诊断学理论与实践

诊断学理论与实践 ›› 2020, Vol. 19 ›› Issue (04): 397-401.doi: 10.16150/j.1671-2870.2020.04.014

• 论著 • 上一篇    下一篇

超声引导下经支气管针吸活检在老年患者肺门及纵隔病变中的诊断价值及漏诊分析

洪贵平1a,2, 陈晓炎1b, 周剑平1a,3(), 陈巍1a,3, 项轶1a,3, 周敏1a,3, 李庆云1a,3   

  1. 1.上海交通大学医学院附属瑞金医院a. 呼吸与危重症医学科,b. 病理科,上海 200025
    2.安徽省铜陵市人民医院老年医学科,安徽 铜陵 244000
    3.上海交通大学医学院呼吸病研究所,上海 200025
  • 收稿日期:2019-09-30 出版日期:2020-08-25 发布日期:2022-07-15
  • 通讯作者: 周剑平 E-mail:zjp11593@rjh.com.cn
  • 基金资助:
    国家自然科学基金青年项目(81700085);上海市重中之重临床重点学科建设项目(2017ZZ02014)

Diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration in elderly patients with hilar and mediastinal lesions and analysis of missed diagnosis

HONG Guiping1a,2, CHEN Xiaoyan1b, ZHOU Jianping1a,3(), CHEN Wei1a,3, XIANG Yi1a,3, ZHOU Min1a,3, LI Qingyun1a,3   

  1. 1a. Department of Respiratory and Critical Care Medicine, 1b. Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
    2. Department of Geriatrics, Tongling People′s Hospital, Anhui Tongling, 244000
    3. Institute of Respiratory Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
  • Received:2019-09-30 Online:2020-08-25 Published:2022-07-15
  • Contact: ZHOU Jianping E-mail:zjp11593@rjh.com.cn

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摘要：

目的： 评价经超声引导下经支气管针吸活检（endobronchial ultrasound-guided transbronchial needle aspiration, EBUS-TBNA）在老年患者肺门及纵隔病变中的诊断价值。方法： 收集2016年1月至2018年12月间在上海交通大学医学院附属瑞金医院呼吸与危重症医学科接受EBUS-TBNA术的206例患者,年龄均≥65岁,所有患者经胸部CT或PET-CT检查显示肺门或纵隔淋巴结肿大,和（或）存在气管旁、支气管旁肿块,且均具有明确的组织病理学结果（包括经皮肺穿刺、胸腔镜、开胸手术及浅表淋巴结活检等检查）。以病理学结果为金标准,计算EBUS-TBNA诊断效能及分析漏诊情况。结果： 206例患者共穿刺气管旁、支气管旁病灶61个以及淋巴结225组,经病理学检查确诊为恶性疾病的患者有151例,其中由EBUS-TBNA确诊为恶性肿瘤的患者为140例;经病理确诊为良性病变的患者55例,其中由EBUS-TBNA确诊者为50例。EBUS-TBNA的总体诊断灵敏度达92.2%,特异度为100%,漏诊率为7.8%。EBUS-TBNA对恶性肿瘤的诊断灵敏度为92.7%,特异度为100%,漏诊率为7.3%;EBUS-TBNA对良性病变的诊断灵敏度为90.9%,特异度为100%,漏诊率为9.1%。造成EBUS-TBNA漏诊的主要原因包括病灶直径小（病灶平均长径或直径<1 cm）、送检组织较小或数量较少等。结论： 在老年患者的肺门及纵隔病变诊断中,EBUS-TBNA具有较高的灵敏度和特异度,但对结果为阴性但病灶的平均长径或直径<1 cm的患者,要注意漏诊的可能。

关键词: 超声内镜引导下经支气管针吸活检, 纵隔病变, 肺门病变, 老年患者

Abstract:

Objective: To assess the diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in elderly patients with hilar and mediastinal lesions. Methods: A total of 206 patients (≥ 65 years of age) hospitalized in the Department of Respiratory and Critical Care Medicine of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine were enrolled, and all had hilar or mediastinal lymphadenopathy, and/or paratracheal and bronchial masses detected on CT or PET-CT, and all had definite histopathologic findings (including percutaneous lung biopsy, thoracoscopy, open thoracic surgery, and superficial lymph node biopsy). The diagnostic efficacy of EBUS-TBNA was assessed by comparison with the pathologic findings as the gold standard and the cases with missed diagnosis were analyzed. Results: Of the 206 patients, 61 lesions had paratracheal and/or bronchial lesions aspirated, and 225 groups of lymph nodes aspirated via EBUS-TBNA. Pathological examination revealed that 151 patients had malignant disease and 55 patients had benign disease. EBUS-TBNA identified 140 cases out of 151 malignant tumors and 50 cases out of 55 benign lesions, respectively. The diagnostic sensitivity, specificity of EBUS-TBNA for malignant tumors were 92.7%, 100%, respectively and the missed diagnosis rate was 7.8%. The diagnostic sensitivity and specificity of EBUS-TBNA for benign lesions were 90.9%, 100%, respectively, and the missed diagnosis rate was 9.1%. The major causes for missed diagnosis included small lesions (diameter <1 cm), small tissue sample or small number of tissue samples to be examined. Conclusions: EBUS-TBNA is a safe and effective approach with high diagnostic sensitivity and specificity for elderly patients with hilar and mediastinal lesions. For lesions with negative result of EBUS-TBNA but lesion with average length or diameter <1 cm, missed diagnosis should be awared of.

Key words: Endobronchial ultrasound-guided transbronchial needle aspiration, Mediastinal lesions, Hilar lesion, Elderly patient

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