支气管内超声引导针吸活检术在纵隔病变诊断及鉴别诊断中的应用价值  

Endobronchial Ultrasound-guided Transbronchial Needle Aspiration for Diagnosis and Differential Diagnosis of Mediastinal Lesions

作　　者：解桢[1] 赵辉[1] 周足力[1] 隋锡朝[1] 王俊[1] 

机构地区：[1]北京大学人民医院胸外科,北京100044

出　　处：《中国微创外科杂志》2013年第4期295-299,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：首都医学发展科研基金资助(项目号2009-3032)

摘　　要：目的探讨支气管内超声引导针吸活检术(endobronchial ultrasound-guided transbronchial needle aspiration,EBUS-TBNA)在单纯纵隔病变诊断及鉴别诊断中的应用价值。方法回顾分析2009年9月～2012年8月164例不伴肺内异常的单纯纵隔病变接受EBUS-TBNA检查的临床资料。组织病理学能够获得明确恶性或良性诊断的患者定义为"明确诊断";取材不满意或者无明确良恶性证据者定义为"未能明确诊断"。对EBUS-TBNA未能明确诊断的患者,进一步接受外科手术活检或至少6个月以上的临床及影像学随诊。结果所有患者检查均耐受良好,无并发症发生。经EBUS-TBNA检查139例获得明确诊断,其中恶性病变68例,良性病变71例,确诊率84.8%(139/164)。未能明确诊断25例,其中取材不满意6例,诊断非特异性淋巴结炎19例。25例未能明确诊断中,10例(包括6例取材不满意者)分别经纵隔镜、胸腔镜或锁骨上淋巴结活检确诊(淋巴瘤4例,Castleman病2例,结节病和纵隔淋巴结结核各1例,成熟性畸胎瘤1例、纵隔淋巴结反应性增生1例),剩余15例经临床及影像学随访均超过6个月,临床诊断无改变。EBUS-TBNA在单纯纵隔病变良恶性诊断和鉴别诊断方面的敏感性、特异性和准确性分别为91.9%(68/74),100%(90/90)和96.3%(158/164),避免了93.9%(154/164)外科活检手术的实施。结论对于单纯纵隔病变,EBUS-TBNA是一种安全有效的诊断及鉴别诊断方法。Objective To investigate the value of endobronchial ultrasound-guided transbronchial needle aspiration（EBUS-TBNA） in diagnosis and differential diagnosis of isolated mediastinal lesions.Methods We analyzed 164 cases of simple mediastinal lesions without pulmonary involvement,who received EBUS-TBNA for diagnosis in our hospital from September 2009 to August 2012.Definitive diagnosis was defined as diagnosis confirmed by pathological examinations,and indefinitive diagnosis was defined as missampling or incomplete sampling of tissues,or no definite proofs obtained.For patients with indefinitive diagnosis,a surgical biopsy or at least 6-month follow-up by imaging examination was carried out.Results The procedure was tolerated well in all the patients without causing any complications.Definitive diagnosis was achieved in 139 patients with EBUS-TBNA [68 cases of malignancies and 71 cases of benign lesions;rate of definite diagnosis： 84.8%（139/164）].Indefinitive diagnosis occurred in 25 patients,including missampling or incomplete sampling in 6 cases and atypical lymphnoditis in the other 19.In these 25 cases,a further diagnosis was then achieved in 10 cases（including the 6 cases of missampling or incomplete sampling） by mediastinoscopy,thoracoscopy,or supraclavicular lymph nodes biopsy,which discovered lymphoma in 4 patients,Castleman disease in 2,sarcoidosis in 1,tuberculosis of the mediastinal lymph nodes in 1,mature teratoma in 1,and reactive hyperplasia of the mediastinal lymph nodes in 1;the other 15 patients were followed up for at least 6 months by imaging examinations,which all confirmed the primary diagnosis.The sensitivity,specificity,and accuracy of EBUS-TBNA were 91.9%（68/74）,100%（90/90）,and 96.3%（158/164）,respectively.With the procedure,93.9%（154/164） of the patients avoided surgical biopsy.Conclusion For simple isolated mediastinal lesions,EBUS-TBNA is a safe and effective method for diagnosis and differential diagnosis.

关 键 词：支气管内超声引导针吸活检术 经支气管针吸活检术 纵隔病变 

分 类 号：R564[医药卫生—呼吸系统]