Clinical Application Of EUS-FNA And EBUS-TBNA In Diagnosis Of The Tumors Adjacent To The Digestive Tract And Respiratory Tract

Objective : To investigate the value of endoscopic ultrasound-guided fine needle aspiration(EUS-FNA)and endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)in diagnosis of tumors adjacent to the digestive tract and respiratory tract,and the value of diagnosis combined with two methods in the whole mediastinal lesions.Methods: 60 patients who underwent EUS-FNA and 78 patients with EBUS-TBNA from May,2013 to February,2017 in the Endoscopy Department of Tumor Hospital of Guangxi Medical University were analyzed retrospectively,then the diagnostic value of EUS-FNA and EBUS-TBNA in digestive or respiratory tract and their adjacent occupying lesions were carried out,and further analyzed the value of diagnosis combining with the two methods in the whole mediastinal lesions.Results : Forty-two patients(70.0%)were diagnosed with EUS-FNA.46 cases of them were malignant lesions and 14 cases were benign lesions.The sensitivity,specificity,positive predictive value and negative predictive value of EUS-FNA in the diagnosis of digestive tract and its adjacent malignant lesions were 75.0%(36/48),100%(12/12),100%(36/36),50.0%(12/24),respectively.78 cases who underwent EBUS-TBNA,65 cases(83.3%)of them were diagnosed.67 cases of them were malignant lesions and 11 cases were benign lesions.The sensitivity,specificity,positive predictive value and negative predictive value of EBUS-TBNA in the diagnosis of mediastinal and pulmonary malignant lesions were 85.3%(58/68),100%(11/11),100%(56 / 56),50%(11/22),respectively.93 cases of mediastinal or hilar lesions were examined by EUS-FNA or EBUS-TBNA,and 64 lung cancer cases were confirmed by two methods.The sensitivity,specificity,positive predictive value and negative predictive value of EUS-FNA combined with EBUS-TBNA for lung cancer were 85.94%(55/64),100%(21/21),100%(55/55)75.0%(27/36),respectively.7 cases of lung adenocarcinoma with EBUS-TBNA were referred for EGFR mutation detection,and 4 cases of them were detected with L858 R mutation,further 6 cases referred for ALK fusion protein detection,and 1 case of them was found positive.The EGFR gene was detected without mutation in 1 case of lung adenocarcinoma with EUS-FNA.Another 1 case was positive referred for ALK fusion protein detection.No serious complications were found in all patients.Conclusions:Endoscopic ultrasound-guided fine needle aspiration(EUS-FNA)and endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)show a high sensitivity and specificity.As a result,they are safe and effective methods in the diagnosis of the lesions adjacent to the digestive tract and respiratory tract.EBUS-TNA combined with EUS-FNA can biopsy the samples in the whole mediastinal region and achieve the purpose of "internal mediastinoscopy",which is sensitive and specific to the diagnosis of lung cancer and has less complications.