The Application Value And Prospection Of EBUS-TBNA And EBUS-GS-TBLB In The Diagnosis Of Extrabronchial Lesions

Purpose:To analyze the final diagnosis results of EBUS-TBNA and EBUS-GS-TBLB,and then further analyze the overall lesions' detection rate,the diagnostic accuracy,the sensitivity and the complications when applying EBUS-TBNA and EBUS-GS-TBLB,thus the clinical value of EBUS in the diagnosis of extrabronchial lesions was probed.Method:The selected cases are outpatients and inpatients in the Bronchoscopy Room of Department of Respiratory,the Second Hospital of Jilin University,from Feb 2016 to Fed 2017.By carefully studying the Chest CT or Enhanced Chest CT,we selected 230 patients who suffered hilar/mediastinal lymphadenopathies and/or tracheobronchial tumors,they were examined with EBUS-TBNA.And by studying the Chest CT with Peripheral Pulmonary Lesion(PPL),we selected 105 patients whose lesions' diameters were less than 3cm,they were examined with EBUS-GS-TBLB.All the patients were examined with conventional bronchoscopy(1T-260 Olympus),the trachea and bronchial lumen were unobstructed in the visual range of endoscope;the sectional mucosa in the focus infectious lumen occasionally showed mild proliferation or slightly external compression stenosis with the mucosal surface being smooth.And then the patients were further examined by EBUS-TBNA and EBUS-GS-TBLB respectively.Therefore,the overall lesions' detection rate,the diagnostic accuracy,the sensitivity and the complications of EBUS-TBNA and EBUS-GS-TBLB can be analyzed referring to the final diagnosis results of all the cases;therefore,the application value of EBUS in the diagnosis of extrabronchial lesions can be evaluated.Results:1.In the 230 patients,280 mediastinal/hilar lymph nodes and 12 tracheobronchial tumors were examined with EBUS-TBNA,among which 150 cases were confirmed as malignant lesions and 80 cases as benign lesions by cytopathologic or histopathologic diagnosis and clinical diagnosis.According to the final diagnosis results,the overalllesions' detection rate of EBUS-TBNA was 100%,the diagnostic accuracy was 86.95%,the diagnostic sensitivity of malignant lesions was 94%,the sensitivity of benign lesions was 73.75%,and the complications were 0%.2.Among 105 patients examined by EBUS-GS,86 cases were detected echoes and followed by TBLB,while 19 cases were not detected echoes and not followed by TBLB.Finally,52 cases of malignant lesions and 53 cases of benign lesions were confirmed by the results of cytopathologic or histopathologic diagnosis and clinical diagnosis.According to the final diagnosis results,the overall lesions' detection rate of EBUS-TBNA was 81.90%,the diagnostic accuracy was 81.90%,the diagnostic sensitivity of malignant lesions was 90.38%,the sensitivity of benign lesions was73.58%,and the complications were 7.61%.3.EBUS has high clinical application value and safety in the diagnosis of extrabronchial lesions.Its main adverse events are related to tracheoscopy,such as tension,anxiety,cough,tachycardia and hypoxemia,etc.There were no serious complications in all patients.Conclusion:1.EBUS-TBNA and EBUS-GS-TBLB are the effective means in the diagnosis of the extrabronchial lesions,and are expected to be a new examination tool for the replacement of mediastinoscopy and other invasive tests.2.EBUS can locate accurately,draw materials accurately,and improve the detection rate and positive diagnosis rate of lesions.