The Value Of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration For Mediastinal Lymphadenopathy

Objective To evaluate the diagnostic value of ultrasound-guided needle biopsy for the diagnosis of hilar and mediastinal lymphadenopathy,and to evaluate the clinical significance of EBUS-TBNA follow-up.Methods A retrospective analysis of 199 patients with mediastinal or hilar lymphadenopathy performed by EBUS-TBNA in Dalian City Center Hospital from2014 to 2016.The puncture was sent for pathological examination.These patients were followed up for the diagnostic criteria of the follow-up diagnosis.The diagnostic value of EBUS-TBNA in the diagnosis of hilar and mediastinal lymphadenopathy and the clinical significance of postoperative follow-up were studied.Results1.A total of 199 patients who met the inclusion criteria were enrolled,including 120males and 79 females,aged 20-88 years,with an average age of(59.08±11.605)years.There were 83 cases with smoking history;17 cases of CT examination showed hilar or mediastinal lymphadenopathy,and 182 cases had various clinical manifestations,including cough,cough,blood in the sputum,fever,chest tightness,Shortness of breath,hoarseness,etc.2.Of the 199 patients enrolled,192 were diagnosed,134 were diagnosed as malignant,58 were benign,4 were benign,and 4 were undiagnosed.Among them,165 cases were diagnosed by EBUS-TBNA,130 cases were confirmed as malignant cases,35 cases were benign cases,and 34 cases were not diagnosed(including 2 cases with malignant unclear and 14 cases with benign unclear diagnosis).Among the malignant cases diagnosed,129 cases of lung cancer and 128 cases of EBUS-TBNA were diagnosed.Among them,49 cases were diagnosed with adenocarcinoma,48 cases were diagnosed by EBUS-BTNA;48 cases of small cell carcinoma,20 cases of squamous cell carcinoma,1 case of large cell carcinoma,1 case of small cell carcinoma and squamous cell carcinoma,1 case of small cell carcinoma and adenocarcinoma,2 cases of adenosquamous carcinoma and 7 cases of undetermined lung cancer were identified.EBUS-TBNA was confirmed.3 cases of lymphoma were diagnosed and 0 cases were diagnosed by EBUS-TBNA.Two other malignant tumors(1 case of Intestinal adenocarcinoma,1 case of germ cell tumor)and EBUS-TBNA were diagnosed.Of the benign lesions diagnosed,23 were sarcoidosis,12 were diagnosed by EBUS-TBNA,10were tuberculosis,6 were diagnosed by EBUS-TBNA,2 were reactive hyperplasia,2were diagnosed by EBUS-TBNA,and 23 were chronic inflammation.EBUS-TBNA confirmed 15 of them.3.EBUS-TBNA examination for the diagnosis of hilar or mediastinal lymphadenopathy:the sensitivity,specificity and accuracy of EBUS-TBNA in the diagnosis of mediastinal lymphadenopathy are 85.9%,100%and 86.4%,the positive predictive value is 100%,the negative predictive value is 20.6%,and the false negative rate is 14.1%).The sensitivity,specificity,positive predictive value and negative predictive value of EBUS-TBNA for diagnosis of lymph node metastasis of lung cancer were 99.2%,100%,100%and 98.6%,respectively,and the sensitivity was 99.2%(95%CI:0.95-1.00).The specificity is 100%(95%CI:0.94-1.00).The sensitivity of EBUS-TBNA in the diagnosis of malignant lymph node metastasis was 97.8%(95%CI:0.92-0.99).The sensitivity of EBUS-TBNA in the diagnosis of benign disease was60.3%(95%CI:0.47-0.73),and the sensitivity of EBUS-TBNA in the diagnosis of benign and malignant diseases was statistically significant(X~2=45.041,P=0.00).ConclusionEBUS-TBNA has a high diagnostic value for hilar or mediastinal lymphadenopathy,and is highly consistent with the final follow-up diagnosis;EBUS-TBNA has a higher diagnostic value for malignant diseases than benign disease.Follow-up after EBUS-TBNA examination is meaningful,especially for cases that are not clearly diagnosed,and cases that have not been diagnosed should continue to be followed up.