Analysis For The Value Of EBUS-TBNA In The Diagnosis Of Mediastinal Lymph Node

Objective: To explore the value of EBUS-TBNA in the diagnosis of the nature of mediastinal lymph node lesions.Methods: The related results of patients who were admitted into EBUS diagnosis and treatment in the Department of Respiratory and Critical Care Medicine of Guilin Medical university Affiliated Hospital from January 1,2017 to December 31,2019were analyzed retrospectively.According to the inclusion and exclusion criteria,609 cases were finally enrolled,and the general data as well as examination results such as the location and size of lymph nodes,whether it is combined with fusion,lung mass,endotracheal lesions,pathological results,chest CT scan results,and ultrasonic bronchoscopy diagnosis of the cases were collected.The biopsy specimens were diagnosed by pathology.Cases that could not be diagnosed by EBUS-TBNA specimens were finally diagnosed by thoracic lung biopsy or surgical operation according to their condition.Results: In this study,609 cases were enrolled,of which 465(76.4%)cases were male and 144(23.6%)cases were female.The average age of male cases was 59.2 ± 9.6 years old,and that of female cases was55.9 ± 11.2 years old.There were 64(10.5%)cases with benign lesions and545(89.5%)cases with malignant lesions.520 cases were clearly diagnosed by EBUS-TBNA and 89 cases could not be clearly diagnosed.Calculated by formula,the diagnostic sensitivity,specificity,positive predictive value and negative predictive value of EBUS-TBNA were99.6%(471/473),95.7%(45/47),99.6%(471/473)and 95.7%(45/47)respectively.When the short axis diameter of the lymph node is 13.35 mm,the diagnostic sensitivity and specificity of EBUS-TBNA are 65% and 72%.And the larger the short axis diameter of lymph node was,the greater the possibility of malignancy was.However,when the short axis diameter of lymph nodes was≥26mm,the short axis diameter of lymph nodes had no significant difference in judging benign and malignant lymph nodes(P<0.05).In EBUS-TBNA confirmed cases,through Logistic binary regression analysis,it was found that lymph node fusion,lung mass and endotracheal lesions were the influencing factors(P<0.05),and the Influencing factors of lymph node fusion,endotracheal lesions,and malignant lung mass was 10.196 times,6.664 times,and 4.312 times that of no lymph node fusion,no endotracheal lesions,and no lung mass.Among them,lymph node fusion has the highest degree of influence.Different types of malignant pathology were statistically significant with the short axis diameter of lymph nodes,lymph node fusion,and endotracheal lesions(P<0.05).In retrospective analysis,only 1 case had postoperative complications,namely transient fever(39℃)and no special treatment was required.Conclusion:(1)When there has lymph node fusion or endotracheal lesions,the disease is likely to be diagnosed by EBUS-TBNA.(2)The larger the diameter of the short axis of the lymph node,or the fusion of the lymph node,or the presence of lung mass or endotracheal lesions,the disease is likely to be diagnosed as malignant by EBUS-TBNA.(3)The location of lymph nodes has no effect on the diagnostic efficacy of EBUS-TBNA on the nature of mediastinal lymph node lesions.(4)The clinical application of EBUS-TBNA technology is safer and more accurate,and there are few postoperative complications.