| 摘要: |
| 目的比较支气管超声引导针吸活检术(endobronchial ultrasound guided transbronchial needle aspiration,EBUS-TBNA)和电子发射断层显像/X线计算机体层成像(positron-emission tomography and computed tomography,PET/CT)用于不明原因纵隔淋巴结肿大诊断的价值,并探讨EBUS-TBNA和PET/CT联合应用的意义。方法回顾性分析解放军总医院呼吸科自2010年12月至2011年8月采用EBUS-TBNA诊断前已采用PET/CT检查的45例不明原因纵隔淋巴结肿大患者的临床资料。所有患者在进行EBUS-TBNA检查前接受普通白光支气管镜检查,均未发现支气管内病变。对于EBUS-TBNA未能明确诊断的患者,可行外科手术切除，并经至少6个月以上的临床和影像学随访。结果EBUS-TBNA诊断恶性纵隔淋巴结的敏感性为81.48%(22/27)、特异性100%(18/18)、阳性预测值100%(22/22)、阴性预测值78.26%(18/23)、准确性88.89%(40/45)；PET/CT诊断恶性纵隔淋巴结的敏感性为92.59%(25/27)、特异性55.56%(10/18)、阳性预测值75.76%(25/33)、阴性预测值83.33%(10/12)、准确性77.78%(34/45),EBUS-TBNA在诊断的特异性(P=0.003)和阳性预测值(P=0.016)方面优于PET/CT。结论EBUS-TBNA在不明原因纵隔淋巴结肿大的诊断方面有较高的价值;与PET/CT联合应用,可使EBUS-TBNA诊断恶性纵隔淋巴结出现假阴性结果的状况得到改善。 |
| 关键词: 纵隔疾病 淋巴结病 经支气管超声引导针吸活检术 正电子发射断层显像/X线计算机体层成像 诊断 |
| DOI：10.3724/SP.J.1008.2012.00493 |
| 投稿时间：2012-03-22修订日期：2012-05-02 |
| 基金项目: |
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| Application of EBUS-TBNA and PET/CT in diagnosing enlarged mediastinal lymph nodes caused by unknown reasons |
| YANG Zhen,TIAN Qing,WANG Hui-shuang,AN Yang,LIU Xing-chen,CHEN Liang-an﹡ |
(Department of Respiratory, General Hospital of PLA, Beijing 100853, China
*Corresponding author.) |
| Abstract: |
| bjectiveTo compare the values of endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) and positron-emission tomography and computed tomography (PET/CT) in diagnosis of enlarged mediastinal lymph nodes caused by unknown reasons, and to study the diagnostic value of the combination of EBUS-TBNA and PET/CT. MethodsA retrospective study was carried out in our hospital. From December 2010 to August 2011, a total of 45 patients with enlarged mediastinal lymph nodes received EBUS-TBNA following PET/CT examination. Conventional bronchoscopy was performed before EBUS-TBNA. The patients with endobronchial lesions were excluded from this study. Patients with negative EBUS-TBNA results underwent surgical biopsies or a minimum of 6 months’ clinical and radiological follow-up. ResultsSensitivities of EBUS-TBNA and PET/CT in diagnosis of enlarged mediastinal lymph nodes were 81.48% (22/27) and 92.59% (25/27), the specificities were 100% (18/18) and 55.56% (10/18), the positive predictive values (PPV) were 100% (22/22) and 75.76% (25/33), the negative predictive values (NPV) were 78.26% (18/23) and 83.33% (10/12), the accuracies were 88.89% (40/45) and 77.78% (34/45), respectively. EBUS-TBNA had a significantly better specificity (P=0.003) and PPV (P=0.016) than PET/CT for diagnosis of enlarge mediastinal lymph nodes. ConclusionEBUS-TBNA is valuable for diagnosing enlarged mediastinal lymph nodes caused by unknown reasons. EBUS-TBNA combined with PET/CT can reduce the false negative results in diagnosis of malignant mediastinal lymph nodes. |
| Key words: mediastinal diseases lymphadenopathy endobronchial ultrasound guided transbronchial needle aspiration positron-emission tomography and computed tomography diagnosis |
