| Background and PurposeCommon diseases of the chest(pulmonary malignant tumors,granulomatous diseases,reactive hyperplasia of the lymph nodes)and metastases of the whole body can cause hilar and mediastinal enlargement,of which lung malignant tumors and granulomatous diseases account for the most part.The incidence and mortality of lung cancer are among the highest in the world,accounting for 30% of the causes of cancer death.Lung cancer is a serious threat to the health of the people in our country and it ranks first among the major cancers.Granulomatous diseases include tuberculosis,sarcoidosis,and fungal infections.Clinically,they are mainly identified by pathology,bacteriology,polymerase chain reaction(PCR),and chest imaging.In addition,some uncommon primary mediastinal diseases and metastases are transferred to the mediastinum.Therefore,the hilar and mediastinal space-occupying lesions should be clearly identified as early as possible in order to achieve symptomatic treatment,shorten the course of treatment,and improve the prognosis of patients.The commonly used diagnostic methods for diagnosing hilar and mediastinal lesions include mediastinal,thoracoscopic,and conventional bronchoscopy,but each has its own drawbacks,which has limited clinical application.Endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)has become a highdiagnostic positive rate,invasiveness,reproducibility,fewer complications and low cost,making it become Clinicians the preferred method for examining hilar and mediastinal lesions.Due to the short introduction time of EBUS-TBNA in China,especially in the First Affiliated Hospital of Zhengzhou University,we have analyzed and summarized the patients who underwent EBUS-TBNA examination in the First Affiliated Hospital of Zhengzhou University for 2 years to explore its application value in hilar and mediastinal lesions.MethodsThe patients with hilar and mediastinal lesions who underwent EBUS-TBNA examination at the First Affiliated Hospital of Zhengzhou University from January 2015 to December 2016 were recruited.All patients were diagnosed according to histopathology result and 3-6 months follow-up.They were divided into benign lesions and malignancy lesions.Calculate the sensitivity,specificity,positive predictive value,and negative predictive value of histopathology(HP)test obtained by EBUS-TBNA in the diagnosis of hilar and mediastinal lesions in malignant lesions and benign lesions;The diagnostic sensitivity,specificity,positive predictive value,and negative predictive value of liquid-based cytology(LCT)in malignant lesions were investigated.The diagnostic value of liquid-based cytology in EBUS-TBNA was discussed.To investigate the positive and negative rates of diagnosis of hilar and mediastinal lesions in the central group of lymph nodes(2R/L,4R/L,7)and peripheral lymph nodes(10R/L,11R/L,12R/L).The chi-square test was used to compare whether there was a statistical difference between the two groups;to study the positive rate and negative rate of histopathology test in benign lesions and malignancy lesion in EBUS-TBNA puncture lymph nodes,and the chi-square test was used to compare the two groups whether there was a statistical difference;in non-small cell lung cancer,the positive rate and negative rate of EGFR gene,ALK gene,Braf gene and Kras gene were determined.ResultsA total of 634 patients were enrolled in the study,puncturing 618 enlarged lymph nodes and 58 lesions.Among them,there were 413 males and 221 females.The age ranged from 15-84 years(average 57.75±12.25 years).None of the patients had complications such as pneumothorax,hemorrhage,and infection.The analysis and summary of the pathological results were as follow.1.The sensitivity of histopathological test diagnosis of malignant lesions obtained by EBUS-TBNA was 94.49%(463/490),the specificity was 99.30%(143/144),the positive predictive value was 99.78%(463/464),the negative predictive value was 84.12%(143/170);the sensitivity for the diagnosis of benign lesions was 99.31%(143/144),the specificity was 94.69%(464/490),the positive predictive value was 83.61%(143/169),the negative predictive value is 99.78%(463/464).2.The sensitivity of liquid-based thin-layer cytology brush for diagnosing malignant lesions was 87.96%(431/490),the specificity was 97.59%(140/142),the positive predictive value was 99.54%(431/433),the negative predictive value was 69.65%(140/201),slightly lower than the diagnostic value of histopathology test.3.In the malignant lesion group,473 lymph nodes were punctured,the number of positive punctures for histopathology test was 450 and the positive rate was 95.14%;in benign lesions,145 lymph nodes were punctured,the number of positive punctures for histopathology test was 133,the positive rate was 91.72%.The difference in the diagnosis of the positive rate of the two groups of lesions by histopathology test is no statistically significant(χ2=2.420,P>0.05).4.There were 473 punctures in the central group of lymph nodes,of which 443 were positive for histopathological puncture,and the positive rate was 93.66%.There were 142 punctures in the peripheral group of lymph nodes,of which 137 were positive for puncture,and the positive rate was 96.48%.The difference in the positive rate of lymph node diagnosis between the two groups by histopathology test is no statistically significant(χ2=1.288,P>0.05).5.In 284 cases of non-small cell lung cancer,the positive rate of EGFR gene mutation was 34.38%(44/128),and the negative rate was 65.62%(84/128),among which the sum of exon 19 and 21 mutations accounted for 81.8%;The positive rate of ALK gene mutation was 4.55%(5/110),and the negative rate was 94.45%(105/110).The positive rate of Braf gene mutation was 5.95%(5/84)and the negative rate was 94.05%(79/84).The positive rate of Kras gene mutation was 17.86%(15/84),and the negative rate was 82.14%(69/84).Conclusions1.In the diagnosis of hilar and mediastinal lesions,whether by benign or malignant lesions,whether to puncture the central group lymph nodes or to puncture the peripheral lymph nodes,the histopathological diagnostic techniques obtained by EBUS-TBNA examination is a effective diagnostic method.The liquid-based thin-layer cytology technique has strong sensitivity and specificity for diagnosis,and the reported results are fast,which can further promote its application in hilar and mediastinal lesions.2.EBUS-TBNA puncture specimens can be used for immunohistochemistry,TB-DNA,NSCLC gene detection,diagnosis and differential diagnosis of tuberculosis and sarcoidosis,identification of lung cancer genotyping. |
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