The Clinical Value Of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration Combined With Rapid On-site Evaluation For Mediastinal And Hilar Lesions

Objective The purpose of this study is to explore the clinical value of EBUS-TBNA combined with ROSE in patients with mediastinal and / or hilar diseases,and to provide an effective method for clinicians to diagnose mediastinal and / or hilar diseases.Methods The clinical data of patients with mediastinal and / or hilar lesions indicated by chest computed tomography(CT)from January 2014 to August 2020 were collected and were divided into two groups: EBUS-TBNA and EBUS-TBNA combined with ROSE.The patients were performed EBUS-TBNA in the Department of Respiratory and critical Medicine,General Hospital of Ningxia Medical University,and the data were complete and in accordance with the inclusion criteria.The general condition of the two groups,the number of puncture needles,the location and number of punctured lymph nodes,the occurrence of complications,the final pathological diagnosis and the final diagnosis were retrospectively analyzed.Results A total of 100 inpatients were collected,including 62 patients in EBUS-TBNA group and 38 patients in EBUS-TBNA combined with ROSE group.In terms of the number of puncture needles,the number of puncture needles in both groups was 1 to 5,and the median number of puncture needles in the EBUS-TBNA group was 4.The median number of puncture needles in the EBUS-TBNA combined with ROSE group was 3.There was significant difference in the number of puncture needles between the two groups(P < 0.05).In terms of the number of lymph node puncture groups,117 lymph nodes were punctured in the two groups,the number of punctured lymph nodes in each focus of the two groups was 1to 3,and the median number of punctured lymph nodes was 1.There was no significant difference in the number of punctured lymph nodes between the two groups(P > 0.05).In terms of the location of punctured lymph nodes,they were mainly in group 7,group 4R,group 4L and group 10 R.In terms of complications,the incidence of complications in the EBUS-TBNA group was 4.8%.The incidence of complications in the ROSE group was 2.6%,but there was no significant difference between the two groups(P > 0.05).In terms of diagnostic value,the sensitivity,specificity,PPV,NPV and accuracy of EBUS-TBNA group were 73.7%,100,100,53.3% and 80.8% respectively.The sensitivity,specificity,PPV,NPV and accuracy of EBUS-TBNA combined with EBUS-TBNA were 89.7%,100,100,66.7% and91.4%,respectively.There was no significant difference in sensitivity,negative predictive value and accuracy between the two groups(P > 0.05).In terms of final diagnosis,38 cases were pathologically diagnosed as malignant tumor in EBUS-TBNA group,including 13 cases of lung squamous cell carcinoma((SCC)),10 cases of lung adenocarcinoma((ADC)),12 cases of small cell lung cancer((SCLC)),1 case of pulmonary large cell neuroendocrine carcinoma((LCNEC)),1 case of lung carcinoid,and the other 1 case was non-Hodgkin’s lymphoma.A total of 14 cases of benign lesions were diagnosed,including 4 cases of tuberculosis,6 cases of sarcoidosis,3 cases of nonspecific lymphadenitis and 1 case of inflammatory reactive hyperplasia.In EBUS-TBNA combined with ROSE group,29 cases of malignant tumor were diagnosed pathologically,including 7 cases of SCC,10 cases of ADC,9 cases of SCLC,1 case of LCNEC,1 case of hilar sarcomatoid carcinoma,and 1 case of Ewing’s sarcoma,while 6 cases of benign lesions were diagnosed,including 5 cases of tuberculosis and 1 case of sarcoidosis,3 cases were not pathologically diagnosed.Conclusion 1.EBUS-TBNA is of great value in the diagnosis of mediastinal and / or hilar lesions.2.Combined use of ROSE on the basis of EBUS-TBNA can reduce the number of median puncture needles.3.Whether EBUS-TBNA combined with Rose can improve the sensitivity,negative predictive value,and accuracy of patients with mediastinal and/or hilar lesions remains to be proved by a large number of prospective studies.