超声支气管镜引导下电刀辅助开窗活检钳活检在纵膈疾病诊断中的临床应用

doi:10.3877/cma.j.issn.1674-6902.2020.05.003

目的

探索在超声支气管镜引导下使用高频电针刀在气管壁开窗，形成通向纵膈病变的孔道，再使用活检钳取样这一新的纵膈活检取样方法对纵膈淋巴结肿大病因的诊断价值，并评估其安全性。

方法

纳入2018年11月至2019年11月我院收治的纵膈疾病患者，先后实施超声支气管镜引导下经支气管针吸活检(EBUS-guided transbronchial needle aspiration, EBUS-TBNA)和超声支气管镜引导下电刀辅助开窗活检钳活检(EBUS-guided cautery-assisted transbronchial forceps biopsy, EBUS-caTBFB)，样本送病理检查，进而比较这两种方法的诊断效能和安全性。

结果

共纳入纵膈疾病患者15例，明确诊断12例，其中恶性肿瘤8例，包括肺腺癌3例、肺鳞癌2例、肺小细胞癌2例和未分型癌1例；良性4例，包括炎性假瘤1例，结核3例，另有病因不明慢性肉芽肿性炎3例。EBUS-TBNA和EBUS-caTBFB样本病理学诊断率分别为53.3%(8/15)和86.7% (13/15)，EBUS-caTBFB组的病理诊断率具有高于EBUS-TBNA组的趋势(P＝0.054)。病因诊断率分别为50% (6/12)和83.3% (10/12)，但两组之间无统计学差异(P＝0.097)。联合两种方法对于纵膈疾病的病理学诊断率和病因诊断率分别为93.3%(14/15)和91.7%(11/12)。所有患者均未出现严重出血、气胸、感染等并发症。

结论

EBUS-caTBFB是一项安全可靠的、可有效诊断纵膈疾病的方法。EBUS-caTBFB与EBUS-TBNA的联合应用可能进一步提高纵膈疾患的诊断率。

关键词: 纵膈疾病, 超声支气管镜, 电刀辅助活检钳活检, 经支气管针吸活检

Objective

To evaluate the diagnostic yield and safety of a novel method, endobronchial ultrasound-guided cautery-assisted transbronchial forceps biopsy (EBUS-caTBFB) to discriminate the etiologies of mediastinal lymphadenopathy.

Methods

Patients admitted in Xinqiao Hospital with mediastinal lymphadenopathy between December 2018 and December 2019 were included in this study. For each of them, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and EBUS-caTBFB were sequentially performed to acquire specimens for pathologic diagnosis. Diagnostic yield and the incidence of complications were compared between the two methods.

Results

15 patients with 8 of malignant cases (3 of adenocarcinoma cases, 2 of squamous carcinoma cases and 1 of unclassified case), 4 of benign cases (1 of inflammatory pseudotumor case and 3 of tuberculosis cases) and 3 of unclear chronic granulomatous inflammation were included. The EBUS-caTBFB tend to has a better pathological diagnostic yield than EBUS-TBNA, with respective rate of 86.7%(13/15)and 53.3%(8/15)(P=0.054). Among the 12 cases diagnosed with definite etiologies, the EBUS-caTBFB also seemed to have a higher etiological diagnostic yield than EBUS-TBNA as the rate was 50.0% (6/12) versus 83.3% (10/12) but without significant difference. The overall diagnostic yield of the two methods was 93.3%(14/15)in pathology and 91.7% (11/12) in etiology. Complications including pneumothorax, severe bleeding and infections were not encountered.

Conclusion

EBUS-caTBFB may be a safe and effective method compared to EBUS-TBNA to obtain specimens for mediastinal adenopathy diagnosis. Furthermore, the combination of the two methods may further improve the overall diagnostic yield.

Key words: Lymphadenopathy, Endobronchial ultrasound, Cautery-assisted transbronchial forceps biopsy, Transbronchial needle aspiration

表1 两种方法病理诊断率比较

疾病诊断		例数	病理诊断率(%)		P值
疾病诊断		例数	EBUS-TBNA	EBUS-caTBFB	P值
肉芽肿性炎		6	50.0	83.3	0.273
	结核	3	33.3	66.7
	不明	3	66.7	100.0
炎性假瘤		1	0.0	100.0
肺癌		8	62.5	87.5	0.285
	鳞状细胞癌	3	66.7	100.0
	腺癌	2	50.0	50.0
	小细胞癌	2	50.0	100.0
未分型		1	100.0	100.0
总　计		15	53.3	86.7	0.054

表1 两种方法病理诊断率比较

疾病诊断		例数	病理诊断率(%)		P值
疾病诊断		例数	EBUS-TBNA	EBUS-caTBFB	P值
肉芽肿性炎		6	50.0	83.3	0.273
	结核	3	33.3	66.7
	不明	3	66.7	100.0
炎性假瘤		1	0.0	100.0
肺癌		8	62.5	87.5	0.285
	鳞状细胞癌	3	66.7	100.0
	腺癌	2	50.0	50.0
	小细胞癌	2	50.0	100.0
未分型		1	100.0	100.0
总　计		15	53.3	86.7	0.054

表2 两种方法病因诊断率比较

疾病诊断		例数	病因诊断率(%)		P值
疾病诊断		例数	EBUS-TBNA	EBUS-caTBFB	P值
良性疾病		4	25.0	75.0	0.243
	结核	3	33.3	66.7
	炎性假瘤	1	0.0	100.0
肺癌		8	62.5	87.5	0.285
	鳞状细胞癌	3	66.7	100.0
	腺癌	2	50.0	50.0
	小细胞癌	2	50.0	100.0
	未分型	1	100.0	100.0
总　计		12	50.0	83.3	0.097

表2 两种方法病因诊断率比较

疾病诊断		例数	病因诊断率(%)		P值
疾病诊断		例数	EBUS-TBNA	EBUS-caTBFB	P值
良性疾病		4	25.0	75.0	0.243
	结核	3	33.3	66.7
	炎性假瘤	1	0.0	100.0
肺癌		8	62.5	87.5	0.285
	鳞状细胞癌	3	66.7	100.0
	腺癌	2	50.0	50.0
	小细胞癌	2	50.0	100.0
	未分型	1	100.0	100.0
总　计		12	50.0	83.3	0.097

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EBUS-guided cautery-assisted transbronchial forceps biopsy in mediastinal disease