支气管内超声引导下经支气管针吸活检术在纵隔及肺门病变诊断中的效能

Efficacy of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of mediastinal and hilar lesions.

作者信息

Liu Ting, Zhang Wenli, Liu Chunmei, Wang Leqiang, Gao Haipeng, Jiang Xiaoxue

机构信息

Department of Plumonary and Critical Care Medicine, Weifang People's Hospital, No.151 Man Street, Guang Wen District, Wei Fang, Shandong 261041, China.

出版信息

Curr Med Imaging. 2023 Apr 28. doi: 10.2174/1573405620666230428121243.

DOI:10.2174/1573405620666230428121243

PMID:37132317

Abstract

BACKGROUND

Mediastinal and hilar lesions may be benign or malignant. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is increasingly used for the diagnosis of these lesions as it is both minimally invasive and safe.

OBJECTIVE

To investigate the clinical efficacy of EBUS-TBNA in the diagnosis and differential diagnosis of mediastinal and hilar lesions.

METHODS

A retrospective observational study was undertaken to investigate patients diagnosed with mediastinal and hilar lymphadenopathy based on imaging at our hospital from 2020 to 2021. After evaluation, EBUS TBNA was used and data including the puncture site, postoperative pathology, and complications were recorded.

RESULTS

Data from 137 patients were included in the study, of which 135 underwent successful EBUS TBNA. A total of 149 lymph node punctures were performed, of which 90 punctures identified malignant lesions. The most common malignancies were small-cell lung carcinoma, adenocarcinoma, and squamous cell carcinoma. Forty-one benign lesions were identified, resulting from sarcoidosis, tuberculosis, and reactive lymphadenitis, amongst others. Follow-up findings showed that 4 cases were malignant tumors, with 1 case of pulmonary tuberculosis and 1 case of sarcoidosis). Four specimens where lymph node puncture was insufficient were subsequently confirmed by other means. The sensitivity of EBUS TBNA for malignant lesions, tuberculosis and sarcoidosis in mediastinal and hilar lesions was 94.7%, 71.4%, and 93.3%, respectively. Similarly, the negative predictive values (NPV) were 88.9%, 98.5%, and 99.2%, and the accuracy was 96.3%, 98.5%, and 99.3%.

CONCLUSION

EBUS TBNA is an effective and feasible approach for the diagnosis of mediastinal and hilar lesions that is minimally invasive and safe.

摘要

背景

纵隔和肺门病变可能是良性的，也可能是恶性的。支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）因其微创且安全，在这些病变的诊断中应用越来越广泛。

目的

探讨EBUS-TBNA在纵隔和肺门病变诊断及鉴别诊断中的临床疗效。

方法

进行一项回顾性观察研究，调查2020年至2021年在我院根据影像学诊断为纵隔和肺门淋巴结肿大的患者。经评估后，采用EBUS-TBNA，并记录穿刺部位、术后病理及并发症等数据。

结果

137例患者的数据纳入研究，其中135例EBUS-TBNA操作成功。共进行了149次淋巴结穿刺，其中90次穿刺确诊为恶性病变。最常见的恶性肿瘤为小细胞肺癌、腺癌和鳞状细胞癌。确诊41例良性病变，病因包括结节病、结核和反应性淋巴结炎等。随访结果显示，4例为恶性肿瘤，1例为肺结核，1例为结节病。另外4例淋巴结穿刺不足的标本随后通过其他方法得到确诊。EBUS-TBNA对纵隔和肺门病变中恶性病变、结核和结节病的敏感性分别为94.7%、71.4%和93.3%。同样，阴性预测值分别为88.9%、98.5%和99.2%，准确率分别为96.3%、98.5%和99.3%。