支气管腔内超声图像评分系统在肺结节良恶性诊断中的应用

目的建立基于支气管腔内超声(EBUS)图像的评分系统从而判别肺结节良恶性。 方法回顾性纳入自2018年5月1日至2020年3月1日期间于苏北人民医院气管镜室行气管镜检查的患者资料，所有患者胸部计算机断层扫描(computer tomography, CT)检查见肺部≤3 cm的肺结节而行常规支气管镜检查未见明显异常。使用超声探头引导下在病变处进行活检与刷检协助诊断，未能明确诊断者行进一步侵袭性操作或治疗后随访观察至少3个月获得最终诊断。分析镜下超声图像形态特征，包括病灶外形、边缘、边界、内部回声强弱、内部回声同质或异质、支气管充气征、不规则无回声区、同心圆影8种不同EBUS图像特点与病灶良恶性的关系，建立简易评分系统，使用SPSS软件分析处理数据。 结果114例肺结节患者中，良性病变65例，恶性病变49例。EBUS图像中的三种图像特征，包括病灶圆形或类圆形外形、边缘不连续、病灶异质性，差异有统计学意义(P<0.05)；根据建立的简易评分系统，绘制ROC曲线，当评分以7为界点时，敏感度(65.3%)和特异度(78.5%)最高，以该点为最佳诊断点；当评分≥7时，诊断肺恶性病变的准确率较高。计算Kappa一致性：系数为0.441(95%CI为0.274～0.607，P<0.01)，具有中等强度一致性。 结论EBUS图像特征可用于鉴别肺结节良恶性，基于该图像的评分系统在鉴别肺结节良恶性中有较好的应用价值。

Application value of the scoring system based on endobronchial ultrasound image in the diagnosis of pulmonary nodules

Objective To attempt to develop a simple scoring system based on images of endobronchial ultrasound(EBUS)to discriminate between benign and malignant pulmonary nodules.Methods data of patients who undergone bronchoscopy in the Bronchoscopy Room of North Jiangsu People′s Hospital during May 1,2018 and March 1,2020 were retrospectively included.all of the patients′chest CT scan showed pulmonary nodules≤3 cm,while routine bronchoscopy showed no obvious abnormalities.Ultrasound probe guided biopsy and brush examination were used to assist in the diagnosis of the disease.Patients with no definite diagnosis were further subjected to invasive surgeries or observations after the treatment for at least 3 months to obtain the final diagnosis.Eight different EBUS image characteristics including lesion shape,margin,border,internal echo strength,homogeneous,or heterogeneous internal echoe,air bronchogram,irregular anechoic area,concentric circles were observed,and the relationship between these image characteristics and the nature of pulmonary nodules were analyzed,a simple scoring system was established,datas were analyzed using SPSS software.Results Among 114 patients with pulmonary nodules,65 were benign and 49 were malignant.Three image features in EBUS images,including round or round shape of lesions,discontinuous margin,and heterogeneous echogenicity,with statistically significant(P<0.05).According to the simple scoring system established,ROC curve was drawn.When the score was set at 7,the sensitivity(65.3%)and specificity(78.5%)were the highest,and this was the best point for diagnosis.When the score is≥7,the diagnosis of pulmonary malignant lesions was more accurate.Kappa consistency was calculated with a coefficient of 0.441(95%CI 0.274-0.607,P<0.01),showing moderate strength consistency.Conclusion EBUS can provide image characteristic information to differentiate the nature of pulmonary nodules,and the scoring system based on the images has a good application value in differentiating benign from malignant pulmonary nodules.