摘要
目的评价气管内超声引导下的经支气管针吸活检（EBUS—TBNA）对肺内良恶性病变的诊断价值和安全性。方法回顾性分析上海市胸科医院于2009年10月9日至2011年11月30日行EBUS-TBNA检查的78例肺内病变患者，胸部CT检查显示气管、支气管周围肺内病变的患者行EBUS-TBNA，未采用现场细胞学方法检测，必要时联合免疫组织化学检测进一步完善诊断。结果78例患者中男48例，女30例，年龄25～80岁，中位年龄为58岁。其中恶性病变65例，良性病变13例。经EBUS-TBNA诊断75例，其中原发性肺癌61例，转移性肺癌1例，肺炎7例，肺结核5例，肺纤维化1例，70例获得了特异的病理学诊断依据，5例仅诊断为良性而未获得特异的病理学诊断依据，3例为假阴性。EBUS-TBNA对肺内良恶性病变鉴别的敏感度、特异度、阳性预测值、阴性预测值及诊断准确性分别为95％、100％、100％、81％、96％。8例来源或类型不明的恶性肿瘤中，结合免疫组织化学检测，确断5例原发性肺癌和1例转移性肺腺癌。1例高凝状态患者术中因穿刺部位的出血形成的阻塞中央气道引起血氧饱和度急剧降低，其余患者未见明显并发症。结论EBUS—TBNA是一项微创、安全的检查方法，对气管、支气管周围的肺内良恶性病变有着较高的诊断价值，结合免疫组织化学检查结果有助于明确恶性病变的病理来源和类型。
Objective To evaluate real-time endobronchial ultrasound-guided transbronchial needle aspiration （EBUS-TBNA） in the diagnosis of intrapulmonary lesions. Methods From October 2009 to November 2011, EBUS-TBNA was performed in 78 patients with paratrachial or parabronchial intrapulmonary lesions proved by CT scan. On-site cytological evaluation was not performed. Immunohistochemistry was applied to distinguish the type of malignant tumor when necessary. Results Sixty-five malignancies and 13 benign diseases were finally diagnosed in 78 intrapulmonary lesions, of which 62 malignancies and 13 benign diseases were distinguished by EBUS-TBNA, including 61 primary lung cancer （adenocarcinoma 36, squamous carcinoma 8, poorly-differentiated carcinoma 5, unknown type carcinoma 3, small cell carcinoma 9 ） , one metastatic lung cancer, 7 pulmonary inflammation, 5 pulmonary tuberculosis and one fibrosis. There were 3 false negative cases which were diagnosed as pulmonary poorly- differentiated carcinoma, pulmonary sarcomatoid carcinoma and pulmonary lymphoma, respectively. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of EBUS-TBNA in distinguishing malignant from benign thoracic lesions was 95% , 100%, 81% , 100% , 96% , respectively. Immunohistochemistry was performed in 8 malignant tumors without definite type or origin, 5 primary lung cancer and one metastatic lung adenocarcinoma were further confirmed. Moderate bleeding from the puncture site during needle aspiration forming blood clot and obstructing the central airway was noted in 1 hypercoagulable subject. Conclusions EBUS-TBNA is a minimally invasive, safe procedure with high sensitivity for distinguishing malignant from benign lesions. Immunohistochemistry can provide evidence for the definitive diagnosis of malignant lesions.
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2013年第1期17-21,共5页
Chinese Journal of Tuberculosis and Respiratory Diseases
基金
上海市市级医院新兴前沿技术联合攻关项目（SHDC12010101）
上海市科委科研计划项目（10411967800）
