| Objective:1.To summarize the ultrasonographic characteristics of mediastinal lymph node metastasis of lung cancer on EBUS-TBNA,and to explore the value of differential diagnosis between mediastinal lymph node and benign enlargement with EBUS endoscopic ultrasonography,so as to improve the biopsy rate of EBUS-TBNA for mediastinal lymph node metastasis of lung cancer.2.To summarize the endoscopic characteristics of EBUS in different pathological types of lung cancer with mediastinal lymph node metastasis,and analyze the differences of endoscopic characteristics of EBUS in different pathological types of lung cancer with mediastinal lymph node metastasis,so as to help clinicians and radiologists to grasp the characteristics of mediastinal lymph node metastasis of different pathological types of lung cancer and improve the ability of clinicians and radiologists in differential diagnosis of mediastinal lymph node metastasis of different pathological types of lung cancer.Materials and Methods:From January 2015 to March 2019,the patients who underwent EBUS-TBNA examination in Cancer Hospital Affiliated to China Medical University due to CT findings of hilar and mediastinal lymphadenopathy were analyzed retrospectively.The final diagnosis was determined according to the results of histopathological examination and follow-up for 6 months,and the EBUS ultrasound characteristics and clinical data were statistically analyzed.In this study,BF-TYPE-UC260FW260 fiberoptic endoscopy system of Olympus company in Japan was selected,equipped with EU-ME1 ultrasound image processing software(including two-dimensional B-ultrasound mode and color Doppler mode);at the top of the bronchoscope,convex probe ultrasound bronchoscope was equipped(CP-EBUS),with the main frequency of 7.5 MHz;NA-201SX-4022 22G special needle was equipped.Observe the following sonographic features on EBUS:?Echo:high echo,equal echo,low echo,no echo,mixed echo;homogeneous,heterogeneous.(2)Diameter line of lymph nodes:length of long axis,length of short axis,aspect ratio of lymph nodes(length of long axis/length of short axis,divided into?1.5 or>1.5).(3)Hilus of lymph node:the morphological structure of hilus is normal and abnormal(including hilar deviation and total loss of hilus).(4)Margin:distinct or indistinct.(5)Shape:regular and irregular.(6)Blood flow signal in lymph nodes:the blood flow in the enlarged lymph nodes was classified by color Doppler mode.According to Adler's semi-quantitative blood flow classification method,the blood flow in the enlarged lymph nodes was divided into 0-3 levels.Level 0,no blood flow;Level 1,a small amount of blood flow signal,one or two dot or short stick color flow signals;Level 2,medium blood flow signal,one main blood vessel or several small blood vessels passing through.Level 3,rich blood flow signal.Among them,level 0-1 is lack of blood supply;level 2-3 is rich in blood supply.(7)The distribution pattern of blood flow in lymph nodes:central hilar vessel distribution,not central hilar vessel distribution.Summarize the sonographic features of mediastinal lymph node metastasis of lung cancer on EBUS image,evaluate the independent predictors of mediastinal lymph node metastasis of lung cancer,and summarize the endoscopic features of EBUS in different pathological types of mediastinal lymph node metastasis of lung cancer.Statistical analysis was performed by the SPSS 20.0 software package.The measurement data conforming to the normal distribution are represented by mean±standard deviation(?x±s),the comparison between only two groups is represented by two independent samples t test;the measurement data not conforming to the normal distribution is represented by median or quartile spacing,and the comparison between only two groups is represented by Mann Whitney U test.?~2 test or Fisher's exact test were used for counting data.Rank sum test was used for rank data.Logistic regression was used in multivariate analysis.Draw the ROC curve of individual and joint diagnosis.Kruskal-Wallis H test was used for comparison among groups.When the difference between groups is statistically significant,the indexes with significant difference are compared in two groups by Bonferroni correction.P<0.05 suggested that the difference was statistically significant.Results:Finally,142 patients were included in the study,including 84 males and 58females,aged 29?76 years with an average age of 57(57.07±8.90)years.There were256 lymph nodes in 142 patients,175(68.4%)with metastasis of lung cancer and 81(31.6%)with benign enlargement.1.The differential diagnosis of mediastinal lymph nodes by EBUS-TBNA:single factor analysis showed that echo,short axis length,aspect ratio,boundary,shape,lymph node hilus,blood flow signal classification and blood flow distribution pattern were the influencing factors to evaluate mediastinal lymph node metastasis(P<0.05);logistic regression analysis showed that echo,long axis length,short axis length and the presence of lymph node hilus were the independent predictors to evaluate mediastinal lymph node metastasis(P<0.05).The value of combined diagnosis of multiple indicators was the highest when all independent predictors were included(AUC=0.879),while the value of combined diagnosis of"echo+length of short axis+presence or absence of lymph hilus"was only inferior to that of all independent indicators(AUC=0.877).2.The long axis and short axis of the metastatic lymph nodes had statistical significance in the comparison of the mediastinal lymph node metastasis from small cell lung cancer and adenocarcinoma group,and the blood flow signal grading had statistical difference in the mediastinal lymph node metastasis from adenocarcinoma and squamous carcinoma.Conclusion:1.Mediastinal lymph node metastasis of lung cancer has certain ultrasound characteristics,which can improve the detection rate of EBUS-TBNA for mediastinal lymph node metastasis of lung cancer.2.There are some differences in the characteristics of EBUS ultrasonic imaging in mediastinal lymph node metastasis of lung cancer from different pathological types. |
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