The Influencing Factors Of The Detection Rate Of EBUS-TBNA And Its Value In The Diagnosis Of Lung Cancer

Part Ⅰ The influencing factors of the detection rate of EBUS-TBNA1 Research background and objectiveAt present,with the increasing clinical application of EBUS-TBNA,there have been plenty of reports about the value of EBUS-TBNA in chest diseases at home and abroad.However,in terms of the positive rate of EBUS-TBNA,there are large differences between multicenters,and it is really necessary to explore the influencing factors of the detection rate of EBUS-TBNA.The purpose of this article is to explore the relevant factors that affect the detection rate of EBUS-TBNA,and to provide convincing evidence for clinical application of EBUS-TBNA and to improve the detection rate.2 Materials and methodsThis study collected clinical data of 971 patients who received EBUS-TBNA in the First Affiliated Hospital of Zhengzhou University from September 2017 to September 2019,including 114 patients who underwent EBUS-TBNA in the Department of Thoracic Surgery.All clinical data and results collected were analyzed by SPSS 24.Chi-square test and multivariate logistic regression analysis were performed on the relevant factors(age,gender,smoking status,numbers of punctured lymph nodes,numbers of punctured lymph nodes,maximum diameter of punctured lymph nodes)affecting the detection rate of EBUS-TBNA,and calculated the χ2 value,OR value,95%CI and P value obtained by corresponding statistical methods.Chi-square test was used for the location of punctured lymph nodes,and the χ2 value and P value were calculated.The difference of P<0.05 was considered to be statistically significant.3 Results3.1 EBUS-TBNA biopsy results and detection rateAmong the 971 patients collected,879 were diagnosed positively by EBUS-TBNA,and the total detection rate was 90.5%(879/971).Among them,the most patients diagnosed with primary lung cancer were 677 cases.The detection rate of EBUS-TBNA for primary lung cancer was 69.7%(677/971).The number of patients diagnosed with sarcoidosis was 117,with a detection rate 12.0%(117/971);42 patients were diagnosed with tuberculosis and the detection rate was 4.3%(42/971);18 patients were diagnosed with community acquired pneumonia and the detection rate was 1.9%(18/971);25 patients were diagnosed with metastatic cancer and the detection rate was 2.6%(25/971).3.2 Analysis of related factors affecting the detection rate of EBUS-TBNA biopsy resultsChi-square test was performed on the collected clinical data of 971 patients.It was found that there were significant statistical differences in the detection rate of EBUS-TBNA among smoking status(smokers and non-smokers),numbers of punctured lymph nodes(≥2 groups and<2 groups),and maximum diameter of punctured lymph nodes(≥1cm and<1cm).P values was 0.004,0.005,and<0.001 respectively.3.3 Multivariate logistic regression analysis of affecting the detection rate of EBUS-TBNA biopsy resultsIn the EBUS-TBNA positive biopsy results,the detection rate of smoking patients was greater than that of non-smoking patients(OR=14.841,95%CI:0.821-2.134,P=0.002);the detection rate of patients with punctured lymph node groups≥2 was greater than that of patients with punctured lymph node groups<2(OR=4.519,95%CI:1.267-9.732,P=0.020);the detection rate of patients with a maximum diameter of punctured lymph nodes ≥1cm was greater than that with a maximum diameter of punctured lymph nodes<1cm(OR=9.473,95%CI:4.372-17.583,p=0.005).Age(OR=1.127,95%CI:0.915-1.479,P=0.892),gender(OR=1.362,95%CI:0.821-2.134,P=0.623)and the number of lymph node punctured in each group(OR=1.725,95%CI:1.115-2.739,P=0.279)had no significant effect on the detection rate of EBUS-TBNA biopsy results.3.4 Impact of the location of punctured lymph nodes on the detection rate of EBUS-TBNA biopsy resultsThe locations of lymph nodes underwent EBUS-TBNA in 971 patients included 2R,4R,4L,7,10R,10L,11R,11L,12R,and 12L.Because the number of cases in the three groups of 2R,12R,and 12L was 5,7,and 3 respectively,the number of samples was small.If the cases were included,the statistical results would be biased.Therefore,the data of these 3 positions were excluded for statistical analysis.A total of 1576 lymph nodes were punctured.The number of positive lymph nodes was 794.The detection rate of single lymph node was 50.4%(794/1576).The effect of lymph nodes in different locations on the detection rate of EBUS-TBNA biopsy was not statistically different,with a P value of 0.120.4 ConclusionsEBUS-TBNA has a high detection rate for definite diagnosis of mediastinal lymph nodes,and is of great significance for the diagnosis and evaluation of chest diseases.This study found that among many relevant factors that affected the detection rate of EBUS-TBNA biopsy results,such as the smoking status of patients,the number of punctured lymph nodes,and the largest diameter of punctured lymph nodes could affect the detection rate of EBUS-TBNA biopsy;for smoking patients,for patients with punctured lymph node groups of≥2,and for patients with a maximum diameter of punctured lymph nodes of≥1 cm,the detection rate of EBUS-TBNA biopsy was higher.The age,gender,number of lymph nodes punctured in each group,and the location of the lymph nodes had no effect on the detection rate of the EBUS-TBNA biopsy.In order to improve the detection rate of EBUS-TBNA biopsy results,during the puncture process,as many lymph nodes as possible and the largest diameter of target lymph nodes should be selected for puncturing,so as to achieve a higher detection rate.Part Ⅱ The value of EBUS-TBNA in the diagnosis of lung cancer1 Research background and objectiveAt present,the extensive application of EBUS-TBNA in the field of interventional pulmonary disease has attracted the attention of clinicians.It is necessary to explore the value of EBUS-TBNA in the diagnosis and staging of lung cancer.From September 2017 to September 2019,a total of 114 patients underwent EBUS-TBNA examination in our department.Among them,imaging examinations were highly suspected to be lung cancer signs,and there were 87 patients who planned to undergo surgical treatments or strive for surgery.However,there are 87 patients who cannot be diagnosed by conventional examination methods.EBUS-TBNA is performed to confirm the diagnosis clearly.Based on this set of data,we explored the value of EBUS-TBNA in the diagnosis and staging of lung cancer.2 Materials and methodsPreoperative chest CT scan and/or PET/CT and conventional bronchoscopy were performed on 87 patients in this group,and the diagnosis was not clear.Among them,68 cases of lung cancer with mediastinal lymph nodes and/or hilar lymph nodes enlargement(shorter diameter≥1cm)were diagnosed by imaging.For further diagnosis and staging,lymph nodes biopsy were performed.19 cases were occupied in the pulmonary parenchymal space-occupying lesions(shorter diameter≥1cm)in the adjacent large airway(such as trachea,main bronchus,and leaf bronchus,etc.).Needle biopsy was performed to confirm the diagnosis of lung lesions.3 Results3.1 EBUS-TBNA punctured sitesA total of 87 patients in this goup underwent EBUS-TBNA punctured at 206 sites.There were 18 sites of lymph nodes punctured in group 4L,71 sites of lymph nodes punctured in group 4R,69 sites of lymph nodes punctured in group 7,9 sites of lymph nodes punctured in group 10L,12 sites of lymph nodes punctured in group 10R,and 27 sites punctured at intrapulmonary lesions.3.2 EBUS-TBNA punctured resultsAmong them,68 cases of lung cancer with mediastinal lymph nodes and/or hilar lymph nodes were suspected by imaging.59 patients were diagnosed with primary lung cancer after EBUS-TBNA biopsy.9 patients were not diagnosed clearly by EBUS-TBNA.3 cases of primary lung cancer,4 cases of pulmonary inflammation,and 1 case of tuberculosis and 1 case of sarcoidosis were confirmed by thoracoscopy or thoracotomy by freezing and routine pathological diagnosis.Intrapulmonary parenchymal space-occupying lesions were 19 cases.15 cases were diagnosed as primary lung cancer,1 case was pulmonary inflammation,and 1 case was tuberculosis after EBUS-TBNA.After conservative treatments of internal medicine and follow-up for 6 months,the lesions were clearly absorbed.1 case of intrapulmonary parenchymal space-occupying lesion at the left upper lobe and 1 case of that at the right middle lobe were confirmed as squamous cell carcinoma by thoracoscopy.3.3 Complications and resultsIntraoperative examinations were well tolerated in all patients,and no related complications occurred.EBUS-TBNA had a high application value in this group,and its sensitivity,specificity,accuracy,positive predictive value and negative predictive value were 93.7%,100%,94.3%,100%and 61.5%respectively.4 ConclusionsEBUS-TBNA is a safe,accurate and minimally invasive examination method.It can locate extrabronchial lesions and lymph nodes in real time.The obtained tissue specimens can be used not only for routine pathological examinations,but also for immunohistochemistry and molecular biology test.It has a high sensitivity,specificity,and accuracy for determining the staging of lung cancer mediastinal lymph nodes and diagnosis of benign and malignant hilar/mediastinal enlarged lymph nodes and pulmonary space-occupying lesions.It is a low-cost,safe and effective method.