ROSE在EBUS-TBNA诊断纵隔、肺门病变中的应用价值  

Value of rapid on-site evaluation in endobronchial ultrasound-guided trans-bronchial needle aspiration for diagnosing hilar and mediastinal lesions

作　　者：鲁沈源 林士军 耿榕梅 陈雄 朱日飞 陈绍山 苏美萍 唐纯丽[2] Lu Shenyuan;Lin Shijun;Geng Rongmei;Chen Xiong;Zhu Rifei;Chen Shaoshan;Su Meiping;Tang Chunli(Department of Respiratory and Critical Care Medicine,the Second Affiliated Hospital of the Chinese University of Hong Kong,Shenzhen,Longgang District People's Hospital of Shenzhen,Shenzhen 518172,China;Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Guangzhou Medical University,National Center for Respiratory Medicine,National Clinical Research Center for Respiratory Disease,State Key Laboratory of Respiratory Disease,Guangzhou Institute of Respiratory Health,Guangzhou 510120,China)

机构地区：[1]香港中文大学(深圳)附属第二医院深圳市龙岗区人民医院呼吸与危重症医学科,深圳518172 [2]广州医科大学附属第一医院呼吸与危重症医学科、国家呼吸医学中心、国家呼吸系统疾病临床医学研究中心呼吸疾病国家重点实验室、广州呼吸健康研究院,广州510120

出　　处：《国际呼吸杂志》2024年第9期1075-1081,共7页International Journal of Respiration

摘　　要：目的探讨快速现场评估(ROSE)在超声引导下经支气管针吸活检(EBUS-TBNA)诊断纵隔、肺门病变中的应用价值。方法本研究为观察性研究,采用非随机抽样的方法选取2021年4月至2022年3月于广州医科大学附属第一医院进行EBUS-TBNA检查的665例纵隔或肺门病变患者为研究对象,根据是否进行ROSE检查将患者分为ROSE组(107例)和非ROSE组(558例)。收集2组患者的性别、年龄、淋巴结穿刺个数、纵隔或肺门病灶穿刺个数、胸部影像学检查测量的淋巴结短径和病灶长径、最终病理检查结果和并发症等临床资料。比较2组患者的性别、年龄、淋巴结短径和病灶长径。以最终病理结果为金标准,采用Kappa检验分析EBUS-TBNA联合ROSE、单独EBUS-TBNA诊断纵隔、肺门病变与金标准的一致性。比较2组患者的并发症发生率。结果ROSE组男68例,女39例,年龄(59.72±11.42)岁;穿刺淋巴结120个,淋巴结短径(16.65±5.81)mm;穿刺纵隔或肺门病灶30个,病灶长径(48.19±17.90)mm。非ROSE组男373例,女185例,年龄(57.82±13.13)岁;穿刺淋巴结605个,淋巴结短径(15.82±6.66)mm;穿刺纵隔或肺门病灶150个,病灶长径(49.68±20.66)mm。2组患者的性别、年龄、淋巴结短径、病灶长径比较,差异均无统计学意义(均P>0.05)。最终病理检查结果显示,ROSE组恶性肿瘤96例、良性病变11例;非ROSE组恶性肿瘤396例、良性病变162例。ROSE组检出恶性肿瘤患者94例,最终病理结果显示恶性肿瘤患者96例;非ROSE组检出恶性肿瘤患者366例,最终病理结果显示恶性肿瘤患者396例。从两种方法与最终病理结果的一致性看,EBUS-TBNA联合ROSE的一致性较单独EBUS-TBNA好(Kappa值0.906比0.876)。ROSE组有1例中度出血和1例重度出血患者;非ROSE组有3例中度出血和1例重度出血患者。2组患者并发症发生率比较差异无统计学意义[1.87%(2/107)比0.72%(4/558),χ^(2)=0.36,P=0.551]。结论EBUS-TBNA联合ROSE对纵隔、肺门Objective To explore the role of rapid on-site evaluation(ROSE)in endobronchial ultrasound-guided trans-bronchial needle aspiration(EBUS-TBNA)for diagnosing hilar and mediastinal lesions.Methods This was an observational study.Totally 665 patients who underwent EBUS-TNBA for hilar and mediastinal lesions between April 2021 and March 2022 at the First Affiliated Hospital of Guangzhou Medical University were enrolled using a non-random sampling method.Based on the performance of ROSE or not,patients were divided into ROSE group(n=107)and non-ROSE group(n=558).Clinical data,such as age,sex,number of punctured lymph nodes,number of punctured hilar and mediastinal lesions,short-axis diameter of lymph nodes and long-axis diameter of the lesions in lung imaging scans,final pathologic results and clinical complications were collected.Sex,age,short-axis diameter of lymph nodes and long-axis diameter of hilar/mediastinal lesions were compared between the two groups.The Kappa test was utilized to assess the concordance between the diagnosis of hilar and mediastinal lesions by EBUS-TNBA with or without ROSE and the final pathological results,which were considered as the gold standard.Clinical complications were also compared between the two groups.Results Of the 107 cases in ROSE group,68 were males and 39 were females,with the age of(59.72±11.42)years.In ROSE group,120 lymph nodes with the short-axis diameter of(16.65±5.81)mm and 30 hilar and mediastinal lesions with the long-axis diameter of(48.19±17.90)mm were sampled.Of the 558 cases in non-ROSE group,373 were males and 185 were females,with the age of(57.82±13.13)years.In non-ROSE group,605 lymph nodes with the short-axis diameter of(15.82±6.66)mm and 150 hilar and mediastinal lesions with the long-axis diameter of(49.68±20.66)mm were sampled.There were no significant differences in the age,sex,short-axis diameter of lymph nodes and long-axis diameter of hilar and mediastinal lesions between groups(all P>0.05).According to the final pathologic results,malignant di

关 键 词：肺疾病 纵隔疾病 超声引导下经支气管针吸活检 快速现场评价 病理结果 

分 类 号：R563[医药卫生—呼吸系统]