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背景与目的经支气管超声引导针吸活检(endobronchial ultrasound-guided transbronchial needle aspira-tion,EBUS-TBNA)是近年来新的纵隔淋巴结定性诊断方法。本研究旨在探讨其应用于肺癌诊断及分期中的价值。方法2009年4月1日-2010年2月8日,75例本院胸部增强CT提示肺内占位伴多发纵隔淋巴结肿大患者接受EBUS-TBNA检查。以最终病理诊断为金标准,检验EBUS-TBNA诊断肺癌纵隔淋巴结转移的准确性、敏感性、特异性、阳性及阴性预测值,并判断其用于非小细胞肺癌N分期的准确率。结果75例患者共计穿刺177组病灶区域,平均穿刺2.4组/例。75例患者,组织病理标本送检率为49.33%。以177组穿刺区域计算,组织病理标本送检率为28.81%。75例患者EBUS-TBNA诊断准确率为98.66%,敏感性为98.43%,特异性为100.00%,阳性预测值为100.00%,阴性预测值为91.67%。以177组穿刺区域计算EBUS-TBNA诊断准确率为96.05%,敏感性为95.10%,特异性为100.00%,阳性预测值为100.00%,阴性预测值为82.93%。上述指标除敏感性(P=0.435)外,均高于CT检查(P<0.05)。73例可行N分期患者中,19例(26.03%)患者EBUS-TBNA检查后出现分期改变。结论EBUS-TBNA准确率较高,创伤小,是用于肺癌诊断及分期的较好方法。
Background and Objective Endobronchial ultrasound-guided transbronchial needle aspira-tion (EBUS-TBNA) is a new method of qualitative diagnosis of mediastinal lymph nodes in recent years. The purpose of this study is to explore its value in the diagnosis and staging of lung cancer. Methods From April 1, 2009 to February 8, 2010, 75 cases of chest CT scan in our hospital suggested EBUS-TBNA in patients with multiple mediastinal lymph nodes in the lung. The accuracy, sensitivity, specificity, positive and negative predictive value of EBUS-TBNA in diagnosis of mediastinal lymph node metastasis of lung cancer were tested by the final pathological diagnosis and the accuracy of EBUS-TBNA for N stage of non-small cell lung cancer was evaluated. Results A total of 75 patients punctured 177 lesions, with an average of 2.4 per case. In 75 cases, the rate of histopathological examination was 49.33%. 177 puncture area calculation, histopathological specimen delivery rate was 28.81%. The diagnostic accuracy of EBUS-TBNA in 75 patients was 98.66%, the sensitivity was 98.43%, the specificity was 100.00%, the positive predictive value was 100.00% and the negative predictive value was 91.67%. The diagnostic accuracy rate of EBUS-TBNA calculated by 177 puncture regions was 96.05%, the sensitivity was 95.10%, the specificity was 100.00%, the positive predictive value was 100.00% and the negative predictive value was 82.93%. Except for the sensitivity (P = 0.435), the above indexes were higher than those of CT (P <0.05). Of 73 patients with operable N staging, 19 (26.03%) patients had staging changes after EBUS-TBNA examination. Conclusion EBUS-TBNA has higher accuracy and less trauma, which is a better method for the diagnosis and staging of lung cancer.