超声内镜引导下支气管针吸活检在肺癌及纵隔病变中的诊断价值
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摘要
目的探讨超声内镜引导下支气管针吸活检(endobronchial ultrasound-guided transbronchial needle aspiration,EBUS-TBNA)在肺癌及纵隔病变中的诊断价值。方法收集复旦大学附属中山医院呼吸内科2015年1至12月就诊病例,对经胸部CT或PET-CT检查显示肺门或纵隔淋巴结肿大及胸内气管、支气管旁肿块的368例患者行EBUS-TBNA检查,回顾分析其临床资料。结果 368例患者经病理学检查确诊恶性肿瘤252例,其中经EBUS-TBNA穿刺活检确诊恶性肿瘤232例,368例患者经EBUS-TBNA共穿刺387组淋巴结,气管、支气管旁肿块56例。EBUS-TBNA诊断肺癌敏感性和特异性分别为92.1%和100%。368例患者经穿刺病理或治疗随访考虑良性病变116例,其诊断符合率为92.9%。结论对于不明原因的肺门及纵隔肿块、纵隔淋巴结肿大的患者,EBUS-TBNA是一种有效、安全的诊断方法,有较高的诊断特异性和敏感性,可为肺癌手术治疗的准确分期提供帮助。
Objective To investigate the diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)in lung carcinoma and mediastinal lesions. Methods From Jan.,2015 to Dec.,2015,368 patients with hilar and/or mediastinal lymphadenopathy or mass outside the airways by CT scan or PET/CT in Department of Pulmonary Medicine,Zhongshan Hospital,Fudan University were enrolled and recieved EBUS-TBNA examination.All of their clinical data were collected. Results Retrospective analysis was performed in the 368 patients.In the 252 patients diagnosed as malignancy,232 patients were diagnosed by EBUS-TBNA,while the other 116 patients were diagnosed as benign disease.The diagnostic concordance rate was 92.9%.A total of 387 lymph nodes and 56 masses outside the airways were found among the 368 patients received EBUSTBNA procedure.The sensitivity and specificity of EBUS-TBNA were 92.1%and 100%,respectively.Conclusions EBUS-TBNA is an effective and safe method with high specificity and sensitivity in diagnosis of unknown hilar and/or mediastinal lymphadenopathy,mediastinal mass as well as lymph node staging in lung cancer patients.
Objective To investigate the diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)in lung carcinoma and mediastinal lesions. Methods From Jan.,2015 to Dec.,2015,368 patients with hilar and/or mediastinal lymphadenopathy or mass outside the airways by CT scan or PET/CT in Department of Pulmonary Medicine,Zhongshan Hospital,Fudan University were enrolled and recieved EBUS-TBNA examination.All of their clinical data were collected. Results Retrospective analysis was performed in the 368 patients.In the 252 patients diagnosed as malignancy,232 patients were diagnosed by EBUS-TBNA,while the other 116 patients were diagnosed as benign disease.The diagnostic concordance rate was 92.9%.A total of 387 lymph nodes and 56 masses outside the airways were found among the 368 patients received EBUSTBNA procedure.The sensitivity and specificity of EBUS-TBNA were 92.1%and 100%,respectively.Conclusions EBUS-TBNA is an effective and safe method with high specificity and sensitivity in diagnosis of unknown hilar and/or mediastinal lymphadenopathy,mediastinal mass as well as lymph node staging in lung cancer patients.
引文
[1]YASUFUKU K,NAKAJIMA T,FUJIWARA T,et al.Role of endobronchial ultrasound-guided transbronchial needle aspiration in the management of lung cancer[J].Gen Thorac Cardiovasc Surg,2008,56(6):268-276.
[2]TOLOZA EM,HARPOLE L,DETTERBEEK F,et al.Noninvasive staging of non-small cell lung cancer:a review of the current evidence[J].Chest,2003,123(1Suppl):137S-146S.
[3]高晓燕,罗广裕,单宏波,等.实时超声支气管镜引导下经支气管针吸活检术在胸部疾病中的诊断价值[J].临床外科杂志,2012,20(10):715-717.
[4]SAFWAT T,KHATTAB A,EL HADDAD S,et al.Endobronchial ultrasound-directed transbronchial needle aspiration in diagnosis of mediastinal lesions:Initial egyptian experience[J].J Bronchology Interv Pulmonol,2009,16(1):18-21.
[5]YASUFUKU K,PIERRE A,DARLING G,et al.A prospective controlled trial of endobronchial ultrasoundguided transbronchial needle aspiration compared with mediastinoscopy for mediastinal lymph node staging of lung cancer[J].Thorac Cardiovasc Surg,2011,142(6):1393-1400.
[6]GU P,ZHAO YZ,JIANG LY,et al.Endobronchial ultrasound-guided transbronchial needle aspiration for staging of lung cancer:a systematic review and meta-analysis[J].Eur J Cancer,2009,45(8):1389-1396.
[7]LEE BE,KLETSMAN E,RUTLEDGE JR,et al.Utility of endobronchial ultrasound-guided mediastinal lymph node biopsy in patients with non-small cell lung cancer[J].J Thorac Cardiovasc Surg,2012,143(3):585-590.
[8]NAVANI N,BOOTH H L,KOCJAN G,et al.Combination of endobronchial ultrasound guided transbronchial needle aspiration with standard bronchoscopic techniques for the diagnosis of stage I and stage pulmonary sarcoidosis[J].Respirology,2011,16(3):467-72.
[9]OKI M,SAKA H,KITAGAWA C,et al.Prospective study of endobronchial ultrasound guided transbronchial needle aspiration of lymph nodes versus transbronchial lung biopsy of lung tissue for diagnosis of sarcoidosis[J].J Thorac Cardiovasc Surg,2012,143(6):1324-1329.
[10]ECKARDT J,OLSEN KE,LICHT PB.Endobronchial ultrasound-guided transbronchial needle aspiration of undiagnosed chest tumors[J].World J Surg,2010,34(8):1823-1827.
[11]ERER OF,EROL S,ANAR C,et al.Diagnostic yield of EBUS-TBNA for lymphoma and review of the literature[J].Endosc Ultrasound,2017,6(5):317-322.
[12]STEINFORT DP,CONMN M,TSUI A,et al.Endobronchial ultrasound-guided transbronchial meedle aspiration for the evaluation of suspected lymphoma[J].J Thorac Oncol,2010,5(6):804-809.
[13]ALMEIDA FA.Bronchoscopy and endobronchial ultrasound for diagnosis and staging of lung cancer[J].Cleve Clin J Med,2012,79(Electronic Suppl1):eS11-eS16.
[2]TOLOZA EM,HARPOLE L,DETTERBEEK F,et al.Noninvasive staging of non-small cell lung cancer:a review of the current evidence[J].Chest,2003,123(1Suppl):137S-146S.
[3]高晓燕,罗广裕,单宏波,等.实时超声支气管镜引导下经支气管针吸活检术在胸部疾病中的诊断价值[J].临床外科杂志,2012,20(10):715-717.
[4]SAFWAT T,KHATTAB A,EL HADDAD S,et al.Endobronchial ultrasound-directed transbronchial needle aspiration in diagnosis of mediastinal lesions:Initial egyptian experience[J].J Bronchology Interv Pulmonol,2009,16(1):18-21.
[5]YASUFUKU K,PIERRE A,DARLING G,et al.A prospective controlled trial of endobronchial ultrasoundguided transbronchial needle aspiration compared with mediastinoscopy for mediastinal lymph node staging of lung cancer[J].Thorac Cardiovasc Surg,2011,142(6):1393-1400.
[6]GU P,ZHAO YZ,JIANG LY,et al.Endobronchial ultrasound-guided transbronchial needle aspiration for staging of lung cancer:a systematic review and meta-analysis[J].Eur J Cancer,2009,45(8):1389-1396.
[7]LEE BE,KLETSMAN E,RUTLEDGE JR,et al.Utility of endobronchial ultrasound-guided mediastinal lymph node biopsy in patients with non-small cell lung cancer[J].J Thorac Cardiovasc Surg,2012,143(3):585-590.
[8]NAVANI N,BOOTH H L,KOCJAN G,et al.Combination of endobronchial ultrasound guided transbronchial needle aspiration with standard bronchoscopic techniques for the diagnosis of stage I and stage pulmonary sarcoidosis[J].Respirology,2011,16(3):467-72.
[9]OKI M,SAKA H,KITAGAWA C,et al.Prospective study of endobronchial ultrasound guided transbronchial needle aspiration of lymph nodes versus transbronchial lung biopsy of lung tissue for diagnosis of sarcoidosis[J].J Thorac Cardiovasc Surg,2012,143(6):1324-1329.
[10]ECKARDT J,OLSEN KE,LICHT PB.Endobronchial ultrasound-guided transbronchial needle aspiration of undiagnosed chest tumors[J].World J Surg,2010,34(8):1823-1827.
[11]ERER OF,EROL S,ANAR C,et al.Diagnostic yield of EBUS-TBNA for lymphoma and review of the literature[J].Endosc Ultrasound,2017,6(5):317-322.
[12]STEINFORT DP,CONMN M,TSUI A,et al.Endobronchial ultrasound-guided transbronchial meedle aspiration for the evaluation of suspected lymphoma[J].J Thorac Oncol,2010,5(6):804-809.
[13]ALMEIDA FA.Bronchoscopy and endobronchial ultrasound for diagnosis and staging of lung cancer[J].Cleve Clin J Med,2012,79(Electronic Suppl1):eS11-eS16.