Trisolini Rocco, Lazzari Agli Luigi, Cancellieri Alessandra, Poletti Venerino, Tinelli Carmine, Baruzzi Giuseppe, Patelli Marco
Unit of Thoracic Endoscopy, Department of Pathology, Maggiore Hospital, Largo Nigrisoli 2, 40133 Bologna, Italy.
Chest. 2003 Dec;124(6):2126-30. doi: 10.1378/chest.124.6.2126.
Transbronchial lung biopsy (TBLB) during flexible bronchoscopy (FB) is the recommended procedure for diagnosing sarcoidosis in most cases, although its yield in stage I disease is reported to be not as high as when parenchymal involvement is radiologically evident. We undertook this study to assess the diagnostic value of transbronchial needle aspiration (TBNA) in sarcoidosis presenting with hilar and/or mediastinal lymphadenopathy (stage I).
Retrospective review of bronchoscopy procedures performed over a 6-year period for the diagnostic workup of hilar and/or mediastinal lymphadenopathy, as detected by chest radiographs.
Urban academic hospital.
Fifty-five patients with hilar and/or mediastinal lymphadenopathy without pulmonary abnormalities were included in the analysis.
After chest CT and physical examinations, all patients underwent FB with TBNA. Patients thought to have clinicoradiologic findings highly consistent with sarcoidosis, as assessed by the bronchoscopists performing the procedures, underwent combined TBNA and TBLB.
A diagnosis of sarcoidosis was established in 32 patients. In the remaining 23 patients, other diseases were pathologically diagnosed. Overall, TBNA was diagnostic in 23 of 32 patients with sarcoidosis (72%) by showing nonnecrotizing granulomas in 28 of 39 lymph node stations sampled (72%). Among the 15 patients who were submitted to both TBNA and TBLB, TBNA exclusively established the diagnosis in 7 of 15 patients (47% increase in the diagnostic rate) and its yield exceeded that of TBLB (11 of 15 patients [73%] vs 6 of 15 patients [40%], respectively). The association of TBNA and TBLB increased the diagnostic yield to 87%.
TBNA may be of great value in the diagnostic evaluation of patients with suspected stage I sarcoidosis, and its use in association with TBLB should be strongly encouraged. TBNA may also preclude the need for further surgical diagnostic procedures in several patients with hilar and/or mediastinal adenopathy due to causes other than sarcoidosis.
在大多数情况下，可弯曲支气管镜检查（FB）时经支气管肺活检（TBLB）是诊断结节病的推荐方法，尽管据报道其在I期疾病中的诊断率不如影像学上实质受累明显时高。我们进行这项研究以评估经支气管针吸活检（TBNA）在以肺门和/或纵隔淋巴结肿大为表现的结节病（I期）中的诊断价值。
对6年间因胸部X线片检测到的肺门和/或纵隔淋巴结肿大进行诊断性检查的支气管镜检查程序进行回顾性分析。
城市学术医院。
纳入55例无肺部异常的肺门和/或纵隔淋巴结肿大患者进行分析。
在胸部CT和体格检查后，所有患者均接受了FB联合TBNA。经实施检查的支气管镜医师评估，认为临床和放射学表现高度符合结节病的患者接受了TBNA联合TBLB。
32例患者确诊为结节病。其余23例患者经病理诊断为其他疾病。总体而言，32例结节病患者中有23例（72%）通过TBNA确诊，在39个采样淋巴结站中的28个（72%）发现非坏死性肉芽肿。在15例同时接受TBNA和TBLB的患者中，仅TBNA就确诊了7例（诊断率提高47%），其诊断率超过了TBLB（分别为15例中的11例[73%]和15例中的6例[40%]）。TBNA和TBLB联合使用使诊断率提高到87%。
TBNA在疑似I期结节病患者的诊断评估中可能具有很大价值，应大力鼓励将其与TBLB联合使用。对于一些因结节病以外原因导致肺门和/或纵隔淋巴结肿大的患者，TBNA还可能避免进一步的手术诊断程序。
