气管内超声引导下经支气管针吸活检在胸部恶性疾病诊断和肺癌个体化治疗中的价值  

Value of endobronchial ultrasound-guided transbronchial needle aspiration in diagnosis of mediastinal or lung malignant lesions and prediction of target therapy in lung cancer

作　　者：李伟[1] 张婷[1,2] 高华[1] 刘超[1] 陈余清[1] 黄礼年[1] 齐学远[1] 武静[1] 王效静[1] 

机构地区：[1]蚌埠医学院第一附属医院呼吸与危重症医学科(安徽省呼吸系病基础与临床省级重点实验室),安徽蚌埠233004 [2]阜阳市第二人民医院呼吸科,安徽阜阳236015

出　　处：《中华全科医学》2016年第9期1435-1438,共4页Chinese Journal of General Practice

基　　金：安徽省科技厅重点实验室绩效考核项目(1206-c0805025);安徽省科技攻关项目(12010402127)

摘　　要：目的 评价气管内超声引导下经支气管针吸活检（endobronchial ultrasound-guided transbronchial needle aspiration,EBUS-TBNA）在胸部恶性疾病诊断和指导肺癌个体化治疗中的应用价值。方法 回顾性分析2012年5月—2015年12月期间91例纵隔或肺门淋巴结肿大或毗邻气道的肿块的胸部恶性疾病患者EBUS-TBNA的诊断结果和24例患者EBUS标本的EGFR突变检测结果。结果 共对227个纵隔、肺门淋巴结和23个肿块实施TBNA。4R和7组是最常受累的纵隔淋巴结;经EBUS-TBNA确诊86例,诊断恶性胸部疾病总体敏感度为94.5%,特异度为100.0%,准确度为94.5%。确诊病例中肺腺癌、小细胞癌、鳞癌和无法分型的非小细胞肺癌分别占确诊总例数的55.8%（48/86）、26.7%（23/86）、7.0%（6/86）和5.8%（5/86）。宫颈癌、结肠癌和食管癌和肾癌纵隔淋巴结转移各1例;超声图像分析表明：类圆形淋巴结[长短径之比（L/S）〈1.5]、不均质回声、边界清晰、中央淋巴门结构消失和不规则血供在恶性病变中是常见征象;EBUS-TBNA标本EGFR敏感突变率为70.8%,病理标本和液基细胞标本EGFR突变阳性率差异无统计学意义（χ2=0.509 1,P=0.47）;本组共17例轻微不良反应,均对症治疗后缓解或自行缓解。结论 EBUS-TBNA操作简单、安全性高,对胸部恶性疾病的诊断和指导肺癌的个体化治疗有重要应用价值。Objective To evaluate the diagnostic value of endobronchial ultrasound-guided transbronchial needle aspira- tion（EBUS-TBNA） in mediastina[ or lung malignant lesions and the prognosticate value of target therapy in lung cancer. Methods Retrospective clinical trial of 91 consecutive patients with enhanced lymph node or mass in the mediastinum, with or without pulmonary lesions non-diagnosis by routine electronic bronchoscope were included in this study between May,2012 and December,2015. The samples were obtained from the lesions using EBUS-TBNA. EGFR mutation in 24 EBUS-TBNA samples was detected. The numbers of final diagnosis, the features of ultrasonic and complication were recor- ded. Results Two hundred and twenty-seven lymph nodes and twenty-three masses were sampled by EBUS-TBNA in 91 malignant patients. The subcarinal nodes and fight lower paratracheal lymph node accounted for 44.2% （304/692） and 31.5 % （218/692 ） ;88 patients were confirmed by EUBS-TBNA. The overall sensitivity, specificity and accuracy of EBUS- TBNA were 94.5% , 100.0% and 94.5% , respectively. The diagnosed cases included 47 cases lung adenoeareinoma （ 54.7% ） ,23 eases of small lung cancer（26.7% ） ,7 cases of squamous cell carcinoma（8.1% ） ,5 NSCLC（5.8% ） ,and 5 cases of non-small lung cancer unable to type ; the metastases from extrapulmonary included 1 case of cervical cancer, 1 case of colon cancer, 1 case of esophageal cancer and 1 case of renal carcinoma. The round lymph nodes （ L/S 〈 1.5 ）, heterogeneous, clear boundary, absence of the lymph door structure and irregular blood supply were the common phenome- non of malignant lesions for ultrasound image. EGFR mutation rate of EBUS-TBNA specimens was 70.8%, the mutation rate of tissue specimens was 63.6% （7/11 ）, and the mutation rate of liquid cytology was 76.9% （ 10/13 ）. The positive rate between two specimens showed no significant difference（X2 = 0.509 1 ,P = 0.47） ; Minor complications were found in 17 cases. Conclusion EBUS-TBNA

关 键 词：气道内超声 经支气管针吸活检 胸部恶性疾病 EGFR突变 

分 类 号：R734[医药卫生—肿瘤] R445.1[医药卫生—临床医学]