经支气管针吸活检术联合建隧活检在临床中的应用价值

The Application Value of Transbronchial Needle Aspiration Biopsy Combined with Tunnel Biopsy in Clinical Practice

摘要: 目的：探讨经支气管针吸活检术联合建隧活检在临床中的应用价值。方法：回顾性分析济宁医学院附属医院呼吸与危重症学科在2023年1月至2024年10月期间胸部CT/胸部增强CT示有肺门/纵隔淋巴结肿大和(或)肺周围病变的病例患者的临床资料分3组，53例行C-TBNA检查的患者为1组、31例行C-TBNA联合建隧活检检查的患者为2组、324例行EBUS-TBNA检查的患者为3组，收集上述3组患者的病理学检查结果、穿刺部位，计算敏感度、特异度、准确率。结果：行C-TBNA诊断的敏感度为79%，特异度为100%，诊断准确率为80.8%；行C-TBNA联合建隧活检诊断的敏感度为95.4%，特异度100%，准确率96.7%；行EBUS-TBNA诊断的敏感度为93.5%，特异度100%，准确率95%；3组准确率相比差异有统计学意义(χ² = 11.532, P = 0.002, P < 0.05)。1组与2组(P = 0.045, P < 0.05)及1组与3组(P = 0.001, P < 0.05)准确率相比有统计学差异，但2组与3组的准确率无统计学差异(P = 1.00, P > 0.05)。结论：C-TBNA联合建隧活检诊断率高于C-TBNA，且不劣于EBUS-TBNA相比，该项技术可以用于纵隔和肺门淋巴结的诊断评估。

Abstract: Objective: To investigate the clinical value of transbronchial needle aspiration biopsy combined with tunnel biopsy. Methods: A retrospective analysis was performed for the clinical data of patients with hilar/mediastinal lymphadenopathy and/or peripulmonary lesions on chest CT/chest contrast- enhanced CT from January 2023 to October 2024, including 1 group of 53 patients who underwent C-TBNA, 2 groups of 31 patients who underwent C-TBNA combined with tunnel biopsy, and 3 groups of 324 patients who underwent EBUS-TBNA. The pathological examination results and puncture sites of the above three groups were collected, and the sensitivity, specificity and accuracy were calculated. Results: The sensitivity, specificity and accuracy of C-TBNA were 79%, 100%, and 80.8%. The sensitivity and specificity of C-TBNA combined with tunnel biopsy were 95.4%, the specificity was 100%, and the accuracy was 96.7%. The sensitivity and specificity of EBUS-TBNA were 93.5%, the specificity was 100%, and the accuracy was 95%. There was a statistically significant difference in accuracy between the three groups (χ² = 11.532, P = 0.002, P < 0.05). There were statistically significant differences in the accuracy between group 1 and group 2 (P = 0.045, P < 0.05) and group 1 and group 3 (P = 0.001, P < 0.05), but there was no significant difference in accuracy between group 2 and group 3 (P = 1.000, P > 0.05). Conclusions: Compared with EBUS-TBNA, this technique can be used for the diagnostic evaluation of mediastinal and hilar lymph nodes.