Clinical Value And Safety Of EBUS-ca-TBFB In Mediastinal Lymph Node Disease

Research purpose:To investigate the diagnostic value and safety of EBUS-ca-TBFB for mediastinal lymph node disease.We wanted to find a method of examination with higher quality specimens and better diagnostic efficacy by comparing EBUS-ca-TBFB with EBUSTBNA.This will guide the clinical management of mediastinal lymph node disease.Research methods:The clinical data of 42 patients who underwent EBUS-ca-TBFB and 46 patients who underwent EBUS-TBNA in the Department of Respiratory and Critical Care Medicine of the First Affiliation of Chengdu Medical College from 01,2019 to 12,2022 were retrospectively collected.The two groups were compared and analysed for general information(including gender,age,smoking history,basic medical history),auxiliary examinations date(including tumor markers,coagulation function,D-dimer,the location and long/short diameter of lymph nodes,whether it is combined with lymph node fusion,whether it is combined with pulmonary/tubular occupancy),pathological diagnostic positivity rate,detection accuracy,specificity,sensitivity and intraoperative and intraoperative and postoperative complications.Result:1.There was no statistical difference in gender,age,smoking history,basic medical history,tumor markers,coagulation function,D-dimer,whether it is combined with lymph node fusion,whether it is combined with pulmonary/tubular occupancy and mediastinal lymph node length/short diameter ratio between the 42 patients in the EBUSca-TBFB group and the 46 patients in the EBUS-TBNA group(P>0.05).2.The positive diagnostic rate was 85.7% in the EBUS-ca-TBFB group and 71.7%in the EBUS-TBNA group.The EBUS-ca-TBFB group had a higher positive pathology rate than the EBUS-TBNA group,however the difference between the two groups was not statistically significant(?2 =2.533,P=0.112).3.The most frequently sampled lymph nodes in the EBUS-ca-TBFB and EBUSTBNA groups were group 7 lymph nodes.The diagnostic positivity rate of group 7 lymph nodes in the two groups was 86.5% and 65.9% respectively,the EBUS-ca-TBFB group was higher than the EBUS-TBNA group and the difference was statistically significant(P<0.05).4.The diagnostic sensitivity was 87.0% for malignant disease and 88.9% for benign disease in the EBUS-ca-TBFB group,while the diagnostic sensitivity of the EBUS-TBNA group was 82.1% for malignant disease and 58.9% for benign disease.The diagnostic sensitivity of the EBUS-ca-TBFB group was higher than the EBUS-TBNA group for both benign and malignant diseases,the difference in diagnostic sensitivity between the two groups was statistically significant for benign diseases(P<0.05).5.The diagnostic accuracy,sensitivity and specificity of EBUS-ca-TBFB were88.10%,87.80% and 100%,While the diagnostic accuracy,sensitivity and specificity of EBUS-TBNA were 74.00%,73.30% and 100%.The EBUS-ca-TBFB group was higher sensitive and accurate than the EBUS-TBNA group in the diagnosis of mediastinal disease,but none of the differences were statistically significant(P>0.05).6.The most common complication between the EBUS-ca-TBFB group and the EBUS-TBNA group was intraoperative bleeding,but no serious complications occurred between the two groups.There was no significant difference in the incidence of overall complications between the two groups.Conclusions:1.The EBUS-ca-TBFB group has a higher positive rate,sensitivity and accuracy in the diagnosis of mediastinal lymph node disease,and its diagnostic efficacy may be superior to that of EBUS-TBNA.2.Station 7 lymph nodes were the most frequently sampled lymph nodes in both modalities.The positive rate of EBUS-ca-TBFB diagnosis in lymph nodes at station 7was also higher than in the EBUS-TBNA group,with a statistically significant difference between the two groups.This validates the better diagnostic efficacy of EBUS-ca-TBFB for mediastinal disease.3.The rate of positivity and sensitivity of EBUS-ca-TBFB was higher than EBUSTBNA for the diagnosis of benign disease,and the differences were all statistically significant.EBUS-ca-TBFB has no significant advantage over EBUS-TBNA in terms of positivity and sensitivity for the diagnosis of malignant disease,but is slightly more sensitive for the diagnosis of lymphoma.Therefore,in patients with preoperative consideration of malignant disease such as lung cancer,both approaches are an option,but EBUS-ca-TBFB is more recommended in patients with preoperative consideration of benign disease or lymphoma.4.Both the EBUS-ca-TBFB and EBUS-TBNA technology had a high safety profile,and there are few patients experiencing serious complications.