使用支气管内超声弹性成像鉴别良恶性淋巴结。
Differentiating malignant and benign lymph nodes using endobronchial ultrasound elastography.
机构信息
Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, HsinChu, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, HsinChu, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Chutung Branch, Chutung, Taiwan.
出版信息
J Formos Med Assoc. 2019 Jan;118(1 Pt 3):436-443. doi: 10.1016/j.jfma.2018.06.021. Epub 2018 Jul 12.
BACKGROUND/PURPOSE: Endobronchial ultrasound (EBUS) elastography is a new technique that provides information on tissue compressibility during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). The purposes of this study were to evaluate the utility of EBUS elastography in differentiating malignant and benign mediastinal lymph nodes (LNs) and to explore the factors that influence its accuracy.
METHODS
A retrospective chart review of patients who underwent EBUS-TBNA from October 2016 to July 2017 was performed. EBUS with conventional B-mode features and elastographic patterns were compared with the final pathology results or clinical follow-up. We used the following EBUS elastographic patterns for classification: type 1, predominantly non-blue (green, yellow and red); type 2, part blue, part non-blue; type 3, predominantly blue. The potential impacts of the characteristics of LNs, the underlying lung diseases and obtaining fibrotic components from EBUS-TBNA specimens were evaluated relative to the accuracy of EBUS elastography.
RESULTS
A total of 206 LNs from 94 patients were retrospectively evaluated. In classifying type 1 as 'benign' and type 3 as 'malignant,' the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy rate were 90.6, 82.6, 71.6, 94.7 and 85.2%, respectively. The EBUS elastographic patterns had higher diagnostic yields and negative predictive values than conventional B-mode features. Logistic regression analysis revealed that central necrosis was a factor that influenced the accuracy of elastography in malignant LNs. The fibrotic component within benign LNs could cause an incorrect elastographic pattern.
CONCLUSION
EBUS elastography is a valuable tool in discriminating benign and malignant mediastinal LNs.
背景/目的：支气管内超声（EBUS）弹性成像是一种新技术，可提供支气管内超声引导下经支气管针吸活检（EBUS-TBNA）过程中组织可压缩性的相关信息。本研究旨在评估 EBUS 弹性成像在鉴别良恶性纵隔淋巴结（LNs）中的作用，并探讨影响其准确性的因素。
方法
回顾性分析了 2016 年 10 月至 2017 年 7 月期间接受 EBUS-TBNA 的患者的病历。将 EBUS 的常规 B 模式特征和弹性成像模式与最终病理结果或临床随访进行比较。我们使用以下 EBUS 弹性成像模式进行分类：1 型，主要为非蓝色（绿色、黄色和红色）；2 型，蓝色和非蓝色部分；3 型，主要为蓝色。评估 LN 的特征、基础肺部疾病以及从 EBUS-TBNA 标本中获得纤维化成分的特点对 EBUS 弹性成像准确性的潜在影响。
结果
共回顾性评估了 94 例患者的 206 个 LN。将 1 型分类为“良性”，3 型分类为“恶性”，其敏感性、特异性、阳性预测值、阴性预测值和诊断准确率分别为 90.6%、82.6%、71.6%、94.7%和 85.2%。与常规 B 模式特征相比，EBUS 弹性成像模式具有更高的诊断率和阴性预测值。Logistic 回归分析显示，中央坏死是影响恶性 LN 弹性成像准确性的因素。良性 LN 内的纤维化成分可能导致错误的弹性成像模式。
结论
EBUS 弹性成像在鉴别良恶性纵隔 LN 方面是一种有价值的工具。
Zotero 插件