气管内超声引导下经支气管针吸活检在肺外肿瘤胸内转移中的诊断价值  

Endobronchial Ultrasound-guided Transbronchial Needle Aspiration in the Diagnosis of Intrathoracic Metastasis from Extrapulmonary Malignancy

作　　者：孙加源[1] 鲍亮[1,2] 滕家俊[1] 钟润波[1] 翁薇琼 张琴[1] 韩宝惠[1] 

机构地区：[1]上海交通大学附属胸科医院内镜室,上海200030 [2]江苏省无锡市第二人民医院呼吸科,无锡214002

出　　处：《中国肺癌杂志》2015年第5期295-300,共6页Chinese Journal of Lung Cancer

基　　金：上海市级医院新兴前沿技术项目(No.SHDCl2010101);上海市卫生局项目(No.20124270);上海市科委科研计划项目(No.134119a6001);上海市胸科医院科技发展基金重大重点项目(No.2014YZDC20200)资助~~

摘　　要：背景与目的气管内超声引导下经支气管针吸活检(endobronchial ultrasound-guided transbronchial needle aspiration,EBUS-TBNA)已广泛应用于增大纵隔及肺门淋巴结的诊断,本研究旨在进一步评价EBUS-TBNA对肺外恶性肿瘤胸内转移的诊断价值和安全性。方法前瞻性入组既往诊断/新发肺外恶性肿瘤、影像学检查提示肺内病变和/或胸内淋巴结增大怀疑为肺外恶性肿瘤胸内转移所致,需行EBUS-TBNA取得病理诊断的患者。结果共41例患者入组,穿刺纵隔/肺门淋巴结67组,肺内肿块5例。EBUS-TBNA明确诊断肺外肿瘤胸内转移14例,原发性肺癌10例,反应性淋巴结炎9例,类结节病反应4例,结核1例;假阴性3例。EBUS-TBNA对肺外肿瘤胸内转移诊断的敏感性和准确性分别为87.50%和95.12%。18例来源或类型不明的恶性肿瘤中,结合免疫组化检测,明确诊断肺外肿瘤胸内转移12例和原发性肺癌6例。结论 EBUS-TBNA是诊断肺外肿瘤胸内转移一种安全、有效的方法,免疫组化检测结果可为鉴别肺外肿瘤胸内转移和原发性肺癌提供有效依据。Background and objective Endobronchial ultrasound guided transbronchial needle aspiration （EBUS-TBNA） has been widely applied in diagnosing mediastinal and hilar adenopathy. hTis study is further to evaluate value and safety of EBUS-TBNA in diagnosing intrathoracic metastasis from extrapulmonary malignancy. Methods Prospectively analysis of 41 patients suspected intrathoracic metastasis from previous diagnosed/concurrent extrapulmonary malignancies in Shanghai Chest Hospital, with radiologic ifndings showing mediastinal/hilar lymph node enlargement or intrapulmonary lesion requiring EBUS-TBNA examination for pathological diagnosis. Results 41 candidate patients enrolled, and 67 mediastinal/hilar lymph nodes and 5 intrapulmonary lesions were aspirated. 14 intrathoracic metastasis, 10 primary lung cancer, 9 reactive lymphadenitis, 4 sarcoid-like reactions, and 1 tuberculosis was diagnosed by EBUS-TBNA. Sensitivity and accuracy of EBUS-TBNA in diagnosing intra-thoracic metastasis was 87.50%and 95.12%, respectively. Immunohistochemistry （IHC） was performed in 18 malignant tumors to obtain deifnite type or origin, twelve intrathoracic metastasis and 6 primary lung cancer were further conifrmed. Conclusion EBUS-TBNA is a safe, effective method for the diagnosis of intrathoracic metastasis from extrapulmonary malignancy. IHC can provide additional evidence for distinguishing extrapulmonary malignancy from primary lung cancer.

关 键 词：肺外肿瘤 支气管超声 针吸活检 免疫组织化学 

分 类 号：R734.2[医药卫生—肿瘤]