超声支气管镜引导下经支气管针吸活检70例临床分析

目的 评价超声支气管镜引导下的经支气管针吸活检(EBUS-TBNA)对纵隔和肺门淋巴结肿大和肺内肿块的诊断价值和安全性.方法 对2009年7月至2010年1月上海市肺科医院胸部CT检查显示胸腔内肿物和(或)纵隔-肺门淋巴结肿大的门诊或住院患者行EBUS-TBNA,观察诊治效果.结果 入选患者70例,男47例,女23例,年龄22～84岁,平均55.7岁.其中门诊患者25例,住院患者45例.穿刺肺门淋巴结120组,肺内肿块11例次.70例患者中,在没有采用现场细胞学诊断的条件下,46例初诊肺癌患者通过EBUS-TBNA明确诊断44例,假阴性2例,诊断肺癌的敏感度为96%,特异度为100%,阳性预测值为100%,阴性预测值为92%,准确率为97%;10例临床诊断为结节病的患者中,5例镜下可见上皮细胞形成的非干酪样肉芽肿改变;4例结核患者中,1例淋巴结涂片中找到抗酸杆菌,淋巴结活枪病理示凝固性坏死.所有患者手术期间未发生并发症.结论 EBUS-TBNA是诊断肺癌和其他不明因纵隔-肺门淋巴结肿大的一种安全、有效的方法.     

经气管镜超声引导针吸活检术联合核酸扩增试验对肺门/纵隔淋巴结结核的诊断价值

目的 探讨经气管镜超声引导针吸活检术（EBUS-TBNA）联合核酸扩增试验（NAAT）对肺门/纵隔淋巴结结核的诊断价值。方法 选取疑似肺门/纵隔淋巴结结核患者159例,患者均接受EBUS-TBNA,获取的标本分别进行组织病理学、结核菌培养、NAAT检测,根据临床诊断结果并经6个月随访最终诊断肺门/纵隔淋巴结结核,比较EBUS-TBNA不同检测方法诊断肺门/纵隔淋巴结结核的效能,记录EBUS-TBNA的不良反应,分析肺门/纵隔淋巴结结核的耐药特征。结果 159例患者经综合诊断肺门/纵隔淋巴结结核121例,92.56%(112/121)的肺门/纵隔淋巴结结核患者通过EBUS-TBNA获得诊断。EBUS-TBNA检测的不良反应发生率为3.14%(5/159)。经EBUS-TBNA穿刺物标本组织病理诊断的灵敏度、特异度、阳性预测值（PPV）、阴性预测值（NPV）、准确率分别为74.38%、78.95%、91.84%、49.18%和75.47%,经EBUS-TBNA穿刺物标本结核菌培养诊断的灵敏度、特异度、PPV、NPV、准确率分别为38.2%、100%、100%、33.63%和52.83%,经...     

超声支气管镜引导下的经支气管针吸活检术的临床应用分析

目的研究超声支气管镜引导下的经支气管针吸活检术(EBUS-TBNA)在肺恶性肿瘤及纵隔肿物中的诊断价值及安全性。方法分析我科2013年10月至2015年10月经胸部CT发现肺门、纵隔淋巴结肿大或气管支气管旁肿物的94例患者行EBUS-TBNA检查结果。结果 94例患者中确诊肺恶性肿瘤80例;共穿刺150组淋巴结,每组平均穿刺2.4针,对肺恶性肿瘤的诊断敏感性为93.02%,特异性为100%,准确性为93.62%;4例患者临床诊断结节病;4例患者临床诊断淋巴结炎。结论 EBUS-TBNA在纵隔、肺门淋巴结和气管支气管旁肿物的诊断和肺恶性肿瘤的分期上有较高的敏感性、特异性、准确性和安全性,是经济有效的诊断方法。     

经气管镜超声引导针吸活检术在肺癌诊断和分期中的应用

目的 评价经气管镜超声引导针吸活检术（endobronchial ultrasound-guided transbronchial needle aspiration,EBUS-TBNA）用于肺癌定性及其分期的诊断价值和安全性.方法 2012年1月~2013年3月,36例本院胸部影像学检查提示胸内气管或支气管旁肿块和/或纵隔、肺门淋巴结肿大,但常规支气管镜检查提示病变部位气道通畅,盲式活检和刷检阴性,无法取得有效病理的支气管外型肺癌患者,接受EBUS-TBNA检查.结果 36例患者中,共穿刺78组病灶区域,平均穿刺2.17组/例,穿刺成功率100%,未发生并发症,平均操作时间为18 min,术后住院时间为1-12 d,中位住院1 d;36例患者行EBUS-TBNA全部同时取得细胞病理学及组织病理学标本（良性1例,恶性35例）,其中21例为鳞癌,11例为腺癌,3例为小细胞癌,1例为乳头状瘤.EBUS-TBNA检查总体准确率92.12%,灵敏度86.13%,特异度100%.结论 EBUS-TBNA检查准确率高、创伤小、安全性好,是伴有纵隔淋巴结肿大的支气管外型肺癌定性诊断及分期的较好方法.     

电视纵隔镜与支气管内超声引导针吸活检术诊断纵隔肿物价值

目的比较电视纵隔镜(VAM)与支气管内超声引导针吸活检术(EBUS-TBNA)对纵隔肿物的诊断价值。方法选择我院胸外科胸部CT检查拟诊纵隔肿物(肿物短径大于1. 0cm),需要进一步明确诊断的126例住院患者分别行VAM、EBUS-TBNA。VAM组:75例; EBUS-TBNA组:51例。根据术后石蜡切片病理结果及随访,分别计算两种方法的准确性、灵敏度、特异度。结果 VAM诊断纵隔肿物的准确性94. 67%,灵敏度94. 12%,特异度100%; EBUS-TBNA诊断纵隔肿物的准确性88. 24%,灵敏度87. 50%,特异度100%。结论在纵隔肿物诊断方面,VAM和EBUS-TBNA均是有效的方法。从创伤、并发症、伦理等因素综合考虑,建议首先EBUS-TBNA。对于纵隔良性病变及淋巴瘤VAM可能具有更高的诊断价值;对于合并有肺门或邻近气管、支气管肺内肿物的患者,EBUS-TBNA在疾病诊断方面具有更明显的优势。     

支气管内超声引导针吸活检术在纵隔肿物及纵隔肿大淋巴结诊断中的临床应用

目的探讨支气管内超声引导针吸活检术(endobronchial ultrasound-guided transbronchial needle aspiration,EBUS-TBNA)在明确纵隔肿物性质和纵隔或肺门肿大淋巴结定性诊断中的应用价值。方法 2012年4月至2013年12月期间,对胸部CT或PET/CT检查提示纵隔占位、纵隔或肺门淋巴结肿大≥1cm的患者行EBUSTBNA检查,阴性者进一步接受纵隔镜检查或胸腔镜、开胸手术明确病变性质。结果本组共203例病例,EBUS-TBNA明确诊断阳性者180例,其中诊断为小细胞肺癌54例,非小细胞肺癌119例,食管癌1例,贲门癌1例,鼻咽癌2例,淋巴瘤3例;EBUS-TBNA阴性者23例,其中5例最终证实为非小细胞肺癌的纵隔淋巴结转移,1例为小细胞肺癌,其余17例为良性病变。EBUS-TBNA在纵隔病变或纵隔淋巴结转移诊断中的灵敏度、特异性和准确性分别为96.8%、100%、97%。检查过程中,患者耐受性均较好,所有病人均无严重并发症发生。结论 EBUSTBNA是一种对纵隔病变及纵隔肿大淋巴结定性诊断安全、有效的方法。     

应用纵隔镜检查术诊断纵隔淋巴结结核和结节病

目的寻找和探索一种区分良恶性纵隔淋巴结肿大,确诊纵隔淋巴结结核和结节病的有效方法。方法应用纵隔镜检查术对胸部ＣＴ或ＭＲＩ检查发现的纵隔淋巴结肿大、临床诊断不清疑为淋巴结结核或结节病者实施此检查,获取病理组织,做出明确诊断,以指导治疗。结果本组２５例患者接受纵隔镜检查,其中１６例被病理诊断为纵隔淋巴结结核,占６４％（其中增殖性结核１４例,占８８％;干酪性结核２例,占１２％）;８例诊为结节病,占３２％;１例难于确定为淋巴结结核或结节病,占４％。非典型的纵隔淋巴结结核与结节病在影像诊断上难于区别,而且在显微镜下也极易混淆。这两种疾病常与其他原因引起的纵隔淋巴结肿大（如恶性淋巴瘤、淋巴结转移性癌等）在影像检查中不易区分,极易误诊,造成误治。本组病例术前影像诊断及临床诊断大多考虑为恶性疾病,其中第一诊断为恶性疾病的占８４％（２１／２５）,有２例已在外院接受化疗。结论对于纵隔区域发现的肿大淋巴结,纵隔镜检查术是一种很有价值的确诊手段,治疗前应尽一切可能获取明确的病理诊断     

支气管镜超声弹性成像在肺门纵隔淋巴结良恶性的诊断价值

目的 探讨经支气管镜实时超声弹性成像鉴别肺门纵隔淋巴结性质的诊断价值.方法 经支气管镜超声弹性成像评价肺门纵隔淋巴结性质,并对该淋巴结行针吸活检术.弹性成像评分为1～4分.l、2分为阴性淋巴结,3、4分为阳性淋巴结.结果 纳入29例患者共43枚淋巴结.不同弹性分级组间良恶性构成比差异有统计学意义(X2＝16.92,P=0.001).弹性成像对恶性淋巴结的敏感度、特异度、准确度分别为70.83％、84.21％、76.74％.结论 经支气管镜实时超声弹性成像的敏感度、特异度、准确度高,有助于肺门纵隔淋巴结良恶性的鉴别诊断.     

EBUS-TBNA在肺癌及纵隔病变中的诊断价值

目的探讨超声支气管镜引导下支气管针吸活检(EBUS-TBNA)在肺癌及纵隔病变中的诊断价值和安全性。方法对本院的经胸部CT或PET-CT检查显示纵隔或肺门淋巴结肿大及胸内气管旁肿块(≥1 cm)的53例患者行EBUS-TBNA检查。结果 53例患者中经病理学检查确诊恶性肿瘤43例,其中肺癌41例。共穿刺68组淋巴结,肺内肿块11例,每组平均穿刺2.1针。41例肺癌患者中经EBUS-TBNA诊断39例,其中取得明确病理诊断37例。诊断肺癌灵敏度、特异度、准确率分别为95.12%、100%、96.23%,另经EBUS-TBNA明确1例转移性神经内分泌癌;4例临床诊断为结节病患者中,3例病理可见多个上皮样细胞增生性结节及非干酪样肉芽肿改变,3例诊断肺结核患者中2例病理可见类上皮样结节,伴郎罕氏巨细胞及坏死。结论对于不明原因的纵隔淋巴结肿大、纵隔及近肺门处肿块的患者,EBUS-TBNA是一种安全、有效的诊断方法,有较高的诊断灵敏度、特异度,对肺癌手术治疗的准确分期提供帮助。     

超声支气管镜下穿刺活检对成人纵隔淋巴结结核的早期诊断价值（附87例临床报告）

目的 探讨超声支气管镜下穿刺活检（EBUS-TBNA）对于纵隔淋巴结结核的早期诊断价值。方法 选取上海市肺科医院2010年1月至2012年12月期间,影像学及临床诊断为纵隔淋巴结结核但气管镜检查无异常的患者共87例;其中男51例,女36例,年龄21～70岁,平均（48.5±11.5）岁。所有患者行EBUS-TBNA,标本送检病理、抗酸杆菌涂片、培养和体外聚合酶链反应检测,根据检测结果进行诊断性治疗并随访3个月,治疗无效者进行纵隔镜检查,最终统计EBUS-TBNA在纵隔淋巴结结核诊断中的诊断率。应用统计软件SPSS 13.0进行数据分析和计算。 结果 66例患者通过EBUS-TBNA直接确诊结核病,1例确诊为非结核分枝杆菌（NTM）感染（菌型鉴定为鸟-胞内分枝杆菌,MAC）;5例确诊肺癌,2例确诊结节病,13例未得到任何阳性证据;13例中6例通过诊断性抗结核治疗确诊结核病,7例行纵隔镜检查,其中3例确诊淋巴瘤,3例肺癌,1例结核病。因此87例患者中最终确诊结核病73例,其中通过EBUS-TBNA确诊66例（90.41%,66/73）。经过EBUS-TBNA确诊结核病的66例中21例（31.82%,21/66）为结核分枝杆菌涂片和（或）培养阳性（3例结核分枝杆菌药敏试验提示耐药）;40例（60.61%,40/66）结核分枝杆菌聚合酶链反应检测阳性,38例（57.58%,38/66）病理检测结果为干酪样坏死或者结核性肉芽肿。 结论 EBUS-TBNA在纵隔淋巴结结核特别是耐药纵隔淋巴结结核的早期诊断上可能具有一定的价值。     

经气管镜超声引导针吸活检术在定性诊断不明原因肺门及纵隔肿块、纵隔淋巴结肿大中的应用价值

背景 不明原因肺门及纵隔肿块、纵隔淋巴结肿大是胸外科常见的一种疾病,尽管纵隔镜或胸腔镜检查是临床诊断纵隔病变良恶性的"金标准",但因对机体损伤较大、检查费用高昂、可重复性差等导致其临床应用受限,故寻找一种安全、有效的诊断方法一直是临床医师面对的难题.目的 探讨经气管镜超声引导针吸活检术(EBUS-TBNA)在定性诊断不...     

Comparison of endobronchial ultrasound, positron emission tomography, and CT for lymph node staging of lung cancer

STUDY OBJECTIVES: To perform a prospective comparison of direct real-time endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA), positron emission tomography (PET), and thoracic CT for detection of mediastinal and hilar lymph node metastasis in patients with lung cancer considered for surgical resection. DESIGN: Prospective patient enrollment. SETTING: University teaching hospital. PATIENTS: One hundred two potentially operable patients with proven (n = 96) or radiologically suspected (n = 6) lung cancer were included in the study. INTERVENTIONS: CT, PET, and EBUS-TBNA were performed prior to surgery for the evaluation of mediastinal and hilar lymph node metastasis. The convex probe EBUS, which is integrated with a convex scanning probe on its tip, was used for EBUS-TBNA. Surgical histology was used as the "gold standard" to confirm lymph node metastasis unless patients were found inoperable for N3 or extensive N2 disease proven by EBUS-TBNA. Main results: EBUS-TBNA was successfully performed in all 102 patients (mean age, 67.8 years) from 147 mediastinal and 53 hilar lymph nodes. EBUS-TBNA proved malignancy in 37 lymph node stations in 24 patients. CT identified 92 positive lymph nodes, and PET identified 89 positive lymph nodes (4 supraclavicular, 63 mediastinal, 22 hilar). The sensitivities of CT, PET, and EBUS-TBNA for the correct diagnosis of mediastinal and hilar lymph node staging were 76.9%, 80.0%, and 92.3%, respectively; specificities were 55.3%, 70.1%, and 100%, and diagnostic accuracies were 60.8%, 72.5%, and 98.0%. EBUS-TBNA was uneventful, and there were no complications. CONCLUSION: Compared to CT and PET, EBUS-TBNA has a high sensitivity as well as specificity for mediastinal and hilar lymph node staging in patients with lung cancer. EBUS-TBNA should be considered for evaluation of the mediastinum early in the staging process of lung cancer.     

Convex probe endobronchial ultrasound: applications beyond conventional indications

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is maturing and gaining acceptance by more and more clinicians for lymph node staging of lung cancer and diagnosis of mediastinal and hilar masses or lymph node enlargement by convex probe endobronchial ultrasound (CP-EBUS). The application of CP-EBUS, however, is not limited to conventional indications. Diagnostically, elastography is a new technology for the differentiation of benign and malignant lymph nodes before aspiration. CP-EBUS can also be used for pulmonary vascular diseases, such as pulmonary embolism (PE) and non-thrombotic endovascular lesions (NELs). Therapeutically, CP-EBUS can be used for cyst drainage and drug injections. CP-EBUS is not limited to observation and aspiration of mediastinal masses and lymph nodes, but is also suitable for exploration of other tissues external to the central airway, which necessitates unprecedented skills for the bronchoscopist.     

Nonsurgical staging of the mediastinum: EBUS and EUS

A tissue diagnosis is frequently needed for accurate lung cancer staging of mediastinal nodes as well as the assessment of mediastinal masses. Noninvasive imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI), positron-emission tomography (PET), and PET-CT provide some answers but no tissue diagnosis. Transbronchial needle aspiration (TBNA), a safe procedure that is performed during routine bronchoscopy, has a high impact on patient management. Unfortunately, TBNA remains underused in current daily practice, mainly due to the lack of real-time needle visualization. The introduction of echo-endoscopes has overcome this problem. Endobronchial ultrasound-guided TBNA (EBUS-TBNA) allows real-time controlled tissue sampling of paratracheal, subcarinal, and hilar lymph nodes. Mediastinal lymph nodes located adjacent to the esophagus can be assessed by esophageal ultrasound-guided fine needle aspiration (EUS-FNA). Owing to the complementary reach of EBUS-TBNA and EUS-FNA in assessing different regions of the mediastinum, recent studies suggest that complete and accurate mediastinal staging can be achieved by the combination of both procedures. It is expected that implementation of minimally invasive endoscopic methods of EBUS-TBNA and EUS-FNA will reduce the need for surgical staging of lung cancer significantly.     

Endobronchial ultrasound-guided transbronchial needle aspiration for lung cancer staging: early experience in Brazil

Objective:

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive, safe and accurate method for collecting samples from mediastinal and hilar lymph nodes. This study focused on the initial results obtained with EBUS-TBNA for lung cancer and lymph node staging at three teaching hospitals in Brazil.

Methods:

This was a retrospective analysis of patients diagnosed with lung cancer and submitted to EBUS-TBNA for mediastinal lymph node staging. The EBUS-TBNA procedures, which involved the use of an EBUS scope, an ultrasound processor, and a compatible, disposable 22 G needle, were performed while the patients were under general anesthesia.

Results:

Between January of 2011 and January of 2014, 149 patients underwent EBUS-TBNA for lymph node staging. The mean age was 66 ± 12 years, and 58% were male. A total of 407 lymph nodes were sampled by EBUS-TBNA. The most common types of lung neoplasm were adenocarcinoma (in 67%) and squamous cell carcinoma (in 24%). For lung cancer staging, EBUS-TBNA was found to have a sensitivity of 96%, a specificity of 100%, and a negative predictive value of 85%.

Conclusions:

We found EBUS-TBNA to be a safe and accurate method for lymph node staging in lung cancer patients.     

Transbronchial and transoesophageal (ultrasound-guided) needle aspirations for the analysis of mediastinal lesions.

A tissue diagnosis of mediastinal nodes is frequently needed for accurate lung cancer staging as well as the assessment of mediastinal masses. Transbronchial needle aspiration (TBNA) is a safe procedure that is performed during routine bronchoscopy. Provided mediastinal metastases are confirmed, TBNA has a high impact on patient management. Unfortunately, TBNA remains underused in current daily practice, mainly due to the lack of real-time needle visualisation. The introduction of echo-endoscopes has overcome this problem. Endobronchial ultrasound-guided TBNA (EBUS-TBNA) allows real-time controlled tissue sampling of paratracheal, subcarinal and hilar lymph nodes. Mediastinal lymph nodes located adjacent to the oesophagus can be assessed by transoesophageal ultrasound-guided fine needle aspiration (EUS-FNA). Owing to the complementary reach of EBUS-TBNA and EUS-FNA in assessing different regions of the mediastinum, recent studies suggest that complete and accurate mediastinal staging can be achieved by the combination of both procedures. It is expected that implementation of minimally invasive endoscopic methods of endobronchial ultrasound-guided transbronchial needle aspiration and transoesophageal ultrasound-guided fine needle aspiration will reduce the need for surgical staging of lung cancer significantly.     

经气管镜针吸活检术和经气管镜超声引导针吸活检术在结节病诊断中的价值

目的探讨经气管镜针吸活检术（TBNA）和经气管镜超声引导针吸活检术（EBUS-TBNA）在结节病诊断中的价值。方法选取15例临床表现和胸部CT检查疑似结节病患者,同时行TBNA和纵隔镜检查。另选取20例疑似结节病的患者行EBUS-TBNA检查。结果 15例同时行TBNA和纵隔镜检查患者中诊断为结节病的12例,TBNA诊断阳性率83.33%（10/12）;20例行EBUS-TBNA患者中诊断为结节病的18例,EBUS-TBNA诊断阳性率为88.89%（16/18）。结论 EBUS-TBNA和TBNA创伤性小、安全性好,在结节病的诊断中有较高的应用价值。     

Current status and clinical applicability of endobronchial ultrasound-guided transbronchial needle aspiration

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has played a key role in the diagnosis of mediastinal, paratracheal, and peribronchial lesions, as well as in lymph node staging for lung cancer. Despite its minimally invasive character, EBUS-TBNA has demonstrated a diagnostic yield comparable with that of established surgical methods. It has therefore gained credibility and has become a routine procedure at various referral centers. A successful EBUS-TBNA procedure requires careful planning, which includes a thorough review of the radiological imaging and special care during specimen collection and preparation, as well as technical expertise, experience with the procedure itself, and knowledge of the potential complications inherent to the procedure. The most common indications for EBUS-TBNA include lymph node staging for lung cancer and the diagnostic investigation of mediastinal/hilar masses and lymph node enlargement. Recently, tumor biomarkers in malignant samples collected during the EBUS-TBNA procedure have begun to be identified, and this molecular analysis has proven to be absolutely feasible. The EBUS-TBNA procedure has yet to be included on the Brazilian Medical Association list of medical procedures approved for reimbursement. The EBUS-TBNA procedure has shown to be a safe and accurate tool for lung cancer staging/restaging, as well as for the diagnosis of mediastinal, paratracheal, and peribronchial lesions/lymph node enlargement