MSCT引导TBNA联合LCT技术在诊断纵隔淋巴结肿大中的应用研究  

Applied Study on the MSCT-guided Transbronchial Needle Aspiration and Liquid-Based Cytologic Test in the Diagnosis of Patients with Enlarged Mediastinal Lymph Node

作　　者：李亚洁[1] 陈凯[2] 

机构地区：[1]宝鸡市中心医院心血管内科,陕西宝鸡721008 [2]宝鸡市中心医院呼吸内科,陕西宝鸡721008

出　　处：《现代检验医学杂志》2015年第5期111-114,共4页Journal of Modern Laboratory Medicine

摘　　要：目的 探讨胸部CT影像学（MSCT）引导经支气管针吸活检术（TBNA）联合液基细胞学（LCT）技术在诊断纵隔淋巴结肿大中的应用价值.方法 回顾性分析2011年8月～2015年4月间在宝鸡市中心医院224例行胸部CT检查发现纵隔淋巴结肿大病例,均行TBNA检查,总结穿刺结果,评价该技术的诊断价值和安全性.结果 ①224例患者经TBNA检查7个部位共394组淋巴结,TBNA穿刺成功788针（96.10％）.②190例恶性肿瘤患者中,TBNA结果阳性180例（94.74％）,其中64例患者TBNA结果是惟一病理学依据.③44例TBNA阴性患者中,除12例经过TBNA确诊为结节病外,其余经开胸手术确诊,2例为淋巴瘤,8例为纵隔淋巴结转移癌,22例阴性.在纵隔淋巴结肿大诊断中敏感度、特异度和准确度分别为94.76％,100％和95.54％.④64例患者行肺癌根治术,以术后淋巴结病理结果为参考,TBNA判断肺癌纵隔淋巴结分期诊断的敏感度、特异度、准确度、阳性预测值和阴性预测值分别是96.05％,100％,96.51％,100％,76.92％.⑤小细胞肺癌TBNA的阳性率高于非小细胞肺癌,差异有统计学意义（χ2值为10.24,P＜0.01）.直径≥3 cm淋巴结TBNA的阳性率稍高于＜3 cm淋巴结,差异无统计学意义（χ2值为1.72,P＞0.05）.结论 MSCT引导TBNA联合LCT技术在诊断纵隔淋巴结肿大中敏感度、准确度等均大大提高,且安全易行,值得基层医院临床推广应用.Objective To study the application value of the MSCT-guided transbronchial needle aspiration （TBNA） and Liq- uid-based Cytologic Test（LCT） in the diagnosis of patients with enlarged mediastinal lymph node. Methods The clinical da- ta of patients with enlarged mediastinal lymph node proven by CT scan who were eligible for TBNA from August 2011 to A- pril 2015 in Baoji Central Hospital were retrospectively analyzed. The diagnostic sensitivity, accuracy, specificity, positive predictive value and negative predictive value were evaluated. Results ① 224 patients with 394 lymph nodes were punc- tured. TBNA procedures were successfully carried out in 788/820 （96.10%）. ②The positive rate of TBNA was 94.74% （180/190） in patients who had been proven to suffer from carcinoma. There were 64 patients that diagnosis of cancer was pathologically determined by TBNA only. ③32 patients were examined by surgery： including 2 lymphoma, 8 mediastinal lymph node metastasis carcinoma, and 22 negative cases. The sensitivity, specificity and accuracy in diagnosing mediastinal enlarged lymph nodes were 94.76 %, 100 %and 95.540%, respectively.④64 patients who were diagnosed NSCLC within Ⅲ A period with 172 lymph nodes were punctured. Overall diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value of cytopathology for mediastinal staging in TBNA specimens were 96.05 %, 100 %, 96.510%, 100 and 76.92 %, respectively. ⑤The positive rate of TBNA in SCLC was higher than that in NSCLC, the difference was statisti- cally significant （χ2= 10.24,P〈0.01）. The positive rate of TBNA in lymph node which diameter was not less than 3 cm was higher,but the difference Was not statistically significant （χ2 =1.72,P〈0.05）. Conclusion The united technology of CT-guided TBNA and LCT is a safe and effective technique in diagnosing mediastinal lymph node. It is worth to clinical ap- plication.

关 键 词：经支气管针吸活检 支气管镜检查 液基细胞技术 肺肿瘤 

分 类 号：R446.8[医药卫生—诊断学]