经气管镜超声引导针吸活检术诊断纵隔病变的价值  

Evaluation of the value of EBUS-TBNA in diagnosis of mediaslinal lesions

作　　者：胡鸿[1] 陈海泉[1] 陈颖[2] 叶挺[1] 平波[2] 杨富[1] 周建华[1] 罗晓阳[1] 沈磊[2] 

机构地区：[1]复旦大学上海医学院肿瘤学系复旦大学附属肿瘤医院胸外科,200032 [2]复旦大学上海医学院肿瘤学系复旦大学附属肿瘤医院病理科,200032

出　　处：《中华肿瘤杂志》2011年第10期787-790,共4页Chinese Journal of Oncology

基　　金：上海市卫生局青年科研项目（2009-28-8）

摘　　要：目的探讨经气管镜超声引导针吸活检术（EBUS—TBNA）用于纵隔病变定性诊断的价值及最佳应用范围。方法对接受EBUS-TBNA检查的123例纵隔病变患者，以最终诊断为金标准，分析EBUS—TBNA诊断纵隔病变的准确率、灵敏度、特异度、阳性及阴性预测值，判断其对于不同纵隔病变的诊断价值，并深入分析EBUS—TBNA用于诊断纵隔病变的最佳范围。结果全部患者共穿刺286组淋巴结，穿刺成功率为100％，无并发症。穿刺部位最终诊断阳性83例，其中EBUS—TBNA直接诊断79例。EBUS-TBNA诊断纵隔病变准确率为96．7％，灵敏度为95．2％，特异度为100％，阳性预测值为100％，阴性预测值为90．0％。针对上皮性癌患者，EBUS—TBNA的诊断准确率为98．8％，灵敏度为98．8％，特异度为100％，阳性预测值为100％，阴性预测值为100％。3例淋巴瘤患者EBUS—TBNA未能诊断。对于纵隔良性病变，EBUS—TBNA能够给出具有临床价值的疾病诊断率为47．2％。结论对于上皮性癌，EBUS-TBNA有望取代纵隔镜检查成为首选的诊断方法；对于包括肉芽肿在内的纵隔良性病变，EBUS—TBNA的诊断价值尚受到诊断设备及技术的限制，存在较大提升空间。对于淋巴瘤等特殊病变，纵隔镜检查尚无法替代，但EBUS—TBNA有望成为一种较好的早期筛查方法。Objective To evaluate the value of endobronchial ultrasound-guided transbronchial needle aspiration （EBUS-TBNA） in diagnosis of mediastinal lesions and to discuss its optimal indication. Methods One hundred and twenty three patients with mediastinal lesions who underwent EBUS-TBNA were included in this study. The accuracy, sensitivity, specificity, positive and negative predictive value of EBUS-TBNA in diagnosis of mediastinal lesions were analyzed according to the final diagnosis and evaluate its value and the optimal indication. Results In the 123 patients, EBUS-TBNA was successfully performed to obtain samples from 286 stations of lymph nodes （2.33 stations/per patient）. The puncture success rate was 100%. The procedure was uneventful without complications. Final diagnosis indicated that there were 83 positive and 40 negative patients. EBUS-TBNA had a sensitivity of 95.2%, specificity of 100%, positive predictive value of 100% , negative predictive value of 90.0% , and overall accuracy of 96.8%. For diagnosis of the epithelial cancer, EBUS-TBNA had an accuracy of 98.8%, sensitivity of 98.8%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 100%. EBUS-TBNA failed to reveal three lymphomas. For diagnosis of benign mediastinal diseases, EBUS-TBNA had a diagnosis rate of 47.2% which had a confirmed clinical application value. Conclusions EBUS-TBNA may be expected to replace the mediastinoscopy as a superior choice for diagnosis of mediastinal epithelial cancers. EBUS-TBNA can not replace mediastinoscopy but being a promising tool for diagnosis of benign mediastinal lesions including granulomas. For certain special diseases such as lymphoma, mediastinoscopy cannot be replaced. However, EBUS-TBNA can be a potentially favorite choice for early stage screening.

关 键 词：经气管镜超声引导针吸活检术 纵隔病变 诊断 

分 类 号：R564[医药卫生—呼吸系统] R734.5[医药卫生—内科学]