Wong M, Yasufuku K, Nakajima T, Herth F J F, Sekine Y, Shibuya K, Iizasa T, Hiroshima K, Lam W K, Fujisawa T
Department of Thoracic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan, and Queen Mary Hospital, Hong Kong SAR, China.
Eur Respir J. 2007 Jun;29(6):1182-6. doi: 10.1183/09031936.00028706. Epub 2007 Mar 1.
A diagnosis of sarcoidosis should be substantiated by pathological means in order to thoroughly exclude other diseases. The role of real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of sarcoidosis has not been reported. The purpose of the present study is to evaluate the diagnostic yield of EBUS-TBNA in demonstrating the pathological features of sarcoidosis. In total, 65 patients with suspected sarcoidosis, with enlarged hilar or mediastinal lymph nodes on computed tomography, were included in the study. Patients with a suspected or known malignancy or previously established diagnosis of sarcoidosis were excluded. Convex probe endobronchial ultrasonography integrated with a separate working channel was used for EBUS-TBNA. Surgical methods were performed in those in whom no granulomas were detected by EBUS-TBNA. Patients were followed up clinically. EBUS-TBNA was performed on a total of 77 lymph node stations in 65 patients. A final diagnosis of sarcoidosis was made for 61 (93.8%) of the patients. The remaining four patients were diagnosed as having Wegener's granulomatosis (n=1) or indefinite (n=3). In patients with a final diagnosis of sarcoidosis, EBUS-TBNA demonstrated noncaseating epithelioid cell granulomas in 56 (91.8%) of the patients. No complications were reported. Endobronchial ultrasound-guided transbronchial needle aspiration proved to be a safe procedure with a high yield for the diagnoses of sarcoidosis.
结节病的诊断应以病理手段证实，以便彻底排除其他疾病。实时支气管内超声引导下经支气管针吸活检（EBUS-TBNA）在结节病诊断中的作用尚未见报道。本研究的目的是评估EBUS-TBNA在显示结节病病理特征方面的诊断率。共有65例疑似结节病患者纳入研究，这些患者在计算机断层扫描上显示肺门或纵隔淋巴结肿大。排除疑似或已知恶性肿瘤或先前已确诊结节病的患者。采用带有独立工作通道的凸阵探头支气管内超声进行EBUS-TBNA。对于EBUS-TBNA未检测到肉芽肿的患者采用手术方法。对患者进行临床随访。65例患者共对77个淋巴结站进行了EBUS-TBNA。61例（93.8%）患者最终诊断为结节病。其余4例患者诊断为韦格纳肉芽肿（n = 1）或诊断不明确（n = 3）。在最终诊断为结节病的患者中，EBUS-TBNA在56例（91.8%）患者中显示出非干酪样上皮样细胞肉芽肿。未报告并发症。支气管内超声引导下经支气管针吸活检被证明是一种安全的检查方法，对结节病的诊断具有较高的阳性率。
