Fritscher-Ravens A, Sriram P V, Topalidis T, Hauber H P, Meyer A, Soehendra N, Pforte A
Departments of Interdisciplinary Endoscopy and Internal Medicine, Pulmonology, University Hospital Eppendorf, Hamburg.
Chest. 2000 Oct;118(4):928-35. doi: 10.1378/chest.118.4.928.
The ability to diagnose sarcoidosis cytologically has been reported previously, but the method is rarely used. Endoscopic ultrasonography (EUS) is a sensitive technique for detecting mediastinal lymph nodes, which in addition provides an opportunity to carry out guided fine-needle aspiration (FNA) cytology. We report herein on the use of EUS-FNA in the diagnosis of sarcoidosis.
Nineteen patients with suspected sarcoidosis were investigated using EUS-FNA with a linear echoendoscope and a 22-gauge Hancke-Vilman needle.
In all 19 patients, EUS revealed enlarged mediastinal lymph nodes (mean size, 2.4 cm), located subcarinally (n = 15), in the aortopulmonary window (n = 12), or in the lower posterior mediastinum (n = 5). The nodes had an isoechoic or hypoechoic appearance, with atypical vessels in five cases. The amount of aspirate obtained using EUS-FNA was adequate in all patients, and contained blood in excess of normal in some, indicating a high degree of vascularity. Cytology demonstrated epithelioid cell granuloma formation, suggesting sarcoidosis. Mycobacterial cultures were negative in all of the patients except one, in whom the final diagnosis was tuberculosis. The specificity and sensitivity of EUS-FNA in the diagnosis of sarcoidosis were 94% and 100%, respectively.
EUS of mediastinal lymph nodes in sarcoidosis reveals certain characteristic features. However, it is not capable of differentiating the lesions from tuberculosis or malignancy. EUS-FNA is a safe and sensitive method of aspirating material for cytology and mycobacterial cultures. We believe it will provide a useful alternative in the diagnosis of sarcoidosis.
先前已有关于通过细胞学诊断结节病的报道，但该方法很少被使用。内镜超声检查（EUS）是检测纵隔淋巴结的一种敏感技术，此外还提供了进行引导性细针穿刺抽吸（FNA）细胞学检查的机会。我们在此报告EUS-FNA在结节病诊断中的应用。
对19例疑似结节病的患者使用线性超声内镜和22号汉克-维尔曼针进行EUS-FNA检查。
所有19例患者的EUS均显示纵隔淋巴结肿大（平均大小为2.4 cm），位于隆突下（n = 15）、主动脉肺窗（n = 12）或后纵隔下部（n = 5）。这些淋巴结呈等回声或低回声，5例有异常血管。所有患者通过EUS-FNA获得的抽吸物量充足，部分患者的抽吸物中血液超过正常量，表明血管丰富。细胞学检查显示上皮样细胞肉芽肿形成，提示结节病。除1例最终诊断为结核病的患者外，所有患者的分枝杆菌培养均为阴性。EUS-FNA诊断结节病的特异性和敏感性分别为94%和100%。
结节病纵隔淋巴结的EUS显示出某些特征性表现。然而，它无法将病变与结核病或恶性肿瘤区分开来。EUS-FNA是一种安全且敏感的获取细胞学和分枝杆菌培养材料的方法。我们认为它将为结节病的诊断提供一种有用的替代方法。
