气管镜下超声影像特征对肺癌纵隔／肺门淋巴结转移的诊断价值  

Diagnostic value of tracheal endoscopic ultrasound imaging to the mediastinal/hilar lymph node metastasis in the lung cancer patients

作　　者：汪浩[1] 姜洪斌[1] 任胜祥[1] 姜格宁[1] 张哲民[1] 周晓[1] 武春燕[1] 张海平[1] 

机构地区：[1]同济大学医学院附属上海市肺科医院胸外科,200433

出　　处：《中华胸心血管外科杂志》2012年第10期605-608,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨超声支气管镜引导下针吸活检术（EBUS—TBNA）超声影像特征对肺癌纵隔／肺门淋巴结的诊断价值。方法回顾性分析2009年10月至2011年9月422例经EBUS—TBNA检查术前未经抗肿瘤治疗的肺癌患者，病理明确诊断为肺癌且术后6个月随访胸部增强CT。肺癌患者683个纵隔／肺门淋巴结人组研究，其中男335例，女87例；年龄24—82岁，中位61岁，EBUS淋巴结超声图像结果与最终病理、随访结果进行比较。结果683个淋巴结短轴直径0．40—4．60cm，平均直径（1．58±0．68）cm；其中恶性淋巴结短轴平均直径（1．75±0．63）cm，良性淋巴结短轴平均直径（0．92±0．40）cm。超声图像下异质性淋巴结527个，其中恶性淋巴结519／527（98．5％）；均质性淋巴结156个，其中恶性淋巴结28／156（17．9％），两种超声图像差异有高度统计学意义（，=489．5，P〈0．01）。短轴直径〉1．0em异质性淋巴结是恶性的敏感性89．4％，特异性100％，准确性89．6％。结论EBUS—TBNA是纵隔／肺门淋巴结活检的一种新手段，基于EBUS成像分类为基础的淋巴结超声图像特征，可用于指导淋巴结穿刺顺序，预测肺癌患者淋巴结的良恶性。Objective To investigate the diagnostic value of EBUS imaging features for metastatic mediastinal/hilar lymph node enlargement in lung cancer. Methods the lung cancer patients with a pathological diagnosis and without preoperative anti-tumor treatment who got the EBUS-TBNA examination from October 2009 to September 2011 were retrospectively analysis. 422 lung cancer patients with 683 mediastinal / hilar lymph nodes were enrolled in this study, including 335 males and 87 females; the median age is 61 years old （range 24-82） , EBUS lymph node ultrasound image and the final pathological or follow-up results were compared by the statistical analysis. Homogeneity in the lymph node EBUS image feature was defined as ： uniform echo in the ultrasound images, cortex existed in the peripheral areas, medulla existed in lymph central with a slightly stronger echo and represent as a small strip. Heterogeneity was defined as ： the ultrasound image was defined as uneven echo involved with coagulation necrosis sign, which was the hypoechoie areas without blood flow in the lymph nodes and represent no blood flow in the CDPI mode. The coagulation necrosis was associated with necrosis within the lymph node. In addition, if the CNS region occupied more than 11% of the entire lymph node in a complete lymph node or just a part of huge lymph nodes in the EBUS imaging window frame, we also regard it as heterogeneity. If a complete lymph node was seen in the EBUS imaging window frame, we measured the longest diameter to the long axis and its vertical maximum diameter to the short axis. If the lymph node was huge and extended the EBUS imaging window frame, we measured the longest diameter in the frame as the long axis of its vertical maximum diameter to be the short axis. As to the EBUS-TBNA negative lymph nodes, we regarded it was malignant lymph node if the diameter of the lymph node increased by 20% in the patients who did not received any chemotherapy or radiotherapy or the diameter of the lymph node increased or decreased by 2

关 键 词：肺肿瘤 诊断 活组织检查 针吸 超声检查 介入性 

分 类 号：R734.2[医药卫生—肿瘤]