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目的探讨支气管内镜超声引导针吸活检术(EBUS-TBNA)在肺癌纵隔淋巴结分期和治疗中的价值。方法回顾分析我院呼吸内科和胸外科2003年5月至2014年5月期间收治的135例经胸部影像学检查(胸部CT或PET/CT)发现纵隔淋巴结肿大(≥1.0 cm)或提示淋巴结阳性的患者并经EBUS-TBNA检查的临床资料。结果 135例患者中,经EBUS-TBNA检查证实纵隔淋巴结转移者106例(阳性),无纵隔淋巴结转移者29例(阴性),阳性患者给以化疗、新辅助化疗或分子靶向治疗,阴性患者中2例放弃治疗自动出院,27例进行外科开胸手术,行肺叶切除术或肺楔形切除术并进行纵隔淋巴结清扫,术后病理证实22例纵隔淋巴结无转移,5例有淋巴结转移(假阴性)。本研究显示EBUS-TBNA的敏感性、特异性、准确性、阳性预测值、阴性预测值及假阴性值分别为95.9%(106/111)、100%(22/22)、96.2%(128/133)、100%(106/106)、81.5%(22/27)和4.5%(5/111)。所有患者检查过程中耐受性良好,无不良并发症。结论 EBUS-TBNA在肺癌纵隔淋巴结分期和治疗方案中有决定性意义。
Objective To investigate the value of endoscopic ultrasonography guided needle aspiration biopsy (EBUS-TBNA) in the staging and treatment of mediastinal lymph nodes in lung cancer. Methods A retrospective analysis of 135 cases of mediastinal lymph nodes (≥1.0 cm) in thoracic and thoracic surgeries (thoracic CT or PET / CT) admitted from May 2003 to May 2014 in our hospital was retrospectively analyzed. Positive patients and clinical data by EBUS-TBNA examination. Results Of the 135 patients, 106 (positive) mediastinal lymph node metastases were confirmed by EBUS-TBNA, 29 (negative) without mediastinal lymph node metastasis. The positive patients were treated with chemotherapy, neoadjuvant chemotherapy or molecular targeted therapy, and negative patients Two patients were given up for treatment of spontaneous discharge, 27 patients underwent surgical thoracotomy, lobectomy or pulmonary wedge resection and mediastinal lymph node dissection. Pathologic examination confirmed that there was no metastasis to mediastinal lymph nodes in 22 cases and lymph node metastasis in 5 cases (false negative ). This study showed that the sensitivity, specificity, accuracy, positive predictive value, negative predictive value and false negative predictive value of EBUS-TBNA were 95.9% (106/111), 100% (22/22), 96.2% 133), 100% (106/106), 81.5% (22/27) and 4.5% (5/111). All patients were well tolerated during the examination and had no adverse complications. Conclusion EBUS-TBNA is of decisive significance in the mediastinal lymph node staging and treatment of lung cancer.