cancer, accuracy of EBUS was measured by its ability to determine the true N2 stage.
A total of 1,656 lymph nodes and 138 peribronchial/peritracheal masses were sampled in 940 patients over the study period. The prevalence of reactive lymphadenopathy was 34%. The overall sensitivity to detect pathological disease was 81.6% (95% CI: 74.2-87.6%) whilst NPV was 74.8% (95% CI: 65.2-82.8%). Amongst patients who underwent EBUS-TBNA for staging purposes, the sensitivity for N2 staging was 83.7% (95% CI: 76.2-89.6%) and NPV was 81.6% (95% CI: 73.2-88.2%). The prevalence of N2 disease was 58%. In the subgroup of patients who proceeded to surgical sampling, the sensitivity was higher with the N2/N3 disease prevalence of 67.4%. The sensitivity of EBUS-TBNA to make a tissue diagnosis of thoracic or extrathoracic cancer was 88% (95% CI: 85.1-90.5%) and a NPV of 62% (95% CI: 54.7-69.0%). The disease prevalence was 83.6%.
This retrospective study of a large volume of patients represents real life practice and provides an accurate representation of the typical cohort of patients referred in for EBUS-TBNA to the general respiratory physician in UK. Our study highlights the pitfalls in collecting and analyzing data but also demonstrates how they can be used to improve service performance.
我们回顾了在过去3年于我们机构接受支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）的未经选择的大量患者队列的诊断性能，并与已发表的标准和现有文献进行比较。
纳入2013年1月至2015年12月期间所有连续接受EBUS的患者进行回顾性分析，临床放射学随访至少6个月。为评估EBUS-TBNA的性能，根据EBUS-TBNA的适应证将患者分为三个亚组：孤立性纵隔和/或肺门淋巴结病（IMHL）的检查、疑似或确诊的非小细胞肺癌（NSCLC）分期以及疑似胸内或胸外癌症的组织诊断。对于因疑似肺癌分期而接受EBUS-TBNA的患者，通过其确定真正N2期的能力来衡量EBUS的准确性。
在研究期间，940例患者共采集了1656个淋巴结和138个支气管周围/气管周围肿物。反应性淋巴结病的患病率为34%。检测病理性疾病的总体敏感性为81.6%（95%CI：74.2-87.6%），阴性预测值为74.8%（95%CI：65.2-82.8%）。在因分期目的接受EBUS-TBNA的患者中，N2分期的敏感性为83.7%（95%CI：76.2-89.6%），阴性预测值为81.6%（95%CI：73.2-88.2%）。N2疾病的患病率为58%。在进行手术采样的患者亚组中，敏感性更高，N2/N3疾病患病率为67.4%。EBUS-TBNA对胸内或胸外癌症进行组织诊断的敏感性为88%（95%CI：85.1-90.5%），阴性预测值为62%（95%CI：54.7-69.0%）。疾病患病率为83.6%。
这项对大量患者的回顾性研究代表了实际临床实践，并准确呈现了英国普通呼吸科医生转诊接受EBUS-TBNA的典型患者队列。我们的研究突出了数据收集和分析中的缺陷，但也展示了如何利用这些数据来改善服务性能。
