支气管内超声引导针吸活检术在Ⅰ、Ⅱ期胸部结节病诊断中的应用价值

摘要

Objective To evaluate the usefulness of endobronchial ultrasound-guided transbronchial needle aspiration ( EBUS-TBNA) in the diagnosis of stage Ⅰand Ⅱthoracic sarcoidosis . Methods A total of 92 patients with suspected stage ⅠandⅡsarcoidosis in our hospital between September 2009 and September 2013 were studied.All the patients underwent EBUS-TBNA. Those with undetermined diagnosis then underwent surgical biopsies or were followed up for at least 6 months. Results EBUS-TBNA was performed in 232 lymph node stations of the 92 patients, 161 (69.4%) of which were located at mediastinum and 71 (30.6%) of which at hilar and interlobar region .Of the 92 patients, 71 were diagnosed as having sarcoidosis , 64 (90.1%) of which were diagnosed with EBUS-TBNA.The sensitivity, specificity, accuracy, positive and negative predictive value of EBUS-TBNA in the diagnosis of stage Ⅰand Ⅱthoracic sarcoidosis were 90.1% (64/71), 100% (21/21), 92.4% (85/92), 100% (64/64) and 75%(21/28), respectively.The procedure was well tolerated by all the patients with no complications observed . Conclusion EBUS-TBNA is an accurate and safe method in the diagnosis of stage ⅠandⅡthoracic sarcoidosis .%目的：评价支气管内超声引导针吸活检术（ endobronchial ultrasound-guided transbronchial needle aspiration ，EBUS-TBNA）对于临床诊断Ⅰ、Ⅱ期胸部结节病的应用价值。方法回顾性分析2009年9月～2013年9月我院92例拟诊Ⅰ期或Ⅱ期胸部结节病并接受EBUS-TBNA的患者的临床资料。 EBUS-TBNA未能明确诊断者，进一步接受外科手术活检或随诊至少6个月。结果92例患者经EBUS-TBNA活检232组淋巴结，其中纵隔淋巴结161组（69．4％），肺门及叶间淋巴结71组（30．6％）。最终诊断胸部结节病71例，其中经EBUS-TBNA明确诊断64例（90．1％）。 EBUS-TBNA诊断Ⅰ、Ⅱ期胸部结节病的敏感性、特异性、准确率、阳性预测值和阴性预测值分别为90．1％（64／71）、100％（21／21）、92．4％（85／92）、100％（64／64）和75％（21／28）。所有患者检查耐受良好，无相关并发症发生。结论 EBUS-TBNA对于Ⅰ、Ⅱ期胸部结节病是一种安全有效的诊断方法。