Mimics软件引导下TBNA与EBUS-TBNA对肺门及纵隔淋巴结肿大的肺占位性病变的诊断效能比较

Comparison of the diagnostic efficacy of Mimics software-guided transbronchial needle aspiration and endobronchial ultrasound-guided transbronchial needle aspiration for hilar and mediastinal lymph node enlargement in pulmonary space-occupying lesions

摘要:

目的 比较Mimics软件引导的经支气管针吸活检（TBNA）与超声引导下经支气管针吸活检（EBUS-TBNA），在诊断肺门及纵隔淋巴结肿大的肺占位性病变方面的有效性。方法 回顾性分析2019年1月－2024年5月该院收治的136例胸部CT显示肺门及纵隔淋巴结肿大（直径 ≥ 1.5 cm）患者的临床资料。68例行Mimics软件引导TBNA的患者纳入Mimics-TBNA组，68例行EBUS-TBNA的患者纳入EBUS-TBNA组，比较两组患者的诊断阳性率、手术时间、检查费用和并发症发生率。结果 136例患者中，86例被确诊为恶性肿瘤。其中，肺癌81例，淋巴瘤及其他转移瘤5例。21例患者被确诊为良性病变。29例诊断结果未确定或穿刺结果为血凝块。Mimics-TBNA组中，43例被确诊为恶性肿瘤，包括：41例肺癌，2例淋巴结及其他转移瘤；9例被确诊为良性病变；16例的诊断结果未能确定，或穿刺结果为血凝块；病灶诊断的总阳性率为76.47%（52/68），恶性肿瘤的诊断阳性率为63.23%（43/68）。EBUS-TBNA组中，43例被确诊为恶性肿瘤，包括：肺癌40例，其他来源的恶性肿瘤3例；12例被确诊为良性病变；13例诊断结果未能确定，或穿刺结果为血凝块；病灶诊断的总阳性率为80.88%（55/68），恶性肿瘤的诊断阳性率为63.23%（43/68）。两组患者均未出现严重并发症。两组患者病灶诊断的总阳性率、恶性肿瘤诊断的阳性率和严重并发症的发生率比较，差异均无统计学意义（P > 0.05）。Mimics-TBNA组手术时间短于EBUS-TBNA组，检查费用少于EBUS-TBNA组，差异均有统计学意义（P < 0.05）。结论 Mimics软件引导的TBNA，有助于缩短手术时间，并降低检查成本，且诊断阳性率和安全性均较高，对纵隔淋巴结肿大的诊断，具有较高的应用价值。

Abstract:

Objective To compare the diagnostic efficacy of transbronchial needle aspiration (TBNA) guided by Mimics software and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in patients with hilar and mediastinal lymph node enlargement in pulmonary space-occupying lesions.Methods A retrospective analysis was conducted on the clinical data of 136 patients with hilar and mediastinal lymph node enlargement (diameter ≥ 1.5 cm) shown by chest CT in the hospital from January 2019 to May 2024. Sixty-eight patients who underwent Mimics software-guided TBNA were included in the Mimics-TBNA group, and 68 patients who underwent EBUS-TBNA were included in the EBUS-TBNA group. The positive diagnostic rate, operation time, examination cost and complication rate of the two groups were compared.Results Among the 136 patients, 86 were ultimately diagnosed with malignant tumors, including 81 with lung cancer and 5 with lymphoma or other metastatic tumors. Additionally, 21 patients were diagnosed with benign lesions, 29 had inconclusive diagnoses or blood clots on aspiration. In the Mimics software-guided TBNA group, 43 patients were diagnosed with malignant tumors (41 with lung cancer and 2 with lymphoma or other metastatic tumors), 9 with benign lesions, and 16 had inconclusive diagnoses or blood clots on aspiration. The overall diagnosis positivity rate for lesions was 76.47% (52/68), and the diagnosis positivity rate for malignant tumors was 63.23% (43/68). In the EBUS-TBNA group, 43 patients were diagnosed with malignant tumors (40 with lung cancer and 3 with other metastatic tumors), 12 with benign lesions, and 13 had inconclusive diagnoses or blood clots on aspiration. The overall diagnosis positivity rate for lesions was 80.88% (55/68), and the diagnosis positivity rate for malignant tumors was 63.23% (43/68). No severe complications were observed in either group. There were no statistically significant differences in the total positive rate of lesion diagnosis, the positive rate of malignant tumor diagnosis and the incidence of severe complications were similar between the two groups of patients (P > 0.05). The operation time of the Mimics-TBNA group was shorter than that of the EBUS-TBNA group, and the examination cost was lower than that of the EBUS-TBNA group. The differences were statistically significant (P < 0.05).Conclusion Mimics software-guided TBNA can significantly shorten the operation time, reduce examination costs, and have a high positive diagnostic rate and safety. It has high application value in the diagnosis of mediastinal lymph node enlargement.