超声引导下经支气管针吸活检 在胸部疾病诊断中的意义

Significance of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of thoracic diseases

摘要:

目的 探讨超声引导下经支气管针吸活检（EBUS-TBNA）在诊断胸部疾病中的应用价值。 方法 选取2016 年3 月—2019 年3 月在石家庄市第一医院行EBUS-TBNA 检查的患者110 例。所有患者行 EBUS-TBNA 检查前接受CT 或正电子发射型计算机断层扫描显像（PET-CT）进行初步筛查。在彩色多普 勒超声指导下，经活检针（18 G）对110 例纳入对象行穿刺活检，以病理检查结果作为金标准，分析EBUSTBNA 在胸部疾病诊断中的应用价值，计算其相应的敏感性、特异性、准确率、阳性预测值、阴性预测值。 分析EBUS-TBNA 与病理诊断的一致性，明确Kappa 值。结果 经CT 或PET-CT 初步筛查，110 例受检者中， 疑似胸部恶性肿瘤81 例（73.64%），疑似结核病29 例（26.36%）。经手术病理诊断，81 例疑似胸部恶性肿瘤 患者中，75 例（92.59%）确诊为恶性肿瘤；29 例疑似结核病患者中，22 例（75.86%）确诊为结核病。EBUSTBNA 诊断胸部恶性肿瘤与病理诊断一致性检验Kappa 值为0.749（95% CI ：0.711，0.904）。EBUS-TBNA 诊断结核病与病理诊断一致性检验Kappa 值为0.731（95% CI ：0.703，0.917）。EBUS-TBNA 诊断恶性瘤纵隔 淋巴结转移与病理诊断一致性检验Kappa 值为0.604（95% CI ：0.697，0.825）。110 例受检者中，2 例（1.82%） 存在轻微不适，但均对该检查方式耐受。结论 EBUS-TBNA 对胸部恶性肿瘤、结核病及恶性瘤纵隔淋巴结 转移的诊断有较高价值，与手术病理诊断呈高度一致性，且安全性高。

Abstract:

Objective To explore the value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of thoracic diseases. Methods 110 patients who underwent EBUS-TBNA examination in our hospital from March 2016 to March 2019 were selected. All patients were hospitalized because of chest discomfort or physical examination. The clinical data of the patients were retrospectively analyzed. All patients were screened by CT or PET-CT before EBUS-TBNA examination. Based on the results of percutaneous lung biopsy, thoracoscopic surgery and thoracotomy, the value of EBUS-TBNA in the diagnosis of thoracic diseases was analyzed, and the corresponding sensitivity, specificity, accuracy, positive predictive value and negative predictive value were calculated. The consistency between EBUS-TBNA and pathological diagnosis was analyzed by Kappa test, and the Kappa test value was defined. Results Preliminary screening by CT or PET-CT showed that 81 cases (73.64%) were suspected of malignant tumors in the chest and 29 cases (26.36%) were suspected of tuberculosis. Surgical and pathological diagnosis showed that 75 (92.59%) of 81 suspected cases of malignant tumors in the chest were diagnosed as malignant tumors. Of 29 suspected tuberculosis patients, 22 (75.86%) were diagnosed as tuberculosis. The Kappa value of the consistency test between EBUS-TBNA diagnosis and pathological diagnosis of chest malignant tumor was 0.749 (95% CI: 0.711, 0.904). The Kappa value of the consistency test between EBUS-TBNA diagnosis and pathological diagnosis of tuberculosis was 0.731 (95% CI: 0.703, 0.917). The Kappa value of the consistency test between EBUS-TBNA diagnosis and pathological diagnosis of mediastinal lymph node metastasis was 0.604 (95% CI: 0.697, 0.825). Of the 110 patients examined, 2 (1.82%) had mild discomfort, but the patients were all tolerant to the test. Conclusions EBUS-TBNA is of high value in the diagnosis of malignant tumors of the chest, tuberculosis and mediastinal lymph node metastases, with high consistency with the surgical pathological diagnosis and ideal safety.