Department of Respiratory and Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Dingjiaqiao 87#, Nanjing, Jiangsu, China.
Department of pathology and pathophysiology, School of Medicine, Southeast University, Dingjiaqiao 87#, Nanjing, Jiangsu, China.
BMC Pulm Med. 2021 Dec 20;21(1):423. doi: 10.1186/s12890-021-01748-4.
Endobronchial ultrasound (EBUS) elastography has been used in EBUS-guided transbronchial needle aspiration (EBUS-TBNA) to identify malignant lymph nodes based on tissue stiffness. Rapid onsite cytological evaluation (ROSE) has been widely utilized for onsite evaluation of sample adequacy and for guiding sampling during EBUS-TBNA. The aim of this study was to investigate the diagnostic value of combined EBUS elastography and ROSE in evaluating mediastinal and hilar lymph node status.
Retrospective chart review was performed from December 2018 to September 2020. Patient demographics, EBUS elastography scores, and ROSE, pathologic, and clinical outcome data were collected. The EBUS elastography scores were classified as follows: Type 1, predominantly nonblue; Type 2, partially blue and partially nonblue; and Type 3, predominantly blue. A receiver operating characteristic curve was used to compare the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio for evaluation of malignant lymph nodes among the EBUS elastography, ROSE, and EBUS combined with ROSE groups.
A total of 245 patients (345 lymph nodes) were included. The sensitivity and specificity of the EBUS elastography group for the diagnosis of malignant lymph nodes were 90.51% and 57.26%, respectively. The sensitivity and specificity in the ROSE group were 96.32% and 79.05%, respectively. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of EBUS elastography combined with ROSE were 86.61%, 92.65%, 11.78, and 0.14, respectively, and the area under the curve was 0.942.
Combining EBUS elastography and ROSE significantly increased the diagnostic value of EBUS-TBNA in evaluating mediastinal and hilar lymph node status compared to each method alone.
经支气管超声引导针吸活检术（EBUS-TBNA）中已使用支气管内超声弹性成像来基于组织硬度识别恶性淋巴结。快速现场细胞学评估（ROSE）已广泛用于现场评估样本充足性，并指导 EBUS-TBNA 期间的采样。本研究旨在探讨联合 EBUS 弹性成像和 ROSE 在评估纵隔和肺门淋巴结状态方面的诊断价值。
对 2018 年 12 月至 2020 年 9 月的病历进行回顾性图表审查。收集患者人口统计学、EBUS 弹性成像评分以及 ROSE、病理和临床结果数据。EBUS 弹性成像评分分为以下三种类型：1 型，主要为非蓝色；2 型，部分蓝色和部分非蓝色；3 型，主要为蓝色。使用受试者工作特征曲线比较 EBUS 弹性成像、ROSE 和 EBUS 联合 ROSE 组评估恶性淋巴结的敏感性、特异性、阳性预测值、阴性预测值、阳性似然比和阴性似然比。
共纳入 245 例患者（345 个淋巴结）。EBUS 弹性成像组诊断恶性淋巴结的敏感性和特异性分别为 90.51%和 57.26%。ROSE 组的敏感性和特异性分别为 96.32%和 79.05%。EBUS 弹性成像联合 ROSE 的敏感性、特异性、阳性似然比和阴性似然比分别为 86.61%、92.65%、11.78 和 0.14，曲线下面积为 0.942。
与单独使用每种方法相比，联合使用 EBUS 弹性成像和 ROSE 可显著提高 EBUS-TBNA 评估纵隔和肺门淋巴结状态的诊断价值。
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