超声支气管镜引导针吸活检术对不明原因纵隔淋巴结肿大性疾病的诊断价值

发布时间：2018-03-29 19:17

本文选题：超声支气管镜引导针吸活检术　切入点：纵隔淋巴结肿大　出处：《广西医科大学》2015年硕士论文

【摘要】：目的评价超声支气管镜引导针吸活检术(endobronchial ultrasound guided transbronchial needle aspiration, EBUS — TBNA)对不明原因纵隔淋巴结肿大性疾病的诊断价值和安全性。方法回顾性分析2013年5月至2014年6月期间在广西医科大学附属肿瘤医院行EBUS-TBNA检查的30例纵隔淋巴结肿大病人,穿刺物送病理学检查。以病理学结果为金标准,研究EBUS-TBNA在纵隔淋巴结肿大性疾病中的诊断价值；对比EBUS-TBNA和CT这两种方法在诊断纵隔恶性病变中的差异。结果30例病人中男20例,女10例,年龄28-82岁,中位年龄55岁,临床最终确诊病例28例,未能明确诊断2例,其中恶性病变27例,良性病变1例。经EBUS-TBNA诊断24例,其中原发性肺癌19例,转移性肺癌1例,纵隔恶性肿瘤3例,肺部炎症1例,4例为假阴性,EBUS-TBNA诊断疾病的敏感度及阴性预测值分别为85.7%、33.6%;EBUS-TBNA诊断恶性疾病的敏感度和阴性预测值分别为85.1%和20%,与CT诊断恶性疾病(敏感度81.4、阴性预测值16.7%)相比较,两者进行X2检验,P0.05,显示两者之间无统计学差异。而EBUS-TBNA在诊断原发性肺癌中敏感度为95%,特异度为100%,阳性预测值为100%,阴性预测值为88.9%。3例来源和病理类型不明的恶性肿瘤中,结合免疫组织化学结果最后确诊2例为原发性肺腺癌,1例为转移性肺癌。所有行EBUS-TBNA检查的患者均未出现严重的并发症。结论EBUS-TBNA作为一种微创、安全的检查方法,它在诊断不明原因纵隔淋巴结肿大性疾病方面有着较高的诊断价值,对于恶性疾病来说,EBUS-TBNA检查略优于CT检查。而对于诊断原发性肺癌,EBUS-TBNA有着很高的诊断价值,结合免疫组织化学检查有助于明确恶性病变的来源及病理类型。
[Abstract]:Objective to evaluate the diagnostic value and safety of endobronchial ultrasound guided transbronchial needle aspiration (EBUS TBNA) for unknown mediastinal lymphadenopathy. Thirty patients with mediastinal lymphadenopathy underwent EBUS-TBNA examination in the Cancer Hospital affiliated to Guangxi Medical University. The diagnostic value of EBUS-TBNA in mediastinal lymphadenopathy was studied, and the difference between EBUS-TBNA and CT in the diagnosis of mediastinal malignant lesions was compared. There were 10 female patients, aged 28-82 years, with a median age of 55 years. 28 cases were diagnosed by clinical final diagnosis, 2 cases were not clearly diagnosed, including 27 cases of malignant lesions and 1 case of benign lesions. 24 cases were diagnosed by EBUS-TBNA, including 19 cases of primary lung cancer and 1 case of metastatic lung cancer. 3 cases of mediastinal malignant tumor, The sensitivity and negative predictive value of EBUS-TBNA for diagnosis of malignant diseases were 85.75.73.6and 85.1% and 20.1%, respectively, compared with those for CT diagnosis of malignant diseases (sensitivity 81.4, negative predictive value 16.7B). The X2 test showed that there was no statistical difference between the two. However, the sensitivity, specificity, positive predictive value, negative predictive value and negative predictive value of EBUS-TBNA in the diagnosis of primary lung cancer were 95, 100, 100 and 88.9.3, respectively. Combined with immunohistochemical results, 2 cases of primary lung adenocarcinoma and 1 case of metastatic lung cancer were confirmed. There were no serious complications in all patients undergoing EBUS-TBNA examination. Conclusion EBUS-TBNA is a minimally invasive and safe method. It has a high diagnostic value in diagnosing mediastinal lymphadenopathy with unknown causes, and is slightly superior to CT in the diagnosis of malignant diseases, but it has a high diagnostic value in the diagnosis of primary lung cancer. Combined with immunohistochemical examination, it is helpful to identify the origin and pathological type of malignant lesions.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R734

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