超声支气管镜引导下针吸活检术对孤立性纵隔/肺门淋巴结肿大的诊断价值

丁群力; 杨莉; 王海; 陈众博; 顾晔

doi:10.16766/j.cnki.issn.1674-4152.002403

超声支气管镜引导下针吸活检术对孤立性纵隔/肺门淋巴结肿大的诊断价值

doi: 10.16766/j.cnki.issn.1674-4152.002403

丁群力¹,
杨莉²,
王海²,
陈众博¹,
顾晔^2, ,

1.
宁波大学医学院附属医院呼吸内科, 浙江宁波 315020
2.
同济大学医学院附属上海市肺科医院内镜中心，上海 200082

基金项目:

浙江省自然科学基金项目 LBY22H180004

宁波市自然科学基金项目 2019A610228

详细信息

通讯作者:
顾晔，E-mail：Drsymons@outlook.com

中图分类号: R562 R564
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出版历程
- 收稿日期: 2021-06-02
- 网络出版日期: 2022-08-20

Endobronchial ultrasound-guided transbronchial needle aspiration for the diagnosis of isolated mediastinal and hilar lymphadenopathy

1.
Department of Respiratory Medicine, the Affiliated Hospital of Medical School of Ningbo University, Ningbo, Zhejiang 315020, China

摘要

摘要: 目的评估超声支气管镜引导下经支气管镜针吸活检(EBUS-TBNA)对孤立性纵隔/肺门淋巴结肿大(IMHL)的诊断价值，分析IMHL的病因分布。方法收集上海市肺科医院和宁波大学医学院附属医院2018年8月—2019年1月胸部CT显示孤立性纵隔/肺门淋巴结肿大并至少一次EBUS-TBNA检查的124例患者临床资料，回顾性分析EBUS-TBNA病理学、细胞学和微生物学检查结果，同期进行纵隔镜检查或随访，得到最终结果，分析IMHL的病因分布，并评估EBUS-TBNA的诊断价值。结果共穿刺208个淋巴结，平均每例1.68个，124例IMHL患者中118例获得病因诊断结果，诊断率为95.2%。其中结节病43例(占34.7%)，淋巴结结核23例(占18.5%)，肿瘤21例(占16.9%)。11例为肺恶性肿瘤术后复发，淋巴瘤3例(占2.4%)，淋巴结反应性增生28例(占22.7%)，6例诊断不明。EBUS-TBNA对肿瘤的诊断率最高，为95.2%，对结核的诊断率为82.6%，对结节病的诊断率为48.8%。EBUS-TBNA对IMHL的总体诊断率为72.6%，特异性为100.0%，阴性预测值为50.0%。结论孤立性纵隔/肺门淋巴结肿大的常见病因是结节病、淋巴结结核和肿瘤，EBUS-TBNA对孤立性纵隔肺门淋巴结肿大的病因诊断是一种敏感性高且安全的初步检查方法。
- 腔内超声检查 /
- 活组织检查 /
- 淋巴结 /
- 针吸
Abstract: Objective To analyse the distribution of aetiology of isolated mediastinal and hilar lymphadenopathy (IMHL) and investigate the diagnostic value and safety of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Methods A total of 124 patients with thoracic CT examinations showing IMHL, which were examined at least once using EBUS-TBNA at the Shanghai Pulmonary Hospital, Tongji University Medical School and the Affiliated Hospital of Medical School of Ningbo University from August 2018 to January 2019, were retrospectively analysed, along with their pathology, cytology and microorganism results. Pathological study or follow-up visit was performed in the same period to make a final diagnosis, analyse the distribution of aetiology of IMHL and investigate the diagnostic value and safety of EBUS-TBNA. Results The study punctured 208 lymph nodes in total, with an average of 1.68 every case. Total 118 of 124 patients with IMHL obtained etiological diagnosis, with a diagnosis rate of 95.2%, including 43 cases of sarcoidosis (34.7%), 23 cases of lymph node tuberculosis (18.5%), 21 cases of neoplasms (16.9%), of which 11 cases were postoperative recurrence of pulmonary malignant tumors, 3 cases of lymphoma (2.4%), 28 cases of reactive hyperplasia of lymph nodes (22.7%), and 6 cases of unknown diagnosis. The diagnosis rate of neoplasms was 95.2%, that of tuberculosis was 82.6%, and that of sarcoidosis was 48.8%. The diagnostic accuracy of EBUS-TBNA was 72.6%, the specificity was 100.0%, and the negative predictive value was 50.0%. Conclusion The common causes of IMHL are sarcoidosis, tuberculosis and neoplasms. EBUS-TBNA is a safe, highly sensitive method that can be used to initially investigate patients with IMHL.
- Endobronchial ultrasound /
- Biopsy /
- Lymph node /
- Needle

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表 1 124例IMHL患者经支气管镜超声引导下穿刺活检位置及比例

Table 1. Location and proportion of needle biopsy guided by transbronchial ultrasound in 124 IMHL patients

淋巴结站点	穿刺淋巴结数(个)	穿刺率(%)
2R	5	2.4
4R	67	32.2
4L	18	8.7
7	75	36.1
10R	10	4.8
10L	4	1.9
11R	15	7.2
11L	14	6.7
合计	208	100.0

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表 2 EBUS-TBNA对124例IMHL患者的病因诊断分布

Table 2. The etiological diagnosis distribution of EBUS-TBNA in 124 patients with IMHL

病因诊断	例数	分布比例(%)	经EBUSTBNA诊断(例)	诊断率(%)
结节病	43	34.7	21	48.8
结核	23	18.5	19	82.6
肿瘤(肺部、其他部位来源)	21	16.9	20	95.2
淋巴瘤	3	2.4	2	66.7
反应性淋巴结肿大	28	22.7	28	100.0
诊断不明	6	4.8	0	0
合计	124	100.0	90	72.6

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表 3 结节病和结核患者临床特征、纵隔/肺门淋巴结特点

Table 3. Clinical characteristics, mediastinal/hilar lymph node characteristics in patients with sarcoidosis and tuberculosis

项目	结节病(43例)	结核(23例)	统计量	P值
年龄(x±s，岁)	54.40±11.87	42.65±16.29	3.350^a	0.001
性别(男/女，例)	6/37	11/12	8.991^b	0.003
肺外淋巴肿大(有/无，例)	5/38	14/9	17.720^b	< 0.001
最大淋巴结直径(x±s，cm)	2.31±0.72	2.27±0.67	0.175^a	0.862
最大淋巴结的CT值(x±s，HU)	62.74±17.75	49.62±12.51	3.150^a	0.002
淋巴结站点数量(x±s，个)	7.84±2.18	4.30±2.36	6.090^a	< 0.001
同时累及12R和/或12L(例)	10	1	3.587^b	0.035
EBUS-TBNA诊断阳性(例)	21	19	7.158^b	0.008
注：^a为t值，^b为χ²值。

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