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

Objective: To investigate the application,diagnostic value and safety of endobronchial ultrasound-guided transdronchial needle aspiration(EBUS-TBNA)in hilar and mediastinal lesions.Methods: A total of 246 patients with thoracic CT examinations showed mediastinal,hilar lymphadenopathy and / or pleural masses,which were examined for EBUS-TBNA in the department of respiratory medicine,Second Affiliated Hospital,Chongqing Medical University from October 2014 to September 2016.The results of cytology or pathology,the positive rate of diagnosis and the incidence of complications were analyzed in all patients who underwent EBUS-TBNA examination.Results: Of the 246 patients,130 cases were malignant tumors,72 benign diseases,26 suspicious cance and 18 cases’ pathological diagnosis cannot be definited.In malignant tumors cases,45 cases were small cell lung cancer and 39 non-small cell lung cancer,42 cases of nonspecific type,1 case of metastatic neuroendocrine carcinoma,2 cases of type B lymphoma and 1 case of primary mediastinal sarcoma.22 cases of non-specific inflammation in benign disease,2 cases of mediastatic cyst,1 case of pulmonary abscess,1 case of pulmonary cyst with actinomycete infection,8 cases of pneumoconiosis,27 cases of mediastinal lymph node tuberculosis,11 cases of sarcoidosis.EBUS-TBNA for the diagnosis rate of mediastinal and hilar lesions is 92.7%,for the diagnosis rate of malignant tumor was 94.0%,for the diagnosis rate of mediastinal lymph node tuberculosis was 84.4%,for the diagnosis rate of sarcoidosis Was 73.3%.6 patients with repeated EBUS-TBNA examination was diagnosed as: 1 case of lung cancer,2 cases of sarcoidosis,3 cases of mediastinal lymph node tuberculosis.Adverse reactions in EBUS-TBNA of 246 patients included hypoxemia in 13 patients,arrhythmia in 5 patients,and 19 cases of intraoperative bleeding.Postoperative complications were mainly manifested as cough and sputum bloody,no serious complications occurred.Conclusion: EBUS-TBNA has good safety and repeatability,for the diagnosis of mediastinal,hilar lesions are safe and effective,especially for the detection rate of malignant disease,for sarcoidosis and tuberculosis of mediastinal,hilar lymph nodes also have important diagnostic value.In practical application,if the first inspection result is not ideal,through repeated EBUS-TBNA inspection increase diagnosis rate.EBUS-TBNA is also an important means of auxiliary examination for the rare mediastinal,hilar disease.