| Objective: To analyze the clinical and pathological data of 377 cases of mediastinal lymphadenopathy by endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA),and to explore the etiology and disease spectrum of mediastinal lymphadenopathy,and to compare the clinical symptoms and imaging features of different diseases leading to mediastinal lymphadenopathy,so as to provide basis for etiology and diagnosis of mediastinal lymphadenopathy.Methods:From January 2014 to September 2019,377 patients with mediastinal lymphadenopathy diagnosed by EBUS-TBNA in the second Hospital of Hebei Medical University were studied.The basic data of denger,age smoking history and case records of all patients were collected,and the results of tracheoscopy,chest computed tomography(CT)imaging and EBUS-TBNA pathological diagnosis were synthesized.Analyzing the etiology and disease spectrum of mediastinal lymphadenopathy.Simultaneously,all cases were divided into benign group and malignant group(malig nant group found definite tumor cells in EBUS pathology).The imaging features of the two groups were analyzed,and the results were retrosp ectively analyzed.Results:1.Basic data:A total of 377 patients with mediastinal lymphadenopathy who underwent EBUS-TBNA were enrolled,including 226 males and151 females with an average age of 59.14 ±13.37 years.A total of 1037 mediastinal lymph nodes were punctured by EBUS-TBNA.The average number of mediastinal lymph nodes was 1.35,2.04 per patient and 2.75 per patient.The mediastinal lymph nodes punctured included 2R,4L,4R,7,10 L,10R,11 L,11R,12 L and 12 R groups.The most frequently punctured swollen lymph nodes and the most punctured lymph nodes were in group 7,followed by 4R group.2.Disease spectrum of mediastinal lymphadenopathy:377 patients with mediastinal lymphadenopathy,there were 227 patients(60.21%)in the malignant group and 130 patients(34.48%)in the benign group.The mediastinal lymphadenopathy caused by the malignant tumor was significantly more than that of the benign disease,with statistical differences(P<0.05).The malignant group included 71 cases(18.83%)patients with small cell lung cancer,67cases(17.78%)patients with adenocarcinoma,38 cases(10.08%)patients with squamous cell carcinoma,35 cases(9.28%)without classification(only cancer cells were found in pathology),10 cases(2.65%)of metastatic carcinoma,3 cases(0.79%)patients with pulmonary sarcoma,1 case(0.27%)patients with large cell carcinoma and 2 cases(0.53%)of lymphoma.The benign group included 41 cases of pneumonia(10.88%).25 cases of lymph node tuberculosis(6.63%),17 cases of interstitial lung disease(4.51%),15 cases of sarcoidosis(3.98%),9 cases of bronchiectasis(2.39%),6 cases of silicosis(1.59%),3 cases of tuberculous pleurisy(0.80%)and 14 cases of other(benign diseases undiagnosed)(3.71%).20 cases(5.31%)were not diagnosed as benign or malignant.The first three causes in malignant tumor group were small cell lung cancer,adenocarcinoma and squamous cell carcinoma,while in benign disease group,the first three causes were pneumonia,lymph node tuberculosis and interstitial lung disease.3.Comparison of clinical symptoms between benign group and malignant group: 357 patients with definite mediastinal lymphadenopathy,including 227 in malignant group,130 in benign group.Cough accounted for 79.74% and 66.92% in malignant group and benign group,66.08% and 46.92% in expectoration of phlegm,34.80% and 34.61% in shortness of breath,16.30% and 33.08% in fever,22.03% and 17.69% in chest tightness,respectively.Chest pain accounted for 16.74% and 11.54%,hemoptysis accounted for 16.74% and 11.54%,edema accounted for 2.64% and 1.54%,shoulder and back pain accounted for 1.76% and 2.31% respectively,hoarseness accounted for 3.96% and 0% respectively,weakness of limbs accounted for 1.76% and 0.77% respectively,and asympto matic accounted for 5.29% and 4.61% respectively.The first three common clinical symptoms in the benign and malignant group were cough,expectoration and shortness of breath.The incidence of cough,expectoration and hoarseness was higher in the malignant tumor group than in the benign disease group,there was a statistical difference(P<0.05).The incidence of fever was higher in the benign disease group than in the malignant tumor group,there was a statistical difference(P<0.05).4.Comparison of imaging features between benign group and malignant group:357 patients with definite mediastinal lymphadenopathy,including 227 patients with malignant group and 130 patients with benign group.The average diameter of mediastinal lymph node in malignant group was 20.03 ±12.52 mm,the range was 10～76mm,and the average diameter of mediastinal lymph node in benign group was 15.07±4.77 mm,the range was 10～32mm.The diameter of mediastinal lymph node in malignant group was significantly larger than that in benign group.The difference was statistically significant(P<0.05).The cases of diameters of mediastinal lymph nodes between 10～19mm in malignant group and benign group were 137 cases(60.35%)and 109 cases(83.85%)respectively,between 20～29mm were 54 cases(23.79%)and 17 cases(13.08%),between 30～39mm were 18 cases(7.93%)and 4 cases(3.07%)respectively,and containing or exceeding 40 mm were 18 cases(7.93%)and 0 case(0%)respectively.Among them,the proportion of lymph node diameters in the benign group in the range of 10-19 mm was significantly higher than that in the malignant group,and the proportion of lymph node diameters greater than 40 mm in the malignant group was significantly higher than that in the benign group.The number of multiple mediastinal lymph nodes in malignant group and benign group was 209 cases(92.07%)and 122 cases(93.85%)respectively,and the number of single lymph nodes was 18 cases(7.93%)and 8 cases(6.15%).Lymph node fusion was 20 cases(8.81%)and 6 cases(4.61%),and lymph node calcification was 5 cases(2.2%)and 9 cases(6.92%).Necrosis was found in 4 cases(1.76%)and 0 cases(0%)respectively.There was no significant difference in multiple incidence,single incidence,fusion rate and necrosis rate of mediastinal lymph nodes between malignant group and benign group(P>0.05).The calcification rate of mediastinal lymph nodes in benign lesion group was higher than that in malignant tumor group,which was statistically different(P<0.05).In malignant group and benign group,nodular shadow accounted for 52.86% and 65.38% respectively,intrapulmonary mass accounted for 45.37% and 4.61%,cable shadow accounted for 16.74% and 37.69%,interstitial changes accounted for 15.42% and 26.92%,patchy shadow accounted for 9.69% and 18.46%,bronchial compression stenosis accounted for 24.67% and 7.69%,pleural effusion accounted for 26.87% and 6.15%,cavities accounted for 4.85% and 4.62%,exudation changes accounted for 1.32% and 4.61%,bronchiectasis accounted for 0.44% and 8.46%,and burrs accounted for 6.61% and 0.05% respectively.The first three imaging features in malignant group were nodule,intrapulmonary mass and pleural effusion,while in benign group,the first three imaging features were nodule,cord shadow and interstitial changes.The incidence of lung mass,pleural effusion,bronchial compression,and burr was significantly higher in the malignant tumor group than in the benign lesion group,while nodular shadow,strip shadow,interstitial change,patch shadow,and bronchiectasis were the opposite.There was a statistical difference(P<0.05).5.EBUS-TBNA safety analysis:in 377 patients with mediastinal lymp hadenopathy and diagnosed by EBUS-TBNA,the main postoperative complications were bleeding,dizziness,nausea and cough,while serious complications such as death,pneumothorax and mediastinal vascular rupture did not occur.Conclusion:1.Common causes of mediastinal lymphadenopathy include malignant tumors(60%)and benign lesions(35%),among them,mediastinal lymphadenopathy caused by malignant tumors is significantly more than benign lesions.The first three causes in malignant group were small cell lung cancer,adenocarcinoma and squamous cell carcinoma,while in benign group,the first three causes were pneumonia,lymph node tuberculosis and interstitial lung disease.2.The first three common clinical symptoms in malignant group and benign group were cough,expectoration and shortness of breath.Cough,expectoration,fever,blood in sputum and hoarseness in malignant tumor group suggested that the incidence of tumor compression and bleeding in malignant group was significantly higher than that in benign group.3.The average diameter of mediastinal lymph nodes in the malignant group was significantly larger than that in the benign group,and the proportion of large diameter lymph nodes(greater than 40mm)in the malignant group was significantly higher than that in the benign group.The calcification rate of mediastinal lymph nodes in the benign group was significantly higher than that in the malignant group,but there was no significant difference in multiple rate,fusion rate and necrosis rate.4.The first three imaging features in malignant group were nodule,intrapulmonary mass and pleural effusion,while in benign group,the first three imaging features were nodule,cord shadow and interstitial changes.The lung imaging characteristics of the malignant group were significantly higher than those of the benign group in the presence of isolated masses in the lung parenchyma or solid nodules,pleural effusion,bronchial compression,burrs.5.EBUS-TBNA is a safe and effective method for the diagnosis of mediastinal lymphadenopathy. |
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