超声支气管镜引导下针吸活检术在肺结节病诊断中的应用价值  

Application value of endobronchial ultrasound-guided transbronchial needle aspiration in diagnosis of pulmonary sarcoidosis

作　　者：刘安[1] 沈圆兵[1] 宫蓓蕾[1] 李殿明[1] 徐圆圆 武静[1] 李伟[1] LIU An;SHEN Yuan-bin;GONG Pei-lei;LI Dian-ming;XU Yuan-yuan;WU Jing;LI Wei(Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233000,China)

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,安徽省蚌埠市233000

出　　处：《广西医学》2021年第12期1419-1422,1426,共5页Guangxi Medical Journal

基　　金：安徽省自然科学基金(1908085MH240);蚌埠医学院自然科学重点项目(BYKY2019096ZD)。

摘　　要：目的探讨超声支气管镜引导下针吸活检术(EBUS-TBNA)在肺结节病诊断中的应用价值。方法回顾性分析35例疑诊Ⅰ期或Ⅱ期肺结节病患者的临床资料,所有患者均行EBUS-TBNA检查。以临床诊断及随访结果为金标准,评估EBUS-TBNA诊断肺结节病的效能。分析肺结节病患者淋巴结超声支气管镜影像特征。结果35例患者(79个淋巴结)均穿刺成功,最终确诊肺结节病27例(62个淋巴结),其中经EBUS-TBNA明确诊断25例,EBUS-TBNA诊断肺结节病的灵敏度为92.5%(25/27),特异度为100%(8/8),阳性预测值为100%(25/25),阴性预测值为80%(8/10),诊断准确率为94.2%(33/35)。短径≥15 mm、椭圆形或不规则形、回声均匀、边界清晰、中央淋巴门结构消失、具有颗粒状外观是肺结节病患者淋巴结超声支气管镜影像最常见的征象。结论EBUS-TBNA对肺结节病具有较高的诊断价值和安全性,可以根据肺结节病患者淋巴结的超声支气管镜影像特征初步判别淋巴结性质,从而选择性地进行穿刺。Objective To investigate the application value of endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)in the diagnosis of pulmonary sarcoidosis.Methods The clinical data of 35 patients with suspected stage Ⅰ or Ⅱ pulmonary sarcoidosis were retrospectively analyzed.All patients underwent EBUS-TBNA examination.Using the clinical diagnosis and follow-up results as the gold standard,the diagnostic efficiency of EBUS-TBNA for pulmonary sarcoidosis was assessed.The endobronchial ultrasound image features of lymph nodes were analyzed in patients with pulmonary sarcoidosis.Results All of the 35 patients(79 lymph nodes)underwent puncture successfully,27 cases(62 lymph nodes)were identified with pulmonary sarcoidosis eventually,including 25 identified by EBUS-TBNA.For diagnosing pulmonary sarcoidosis,EBUS-TBNA had a sensitivity of 92.5%(25/27),specificity of 100%(8/8),positive predictive value of 100%(25/25),negative predictive value of 80%(8/10),and diagnostic accuracy rate of 94.2%(33/35).The most common signs of lymph nodes on endobronchial ultrasound in patients with pulmonary sarcoidosis included short diameter≥15 mm,oval or irregular-shaped masses,homogeneous echo,well-defined boundary,absence of central lymphatic hilum structure,and granular appearance.Conclusion EBUS-TBNA has higher diagnostic value and safety for pulmonary sarcoidosis,and can preliminarily identify the property of lymph nodes in accordance with the endobronchial ultrasound image characteristics of lymph nodes in patients with pulmonary sarcoidosis,thereby,it can be used to perform puncture selectively.

关 键 词：肺结节病 超声支气管镜引导下针吸活检术 淋巴结 超声影像 诊断价值 

分 类 号：R445.1[医药卫生—影像医学与核医学]