EBUS-TBNA对肺癌的肺门或纵隔肿大淋巴结诊断价值的Meta分析

The Diagnostic Value of EBUS-TBNA in Hilar or Mediastinal Enlarged Lymph Nodes of Lung Cancer: A Meta-Analysis

摘要: 目的：使用Meta分析评价超声内镜引导下的经支气管针吸活检术(EBUS-TBNA)对肺癌的肺门或纵隔肿大淋巴结的诊断价值。方法：通过计算机检索PubMed、中国知网(CNKI)、维普科技期刊数据库(VIP)和万方医学网等数据库，检索时间至2022年8月，对所有文献进行筛选、资料提取并依据Cochrane系统进行质量评价，采用Stata15.0软件进行Meta分析。结果：最终纳入13篇文献，共计1418例受试者，研究结果显示：EBUS-TBNA诊断肺癌的肺门或纵隔肿大淋巴结有较高的灵敏度0.93 (0.91, 0.94)、特异度1.00 (0.37, 1.00)、阳性似然比14546.2 (0.4, 5.0e+08)、阴性似然比0.07 (0.06, 0.09)及诊断比值比202,892 (6, 7.3e+09)，绘制受试者工作特征(ROC)曲线、计算曲线下面积AUC为0.96 (0.94~0.97)并绘制Fagan图得出若受试者经EBUS-TBNA对肺癌的肺门或纵隔肿大淋巴结诊断是阳性结果，其概率为100%，若是阴性结果，其无相应疾病的概率则为2%。纳入13篇文献均介绍了术后并发症，经EBUS-TBNA诊断肺癌的肺门或纵隔肿大淋巴结术后发生咳嗽(9例)、咯血(4例)、气胸(2例)、术后痰中带血(3例)、一过性的低氧血症(3例)、心律失常(1例)、感染(1例)，研究显示多数受试者可耐受此操作，操作过程中较少发生大血管破裂出血、气胸、一过性的低氧血症等严重并发症。结论：EBUS-TBNA对肺癌的肺门或纵隔肿大淋巴结的诊断具有较高的灵敏度、特异度、准确率及安全性，是诊断肺癌的肺门或纵隔肿大淋巴结的一项重要的诊疗路径，为肺癌的肺门或纵隔肿大淋巴结的定性及分期提供了新的途径。

Abstract: Objective: To evaluate the diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in hilar or mediastinal enlarged lymph nodes of lung cancer by Me-ta-analysis. Methods: PubMed, CNKI, VIP and Wan were searched by computer. All literatures were screened, data extracted and performed according to the Cochrane system. The retrieval time was until August 2022. Quality evaluation was conducted by Meta-analysis using Stata15.0 software. Results: A total of 1418 subjects were included in 13 literatures. The results showed that: EBUS-TBNA had higher sensitivity of 0.93 (0.91, 0.94), specificity of 1.00 (0.37, 1.00), positive like-lihood ratio of 14546.2 (0.4, 5.0e+08), negative likelihood ratio of 0.07 (0.06, 0.09) and diagnostic odds ratio of 202,892 (6, 7.3e+09) in the diagnosis of hilar or mediastinal enlarged lymph nodes of lung cancer, draw and sum the ROC curve, calculate the AUC of the area under the curve to be 0.96 (0.94~0.97), draw the Fagan diagram, and conclude that if the subjects’ diagnosis of hilar or medi-astinal enlarged lymph node of lung cancer by EBUS-TBNA is positive, the probability is 100%. A negative result was associated with a 2% chance of being free of disease. The 13 included litera-tures all mentioned postoperative complications, including cough (9 cases), hemoptysis (4 cases), pneumothorax (2 cases), blood in postoperative sputum (3 cases), transient hypoxemia (3 cases), arrhythmia (1 case) and infection (1 case) in hilar or mediastinal enlarged lymph nodes diagnosed by EBUS-TBNA. Studies have shown that most subjects can tolerate this procedure, and few serious complications such as large vessel rupture and bleeding, pneumothorax, and transient hypoxemia occur during the procedure. Conclusion: EBUS-TBNA has high sensitivity, specificity, accuracy and safety in the diagnosis of hilar or mediastinal enlarged lymph nodes of lung cancer, which is an im-portant diagnosis and treatment path for hilar or mediastinal enlarged lymph nodes of lung cancer, and provides a new approach for the qualitative and staging of hilar or mediastinal enlarged lymph nodes of lung cancer.