The Value Of Convex Probe Endobronchial Ultrasound-guided Transbronchial Needle Aspiration In Hilar,Mediastinal Lesions

Objective:1.To investigate the diagnostic value and safety of endobronchial ultrasound-guided transdronchial needle aspiration(EBUS-TBNA)in patients with hilar,mediastinal lesions.2.To investigate the diagnostic value of the EBUS imaging features in benign and malignant lymph nodes,when longitudinal/transverse diameter ratio is 1.5.3.To evaluate the value of liquid-based thin-layer cytology(TCT)and His topathology(HP)in the diagnosis of mediastinum by endobronchial ultrasoundguided transdronchial needle aspiration biopsy(EBUS-TNBA).Methods:A total of 92 patients with pulmonary portal and mediastinal lesions,which were examined for EBUS-TBNA in the department of respiratory medicine,First Hospital,Jilin University from June 2013 to June 2017.The results of cytology or pathology,the positive rate of diagnosis and the incidence of complications were analyzed in all patients.Results:After EBUS-TBNA examination,a total of 106 sites of enlarged lymph nodes were examined in 92 patients,with 1 to 5 puncture points.9 cases(9.8%)of squamous cell carcinoma,24 cases(26.1 %)of adenocarcinoma,26 cases(28.3 %)of small cell lung cancer,4 cases(5.4 %)of lymphoma,2 cases of mediastinal neuroendocacirnoma(2.2 %),2 cases of mediastinal metastasis of breast cancer(2.2 %),7 cases of lymph node tuberculosis(7.6 %),5 cases of sarcoidosis(5.4 %),10 cases of inflammation(10.9 %)and 3 cases of missed diagnosis.In 59 patients with lung cancer,42 were diagnosed by HP,42 by TCT and 52 by combined diagnosis.In total,106 lymph nodes were punctured.The mean transverse diameterof benign lymph nodes was 19.2 mm,that of malignant lymph nodes was 18.7 mm,The mean longitudinal/transversediameter rate of benign lymph nodes was 1.24 mm,and that of malignant lymph nodes was 1.30 mm.In 92 patients,intraoperative and postoperative complications of EBUS-TNBA included 15 cases of bleeding at the puncture point,1 case of hypoxemia,1 case of a transient increase in heart rate and 2cases of elevated blood pressure.There were 4 cases of sputum with blood,no serious complications such as hemoptysis,pneumothorax and mediastinal emphysema.Conclusion:This study confirms that EBUS-TBNA is a safe and effective diagnostic method for mediastinum and pulmonary hilar occupying lesions,and a higher diagnostic rate for malignant diseases than benign.The combination of Histopathology and liquid-based thin layer cytology in EBUS-TBNA diagnosis of lung cancer is higher than that of a single method.