超声内镜引导针吸活检对肺门及纵隔占位性病变的诊断价值  

Evaluation of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of hilar and mediastinal masses of unknown etiologies

作　　者：胡洁[1] 苏永华[1] 殷霞[1] 洪群英[1] 李春[1] 叶茂松[1] 李菁[1] 胡沁[2] 石园[2] 白春学[1] 张新[1] 

机构地区：[1]复旦大学附属中山医院呼吸内科,上海200032 [2]复旦大学附属中山医院病理科,上海200032

出　　处：《中华医学杂志》2012年第8期528-531,共4页National Medical Journal of China

基　　金：基金项目：上海市重点学科（第二期）建设计划项目（B115）

摘　　要：目的 探讨超声内镜引导下经支气管针吸活检（EBUS-TBNA）对经传统方法检查不能明确病因的肺门及纵隔占位性病变的诊断价值.方法 收集2009年9月至2011年3月在中山医院就诊的纵隔和（或）肺门占位性病变患者91例,行EBUS-TBNA检查,对病理结果与诊断符合率进行对比分析.结果 91例均顺利完成EBUS-TBNA,其中恶性肿瘤61例,敏感度为91.7％,特异度为100％,诊断符合率为91.8％；良性病变30例,其诊断符合率为60.0％.获取组织条标本者,具有较完整病理组织结构的比例为36.9％（24/65）.对良性病变和全部病例,细胞学联合组织病理检查诊断符合率明显高于单纯细胞学检查（P＜0.01）,对恶性病变,联合检测诊断符合率较单纯细胞学检测有增高趋势,但差异无统计学意义（P＞0.05）.结论 EBUS-TBNA诊断病因不明的肺门及纵隔占位性病变安全、有效,对良、恶性病变的诊断价值不同.Objective To explore the diagnostic values of endobronchial ultrasound-guided transbronchial needle aspiration （EBUS-TBNA） in the patients with hilar and mediastinal masses.Methods A total of 91 patients with mediastinal/hilar masses undergoing EBUS-TBNA in Zhongshan Hospital between September 2009 and March 2011 were retrospectively enrolled.Their unknown etiologies were difficult to be assessed by a traditional biopsy.The association of pathologic examinations and clinical data were analyzed.Results Among them,61 patients had malignant lesions while 30 patients were diagnosed with benign diseases.In the cases with malignant lesions,the diagnostic sensitivity,specificity and accordance rate were 91.67%,100% and 91.80% respectively.The diagnostic accordance rate of benign lesions was 60%.And 36.9% （24/65） of the samples were small-sized so as to improve the diagnostic accuracy.The combination of cytology and histology significantly increased the diagnostic accordance versus cytology alone in all cases （P 〈0.01 ）. But there was no statistically significant difference in the malignant lesion subgroup with a better tendency （P 〉 0.05 ）. No severe complication occurred. Conclusion With a high diagnostic accuracy and a low complication rate for the patients with hilar and mediastinal masses of unknown etiologies,EBUS-TBNA has different values for diagnosing malignant and benign lesions.

关 键 词：支气管镜检查 腔内超声检查 活组织检查 针吸 肺门 纵隔 

分 类 号：R445.1[医药卫生—影像医学与核医学]