经支气管针吸活检术联合超声内镜引导下经食管细针穿刺活检术在纵隔肺门病变中的诊断价值  

Diagnostic value of transbronchial needle aspiration combined with transesophageal endoscopic ultrasound-guided fine needle aspiration in mediastinal and pulmonary hilar lesions

作　　者：李晓燕[1] 程贵余[2] 张智慧[3] 吕宁[4] 张月明[1] 邹霜梅[4] 薛丽燕[4] 张蕾[1] 倪晓光[1] 赖少清[1] 贺舜[1] 于桂香[1] 鞠凤环[1] 荀华英[1] 程荣荣[1] 王贵齐[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院内镜科,北京100021 [2]中国医学科学院北京协和医学院肿瘤医院胸外科,北京100021 [3]中国医学科学院北京协和医学院肿瘤医院细胞学室,北京100021 [4]中国医学科学院北京协和医学院肿瘤医院病理科,北京100021

出　　处：《中华肿瘤杂志》2009年第7期536-540,共5页Chinese Journal of Oncology

基　　金：863重大项目（2006AA02A401）;卫生部部署（管）临床学科重点项目（2007-2010）

摘　　要：目的探讨经支气管针吸活检术（TBNA）联合超声内镜引导下经食管细针穿刺活检术（EUS—FNA）在纵隔、肺门病变的定性诊断及肺癌N分期中的应用价值。方法对129例影像学检查提示存在纵隔、肺门病变的患者行TBNA或EUS—FNA，穿刺标本均行病理和细胞学检查。结果联合应用TBNA和EUS—FNA的诊断率为899％（116／129），其中行TBNA59例，诊断率为84．7％（50／59）；行EUS—FNA70例，诊断率为94．3％（66／70）。细胞学和病理学诊断率分别为92．2％（107／116）和87．9％（102／116）。通过病理检查，可使诊断率提高8．4％（9／107）。116例通过穿刺诊断的患者中，有103例患者得到明确组织分型，细胞学和病理组织分型诊断率分别为73．8％（76／103）和89．3％（92／103）。通过病理检查，可使组织分型诊断率提高35．5％（27／76）。结论联合应用TBNA和EUS—FNA能扩大穿刺技术对纵隔肺门病变的诊断范围，提高诊断水平。病理检查可提高TBNA和EUS—FNA的诊断率和组织分型的诊断率。Objective To evaluate the value of transbronchial needle aspiration （TBNA） combined with transesophageal endoscopic ultrasound-guided fine needle aspiration （EUS-FNA） in the diagnosis of mediastinal and pulmonary hilar lesions as well as in the lymph node staging （ N staging） of lung cancer. Methods 129 patients with mediastinal and pulmonary hilar lesions underwent either TBNA or EUS-FNA with cytological needle aspiration. The samples obtained from TBNA or EUS-FNA were examined by both cytologiy and histopathology. Results Of the 129 patients, 59 underwent TBNA and 70 EUS-FNA. The diagnostic rate were 84.7% （50/59）by TBNA and 94.3% （66/70） by EUS-FNA, resepectively. The diagnosis of 116 （89. 9% ）patients were confirmed by either TBNA or EUS-FNA. The pathological and cytological diagnostic rates were 92.2% （ 107/116 ） and 88.0% （102/116）, resepectively. The diagnostic rate was elevated by 8.4% （ 9/107 ） through pathological examination. The histological classification rates by cytological and pathological examination were 73.8% （76/116） and 89.3% （92/103）, respectively. The diagnostic rate of histological classification was elevated by 35.5% （27/76） through pathological examination. Conclusion The combination of TBNA and EUS-FNA can improve the diagnostic rate for wider mediastinal and pulmlonary hilar lesions. Pathological examination of the samples obtained from the TBNA and EUS-FNA can elevate not only the rate of diagnosis but also the rate of histological classification.

关 键 词：肺肿瘤 经支气管针吸活检术 超声内镜引导下细针穿刺活检术 

分 类 号：R686[医药卫生—骨科学]