Application Value Of EBUS-TBNA With ROSE In Diagnosis Of Mediastinal / Hilar Lymph Node Enlargement

Objective:Endobronchial ultrasound guided transbronchial needle aspiration(EBUS-TBNA)is an indispensable technology for diagnosing hilar / mediastinal lymph node / mass lesions and staging lung malignant tumors.Rapid on-site evaluation(ROSE)has been advocated as an auxiliary tool for assessing the accuracy and adequacy of biopsy samples in recent years at home and abroad.But there are few domestic studies investigating specifically how the diagnostic effect of EBUS-TBNA with ROSE to obtain specimens.The purpose of this study was to explore the application value of EBUS-TBNA with ROSE in the diagnosis of mediastinal / hilar enlarged lymph node disease.Methods:Retrospective analysis of 225 cases of chest imaging(including: chest computed tomography,CT / chest computed enhanced tomography,enhanced CT)/positron emission tomography,PET-CT)found single or multiple enlarged lymph nodes in the mediastinum and / or hilum in the endoscopy room of the Respiratory of the First Hospital of Jilin University from June 2013 to December 2019.There were 87 cases performed EBUS-TBNA with ROSE,138 cases without ROSE.All patients' biopsy specimens were sent to the Department of Pathology of the First Hospital of Jilin University for film production and interpretation.The ROSE substrates were interpreted by a Cytopathologist from the Department of Respiratory of the First Hospital of Jilin University.Those who failed to define diagnosis by biopsy specimens in the above two groups were further selected for other invasive procedures or at least 6 months of clinical follow-up.The final diagnosis results of the two groups of specimens were recorded,and all data were analyzed statistically using SPSS19 software.Analyze the results of puncture and complications of the two groups of patients,analyze the accuracy,sensitivity,specificity,positive and negative predictive values between EBUS-TBNA with ROSE and EBUS-TBNA to diagnose mediastinal / hilar enlarged lymph node lesions.Comparise of the detection of mediastinal lymph node metastasis in primary lung cancer between the two groups,and to study the application value of EBUS-TBNA with ROSE in the diagnosis of mediastinal / hilar enlarged lymph node lesions.Results:225 cases were included in the study.A total of 435 lymph nodes were punctured.The median number puncture groups was 2 groups / case in the EBUS-TBNA group,the median puncture times was 4 times / case,and the median length of the punctured lymph nodes was 1.80 cm.The median short diameter was 1.50 cm,and the number of unqualified puncture specimens was 16 cases.The median number of puncture groups in the EBUS-TBNA with ROSE group was 1 group / case,and the median of puncture times was 3 times / case.The median long diameter of the lymph nodes was 1.90 cm,the median short diameter was 1.60 cm,and the number of unqualified puncture specimens was 2 cases.There was no statistical difference in the size of the punctured lymph nodes between the two groups(P > 0.05),and there were statistical differences in the number of punctured needles,the number of punctured lymph nodes,and the qualified rate of puncture specimen(P < 0.05).There were no operation-related complications in all 225 cases,and only a few patients had adverse reactions such as mild puncture point bleeding and hypoxemia,and there was no statistical difference between the two groups(P > 0.05).Compared with the final diagnosis,EBUS-TBNA was 69 positive cases,61 negative cases,0 false positive cases,8 false negative cases,and EBUS-TBNA with ROSE group diagnosed 51 positive cases,34 negative cases,0 false positive cases and 2false negative cases.The overall accuracy of EBUS-TBNA diagnosis of mediastinal / hilar lymphadenopathy was 94.20%,sensitivity was 89.61%,specificity was 100.00%,positive predictive value was 100.00%,and negative predictive value was 88.40%.The overall diagnostic accuracy of the EBUS-TBNA with ROSE group was 97.70%,the sensitivity was 96.23%,the specificity was 100.00%,the positive predictive value was 100.00%,and the negative predictive value was 94.44%.There were no statistical differences in accuracy,sensitivity,and negative predictive value(P > 0.05).For primary lung cancer with mediastinal / hilar enlarged lymph node metastasis,the positive rate in the EBUS-TBNA group was 93.15%,and the EBUS-TBNA combined with ROSE group was 96.15%.There was no statistical difference(P = 0.745> 0.05).Conclutions:1.EBUS-TBNA with ROSE neither improves sensitivity,negative predictive value,nor reduces complications in the diagnosis of mediastinal / hilar lymph node enlargement.2.EBUS-TBNA with ROSE can reduce the number of puncture of mediastinal lymph nodes and puncture groups;can improve the qualified rate of collected specimens,make up for the defect of less tissue and low qualified rate of specimens sent by EBUS-TBNA.