Clinical Application Of Endobronchial Ultrasound Guided Transbronchial Needle Aspiration In The Diagnosis Of Mediastinal Lesions

Objective:To investigate the Clinical application of ultrasound bronchoscope guidedbronchoscopic needle aspiration (EBUS-TBNA) in mediastinal lesions diagnosisand complications, provide a reference for the clinical application of the technology.Methods:A retrospective study was carried out in Shanghai Changhai Hospitalinterventional pulmonology center from February2014to August201484caseswere collected to analysis the value of EBUS-TBNA in the diagnosis of mediastinallesions. Inclusion criteria:1、Radiological examinations showed hilar and (or)mediastinal lymph nodes of the lungs.2、Radiological examinations showed.unexplained mediastinal and (or) hilar lymphadenopathy.3、 Unexplainedmediastinal lesions.4、The longest diameter of occupying or mediastinal lymphnodes greater than1.0cm. Exclusion criteria:1、A clearly pathological wereobtained by conventional bronchoscopy.2、Superficial lymph nodes, may besuperficial lymph node biopsy pathology were clear.3、 Having other ways to clearpathological examination Patients demographic characteristics: male58, female26,male/female1.8.31to78aged years, mean60.9years. First, useing conventionalbronchoscopy (1T-260, Olympus) into nasal cavity, according to the order to checkthe glottis, trachea, bronchus carina and at all levels, according to the contralateralbronchial check the order after the affected side. After checking the end of the exitroutine bronchoscopy and bronchoscopic ultrasound transducer (BF-UC260FW,Olympus) examination. Ultrasound bronchoscope through the glottis after openingthe ultrasound screen, followed by examination of each group lymph nodes and lesions. Locate lymph nodes are positioned according to the Moutain and otherstaging systems. Dual display can be observed by endoscopic ultrasound image andthe corresponding image, turn color Doppler scan, identify and determine theperipheral blood flow and vascular lesions. After puncture groups the number, sizeand characteristics of ultrasound images of the lymph nodes were recorded. Tissuesamples using liquid-based storage solution softening save inspection. Lineliquid-based cytology and histology technical inspection pathology. Histologicalsamples using formalin-fixed paraffin-embedded sections, if necessary,immunohistochemical examination. Cytology or biopsy specimen shows multiplecell histology pathology group, TBNA needle into the lymph nodes can beconsidered as qualified specimen; if a large number of red blood cells or lessnucleated cells, TBNA needle is considered failed. EBUS-TBNA for the diagnosismethod by thoracotomy, thoracoscopy or mediastinoscopy and other pathologyverification. According to the definition of the calculation of sensitivity, specificity,positive predictive value, negative predictive value and diagnostic yield. Allstatistical results were using SPSS17.0statistical software.Results:After EBUS-TBNA examination84cases, a total of puncture and mediastinallymph nodes occupying167sites, each site of the puncture needle3-5. Cytologicalor histopathological diagnosis confirmed31cases of adenocarcinoma,10cases ofsquamous cell carcinoma,15cases of small cell lung cancer,2cases of bronchialcyst,2cases of unclassified non-small cell lung cancer,1case of adenoid cysticcarcinoma, unclassified malignant five cases, five cases of sarcoidosis, seven casesof tuberculosis, one case of neurofibroma, five cases of non-specific inflammationprompted by the6-month follow-up or surgery,5cases of non-specificinflammation in patients with cytology, one case diagnosed as sarcoidosis, twocases of inflammation, one case diagnosed as lymphoma, one case diagnosied ofsquamous cell carcinoma.EBUS-TBNA cytology or biopsy specimens histopathologic examinationwere clearly defined as positive. no pathological findings clearly defined as negative. The diagnosis of malignant lesions sensitivity is96.8%, specificity is100%,positive predictive value is100%and a negative predictive value is90.0%, thediagnostic accuracy is94.04%. According to the size of the lymph nodes puncturedinto A, B groups, lymph nodes longest diameter>2cm is group A, lymph longestdiameter≤2cm is group B, the diagnostic yield compared the two groups A groupof malignant disease was significantly higher than that of group B, there wassignificant difference.EBUS-TBNA has higher security, some adverse reactions related to theoperation and bronchoscopy, such as anxiety, cough, hypoxia and so on. Adverseevents and complications due to fewer puncture, in this study all the patients in theintraoperative bleeding complications included three cases, local injection ofepinephrine hemostasis after dilution, one case of nasal bleeding, gauze packing tothe outside After nasal bleeding.6cases of sinus tachycardia, a transient increase inblood pressure of two cases, after temporarily stop the operation, blood pressure,heart rate returned to normal, proceed to complete the inspection. Postoperativecomplications included one case of bronchial cyst infection, fever in24patients,reviewed of lung CT showed significantly increased mediastinal cyst, one weekafter the anti-infection, symptoms improved. All operations without seriouscomplications.Conclusion：EBUS-TBNAas a new method of examination can be done to mediastinal andhilar lymph nodes and lung lesions to implement real-time scanning puncture. Thediagnosis sensitivity and specificity of lesions around the trachea and mediastinalwere higher, such as mediastinoscopy, less invasive and more safer, It has being animportant diagnostic tool for the diagnosis of lung cancer、mediastinal lesions andlung cancer staging.