支气管内超声针吸与常规支气管镜活检术对支气管外压性狭窄的肺恶性肿瘤诊断比较  

Comparison of the diagnostic effect of endobronchial ultrasound-guided transbronchial needle aspiration and conventional bronchoscopic biopsy in lung cancer presenting with external bronchial stenosis

作　　者：何馨[1] 吴艳军[1] 聂姗[1] 徐波[1] 贾楠[1] 杨霭琳 姚志刚[1] 王浩彦[1] HE Xin;WU Yanjun;NIE Shan;XU Bo;JIA Nan;YANG Ailin;YAO Zhigang;WANG Haoyan(Department of Respiratory Medicine,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院呼吸内科,100050

出　　处：《心肺血管病杂志》2021年第9期921-926,共6页Journal of Cardiovascular and Pulmonary Diseases

基　　金：首都卫生发展科研专项(2018-2-2024)。

摘　　要：目的:探讨经支气管内超声引导针吸活检术(EBUS-TBNA)在表现为支气管外压性狭窄的肺部恶性肿瘤的应用价值。方法:回顾性分析首都医科大学附属北京友谊医院,2018年7月至2020年11月,经胸部CT发现纵膈和/或肺门淋巴结肿大且伴有支气管外压性狭窄的、完成常规电子支气管镜及EBUS检查,且最终确诊为肺恶性肿瘤的患者的相关资料。对比支气管外压性狭窄病变常规支气管镜活检术与EBUS-TBNA的诊断准确率。结果:共有46例患者完成常规电子支气管镜检查及EBUS-TBNA。与常规活检相比,EBUS-TBNA所获得的细胞学标本诊断准确率(84.8%vs.43.5%,P<0.001)、组织学标本诊断准确率(82.6%vs.50.0%,P=0.001)、综合诊断准确率(细胞学联合组织学)(84.8%vs.58.7%,P=0.005)及液基薄层细胞学检查(TCT)诊断准确率(78.3%vs.39.1%,P<0.001)均明显提高;同时,EBUS-TBNA明显提高了短径≤3 cm的淋巴结/占位的诊断准确率(82.9%vs.60.0%,P=0.034);而EBUS-TBNA诊断准确率与EBUS-TBNA TCT诊断准确率相比,无明显差异(84.8%vs.78.3%,P=0.420)。按最终确诊肿瘤病理类型进行分组,小细胞肺癌(SCLC)的EBUS-TBNA TCT诊断准确率明显高于非小细胞肺癌(NSCLC)(90.9%vs.66.7%,P=0.046)。结论:与常规支气管镜活检相比,EBUS-TBNA可以显著提高表现为支气管外压性狭窄的肺恶性肿瘤,特别是直径≤3 cm的病变的诊断准确率。EBUS-TBNA TCT对于SCLC的诊断准确率较NSCLC高,是EBUS-TBNA的有益补充。Objective:To investigate the value of endobronchial guided needle biopsy(EBUS-TBNA)technology in lung cancer patients with external bronchial stenosis.Methods:Retrospective analysis was per-formed on the data of patients with mediastinal and/or hilar lymph node enlargement accompanied by external bronchoconstriction on chest CT in Beijing Friendship Hospital affiliated to Capital Medical University from July 2018 to November 2021,who completed conventional electronic bronchoscopy and EBUS examination succes-sively and were finally diagnosed with lung cancer.The diagnostic accuracy of conventional bronchoscopy biopsy and EBUS-TBNA in patients with external bronchial stenosis was compared.Results:A total of 46 patients completed conventional bronchoscopy biopsy and EBUS-TBNA.Compared to conventional bronchoscopy biopsy,the diagnostic accuracy of EBUS-TBNA for cytologic specimens(84.8%vs.43.5%,P<0.001),histological specimens(82.6%vs.50.0%,P=0.001),comprehensive diagnostic accuracy(cytology combined with his-tology)(84.8%vs.58.7%,P=0.005)were significantly improved.And the diagnostic accuracy of thinprep cytologic test(TCT)was significantly improved(78.3%vs.39.1%,P<0.001).At the same time,EBUS-TB-NA significantly improved the diagnostic accuracy of lesions with short diameter≤3 cm(82.9%vs.60.0%,P=0.034).There was no significant difference in diagnostic accuracy between EBUS-TBNA and EBUS-TBNA TCT(84.8%vs.78.3%,P=0.420).The diagnostic accuracy of EBUS-TBNA TCT for small cell lung cancer(SCLC)was significant higher than that for non-small cell lung cancer(NSCLC)(90.9%vs.66.7%,P=0.046).Conclusions:Compared with conventional bronchoscopy biopsy,EBUS-TBNA can significantly improve the diagnostic accuracy of lung cancer presenting with external bronchial stenosis,especially lesions with diameter less than 3 cm.The diagnostic accuracy of EBUS-TBNA TCT for SCLC is higher than that for NSCLC,which is a beneficial supplement to EBUS-TBNA.

关 键 词：经支气管内超声引导针吸活检术 支气管外压性狭窄 肺癌 液基薄层细胞学检查 

分 类 号：R56[医药卫生—呼吸系统]