Diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration combine X-ray guided tranbronchial lung biopsy in hilar and mediastinal diseases

doi:10.3877/cma.j.issn.1674-6902.2024.05.002

Abstract

Abstract:

Objective

To investigate the diagnostic value of endobronchial bronchial ultrasound-guided Transbronchial Needle Aspiration combine X-ray guided tranbronchial lung biopsy in hilar and mediastinal diseases.

Methods

Retrospectively analyzed the clinical data of 89 patients with hilar and mediastinum diseases who underwent X-ray guided tranbronchial lung biopsy （TBLB） and/or endobronchial bronchial ultrasound-guided Transbronchial Needle Aspiration （EBUS-TBNA） in Hongkong University-Shenzhen hospital from August 2020 to November 2021. The diagnostic yield of EBUS-TBNA combined with TBLB in hilar and mediastinum diseases was analyzed.

Results

89 patients with hilar and mediastinal diseases were underwent transbronchial TBLB and/or EBUS-TBNA biopsy. 80 patients were pathologically positive （89.89%）， 69 cases of lung carcinoma， 5 cases of pulmonary tuberculosis，2 cases of pulmonary sarcoidosis， one case of pulmonary mycosis， one case of pulmonary abscess， one case of organizing pneumonia and one case of pulmonary actinomycosis were diagnosed. The total biopsy positive rate of EBUS-TBNA was 61.80%（55/89）， and TBLB was 67.19%（43/64）. 64 patients who underwent EBUS-TBNA combined with TBLB， 53 （82.81%） had a positive pathological diagnosis. 25 patients who underwent EBUS-TBNA only， 16 （64.0%） had a positive pathological diagnosis. The positive rate of EBUS-TBNA combined with TBLB was statistically significantly higher than that of EBUS-TBNA alone （P＜0.05）.

Conclusion

Combination of EBUS-TBNA and X-ray guided TBLB can significantly improve the pathological diagnosis yield in hilar and mediastinal diseases.

Key words: Endobronchial bronchial ultrasound-guided transbronchial needle aspiration, Transbronchial needle aspiration, Tranbronchial lung biopsy, Hilar adenopathy, Mediastinal adenopathy

Wei Xu, Min Liu, Zhanghua Zhong, Yanli Pei, Lei Rong. Diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration combine X-ray guided tranbronchial lung biopsy in hilar and mediastinal diseases[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2024, 17(05): 680-684.

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淋巴结区域	穿刺淋巴结（n）	穿刺率（%）	病理阳性（n）	病理阳性率（%）
2R	9	4.76	5	55.56
4R	49	25.93	38	77.55
4L	15	7.94	5	33.33
7区	60	31.75	31	51.67
10R	13	6.88	6	46.15
10L	7	3.70	3	42.86
11R	4	2.12	0	0.00
11L	8	4.23	5	62.50
肺门肿块	24	12.70	18	75.00
总计	189		111	58.73

淋巴结区域	穿刺淋巴结（n）	穿刺率（%）	病理阳性（n）	病理阳性率（%）
2R	9	4.76	5	55.56
4R	49	25.93	38	77.55
4L	15	7.94	5	33.33
7区	60	31.75	31	51.67
10R	13	6.88	6	46.15
10L	7	3.70	3	42.86
11R	4	2.12	0	0.00
11L	8	4.23	5	62.50
肺门肿块	24	12.70	18	75.00
总计	189		111	58.73

穿刺部位	例数	PET-CT诊断		Kappa值
穿刺部位	例数	阳性	阴性	Kappa值
纵隔淋巴结	40			0.565
病理诊断阳性		22（78.57）	2（16.67）
病理诊断阴性		6（21.43）	10（83.33）
肺门肿块	10
病理诊断阳性		9（90.00）	0（0.00）
病理诊断阴性		1（10.00）	0（0.00）

穿刺部位	例数	PET-CT诊断		Kappa值
穿刺部位	例数	阳性	阴性	Kappa值
纵隔淋巴结	40			0.565
病理诊断阳性		22（78.57）	2（16.67）
病理诊断阴性		6（21.43）	10（83.33）
肺门肿块	10
病理诊断阳性		9（90.00）	0（0.00）
病理诊断阴性		1（10.00）	0（0.00）

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