Objective: To evaluate the role of endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) in lymph node staging and resectability assessment of patients with non-small cell lung cancer (NSCLC). Methods: The clinical data of 154 patients with NSCLC who underwent EBUS-TBNA from March 2015 to December 2018 were collected. All accessible mediastinal and hilar lymph nodes were systematically explored and punctured using EBUS-TBNA. EBUS-TBNA and CT were used for preoperative staging and resectability evaluation. Results: The sensitivity, specificity and accuracy of EBUS-TBNA were 94.2%, 100.0% and 96.0%, respectively, while those of CT were 89.9%, 31.8% and 72.0%, respectively. The differences were statistically significant (P<0.05). The sensitivity, specificity and accuracy of EBUS-TBNA in lymph nodes with short diameter less than 15 mm were 92.4%, 100.0% and 96.0%, respectively, while those of CT were 80.7%, 34.8% and 60.1%, respectively, with statistical differences (P<0.05). The staging of 62 patients was changed, 27 cases were up-regulated and 35 cases were down-regulated. Among them, 32 cases had been changed to resectable. The evaluating resectability of EBUS-TBNA showed excellent consistency with that of pathological results (Kappa=0.95). The sensitivity and specificity were 100.0% and 97.2%, respectively. Conclusion: EBUS-TBNA can systemically evaluate the metastatic status of NSCLC patients and improve the accuracy of preoperative lymph node staging and resectability assessment.
目的： 探讨在超声支气管镜引导下经支气管壁针吸活检术(EBUS－TBNA)对非小细胞肺癌(NSCLC)患者淋巴结分期的评价以及对手术可切除性评估的影响。 方法： 收集2015年3月至2018年12月，在中国科学院大学宁波华美医院接受EBUS－TBNA的NSCLC患者154例。应用EBUS－TBNA系统性地对所有可及的纵隔和肺门淋巴结进行探查及穿刺。比较EBUS－TBNA和增强CT作为术前淋巴结分期和可切除性评价的效果。 结果： 154例NSCLC患者成功穿刺475组淋巴结，EBUS－TBNA的灵敏度、特异度和准确率分别为94.2%、100.0%和96.0%，而CT分别为89.9%、31.8%和72.0%，差异均有统计学意义(均P<0.05)。在短径≤15 mm的淋巴结中，EBUS－TBNA的灵敏度、特异度和准确率分别为92.4%、100.0%和96.0%，而CT分别为80.7%、34.8%和60.1%，差异均有统计学意义(均P<0.05)。有62例患者的淋巴结分期发生改变，分期进展27例，改善35例，其中32例患者手术可切除性发生改变。EBUS－TBNA判断手术可切除性与依据病理结果对手术可切除性评估的一致性Kappa系数为0.95，灵敏度为100.0%，特异度为97.2%。 结论： 应用EBUS－TBNA系统性评价NSCLC患者淋巴结的转移情况，能够提高NSCLC患者术前淋巴结分期和手术可切除性评估的准确性。.
Keywords: Carcinoma, non-small-cell lung; Endobronchial ultrasound guided transbronchial needle aspiration; Lymph node staging; Resectability; Systematic evaluation.