EBUS-TBNA和纵隔镜检查术在纵隔淋巴结诊断与分期中的对照研究  

Diagnosis and Staging of Mediastinal Lymphadenopathy:EBUS-TBNA Versus Mediastinoscopy

作　　者：廖日强[1] 杨学宁[1] 汪斌超[1] 严红虹[1] 钟文昭[1] 聂强[1] 叶云捷[1] 吴一龙[1] 

机构地区：[1]广东省人民医院肿瘤中心,广东省肺癌研究所,广东省医学科学院,广州市510630

出　　处：《中国肿瘤临床》2011年第24期1501-1504,共4页Chinese Journal of Clinical Oncology

基　　金：广东省科技厅科技攻关项目基金(编号:2006B60101010)

摘　　要：目的:以影像学纵隔淋巴结异常的患者为研究对象,比较EBUS-TBNA和纵隔镜检查术诊断纵隔淋巴结转移和肺癌纵隔分期的价值。方法:对纵隔淋巴结异常的患者先行EBUS-TBNA,不管EBUS-TBNA的结果如何,再行纵隔镜检查术。以病理结果或临床随访为标准,比较两者在诊断纵隔淋巴结转移和肺癌纵隔分期中的价值。结果:2009年12月至2011年4月期间,共33例患者纳入分析,其中23例最后确诊为肺癌,10例为良性病变;EBUS-TBNA和纵隔镜检查术对肺癌纵隔淋巴结分期的敏感性、特异性和准确率相同,分别为90.0%、100%和91.3%;诊断肺癌纵隔淋巴结转移的敏感性、特异度和准确率分别为88.5%、100%、91.4%和80.8%、100%、85.7%,差异无统计学意义;3例开胸术的患者未发现新的纵隔淋巴结转移;EBUS-TBNA检出90%(18/20)的阳性患者,但其中仅5例诊断出癌细胞或非小细胞肺癌;5组纵隔镜检查术假阴性的淋巴结有2组位于隆突下淋巴结。结论:EBUS-TBNA在肺癌纵隔分期和纵隔淋巴结转移诊断中的价值与纵隔镜检查术相似,两者具有互补性。对EBUS-TBNA阴性或者病理不能具体分型的患者,需再行纵隔镜检查术。Objective： To compare EBUS-TBNA and mediastinoscopy in yielding a diagnosis and staging of mediastinal in patients with mediastinal lymphadenopathy. Methods： Prospective enrolled patients with mediastinal lymphadenopathy underwent EBUS-TBNA following mediastinoscopy, regardless of the result of EBUS-TBNA. Pathologic result and clinical follow-up were used as the accepted standard to compare the role of EBUS-TBNA and mediastinoscopy. Results： EBUS-TBNA and mediastinoscopy were performed in 33 patients between December 2009 and April 2011. Lung cancer was proven in 23 patients, whereas the rest were benign cases. No significant differences were found between EBUS-TBNA and mediastinoscopy during the diagnosis. The sensitivity, specifici- ty, and accuracy of EBUS-TBNA as well as mediastinoscopy in mediastinal staging were 90.0%, 100%, and 91.3%, respectively. On the other hand, the sensitivity, specificity, and accuracy of EBUS-TBNA and mediastinoscopy in diagnosing mediastinal lymph nodes were 88.5%, 100%, 91.4% and 80.8%, 100%, and 85.7% respectively. No additional metastatic mediastinal lymph node was found after thoracotomy. Most of the mediastinal metastases （ 90%, 18/20 ） were diagnosed by EBUS-TBNA, however, 5 patients were diagnosed with cancer cells or non-small lung cancer. Five false-negative lymph node stations were observed on mediastinoscopy, and 2 were on the subcarinal lymph node station. Conclusion： EBUS-TBNA has high sensitivity, specificity, and accuracy in mediastinal staging and diagnosis yield as well as mediastinoscopy. Results of EBUS-TBNA and mediastinoscopy complement each other. However, the EBUS-TBNA result is negative or uncertain. Mediastinoscopy is required to assess the mediastinum if the EBUS-TBNA result is negative or uncertain.

关 键 词：EBUS-TBNA 纵隔镜检查术 纵隔淋巴结 肺癌 纵隔分期 

分 类 号：R734.2[医药卫生—肿瘤]