Herth F J F, Eberhardt R, Vilmann P, Krasnik M, Ernst A
Department of Internal Medicine, Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Germany.
Thorax. 2006 Sep;61(9):795-8. doi: 10.1136/thx.2005.047829. Epub 2006 May 31.
Transbronchial needle aspiration (TBNA) is an established method for sampling mediastinal lymph nodes to aid in diagnosing lymphadenopathy and in staging lung cancers. Real-time endobronchial ultrasound (EBUS) guidance is a new method of TBNA that may increase the ability to sample these nodes and hence to determine a diagnosis. A descriptive study was conducted to test this new method.
Consecutive patients referred for TBNA of mediastinal lymph nodes were included in the trial. When a node was detected, a puncture was performed under real-time ultrasound control. The primary end point was the number of successful biopsy specimens. Diagnostic results from the biopsies were compared with operative findings. Lymph node stations were classified according to the recently adopted American Thoracic Society scheme.
From 502 patients (316 men) of mean age 59 years (range 24-82), 572 lymph nodes were punctured and 535 (94%) resulted in a diagnosis. Biopsy specimens were taken from lymph nodes in region 2L (40 nodes), 2R (53 nodes), 3 (35 nodes), 4R (86 nodes), 4L (77 nodes), 7 (127 nodes), 10R (38 nodes), 10L (43 nodes), 11R (40 nodes) and 11L (33 nodes). The mean (SD) diameter of the nodes was 1.6 (0.36) cm and the range was 0.8-3.2 cm (SD range 0.8-4.3). Sensitivity was 94%, specificity 100%, and the positive predictive value was 100% calculated per patient. No complications occurred.
EBUS-TBNA is a promising new method for sampling mediastinal lymph nodes. It appears to permit more and smaller nodes to be sampled than conventional TBNA, and it is safe.
经支气管针吸活检术（TBNA）是一种用于获取纵隔淋巴结样本以辅助诊断淋巴结病和肺癌分期的既定方法。实时支气管内超声（EBUS）引导是一种新的TBNA方法，可能会提高获取这些淋巴结样本的能力，从而有助于确定诊断。进行了一项描述性研究以测试这种新方法。
连续纳入因纵隔淋巴结TBNA而转诊的患者。当检测到淋巴结时，在实时超声引导下进行穿刺。主要终点是成功获取活检标本的数量。将活检的诊断结果与手术结果进行比较。根据最近采用的美国胸科学会方案对淋巴结站进行分类。
在502例患者（316例男性）中，平均年龄59岁（范围24 - 82岁），共穿刺了572个淋巴结，其中535个（94%）获得了诊断结果。活检标本取自2L区（40个淋巴结）、2R区（53个淋巴结）、3区（35个淋巴结）、4R区（86个淋巴结）、4L区（77个淋巴结）、7区（127个淋巴结）、10R区（38个淋巴结）、10L区（43个淋巴结）、11R区（40个淋巴结）和11L区（33个淋巴结）。淋巴结的平均（标准差）直径为1.6（0.36）cm，范围为0.8 - 3.2 cm（标准差范围0.8 - 4.3）。按患者计算，敏感性为94%，特异性为100%，阳性预测值为100%。未发生并发症。
EBUS - TBNA是一种很有前景的获取纵隔淋巴结样本的新方法。与传统TBNA相比，它似乎能够获取更多更小的淋巴结样本，并且是安全的。
