快速现场评价在经气管镜超声引导针吸活检诊断纵隔病灶中的应用

Application of rapid on-site evaluation of endo-bronchial ultrasound-guided transbronchial needle aspirations for the diagnosis of mediastinal lesions

摘要:

目的 探讨快速现场评价（ROSE）在经气管镜超声引导针吸活检（EBUS-TBNA）诊断纵隔肿物中的价值。方法 回顾性分析该院211例通过胸部CT显示纵隔／肺门病灶（包括肿大的淋巴结/肿块）的患者的临床资料，在有或无快速现场细胞学评价（C-ROSE）下行EBUS-TBNA检查。结果 C-ROSE组和未行C-ROSE组的敏感度分别为93.88%和92.45%，特异度分别为97.73%和93.85%，两组比较，差异均无统计学意义（P > 0.05）。由肺科医师担任解读的ROSE结果敏感度为87.76%（43/49）、特异度为88.64%（39/44），与专业细胞学病理人员结果高度一致（κ = 0.806）。ROSE指导下率先肺癌3基因（EGFR、ALK和ROS1）检测完成率为65.52%（19/29），后续免疫组化完成率为31.03%（9/29）。结论 在EBUS-TBNA过程中应用ROSE，临床医师与病理医师在诊断上具有高度的一致性，临床医生即刻知晓病理倾向，为后续诊疗方案提供了依据。

Abstract:

Objective To discuss the value of rapid on-site evaluation (ROSE) in diagnosis of mediastinal lesions by endobronchial ultrasound-guided transbronchial needle aspirations (EBUS-TBNA).Methods Clinical data of 211 patients underwent EBUS-TBNA with or without C-ROSE on chest computed tomography (CT) showed mediastinal/hilar lesions (including enlarged lymph nodes/masses) were retrospectively analyzed.Results The sensitivity of cytological ROSE (C-ROSE) group and No C-ROSE group were 93.88% and 92.45%, the specificity were 97.73% and 93.85%, respectively (P > 0.05). The sensitivity of the ROSE results interpreted by pulmonologist was 87.76% (43/49) and the specificity was 88.64% (39/44), which were highly consistent with the results of professional cytopathologist (κ = 0.806). Under the guidance of ROSE, the completion rate of the first detection of lung cancer 3 genes (EGFR, ALK and ROS1) was 65.52% (19/29), the subsequent immunohistochemical completion rate was 31.03% (9/29).Conclusion ROSE was applied in the EBUS-TBNA process, clinicians and pathologists had a high degree of consistency in diagnosis, and the pathological types could be immediately known, and provide guidance for the subsequent diagnosis and treatment plans.