Garwood Susan, Judson Marc A, Silvestri Gerard, Hoda Rana, Fraig Mostafa, Doelken Peter
Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.
Chest. 2007 Oct;132(4):1298-304. doi: 10.1378/chest.07-0998. Epub 2007 Sep 21.
The diagnosis of pulmonary sarcoidosis can be established by a variety of techniques. Transbronchial lung biopsy is often the preferred approach, but it is frequently nondiagnostic and carries a risk of pneumothorax and bleeding. Mediastinoscopy is often suggested as the next diagnostic step but entails significant cost and associated morbidity. Endobronchial ultrasound (EBUS) with transbronchial needle aspiration (TBNA) is emerging as a safe, minimally invasive tool for the primary diagnosis of mediastinal and hilar lymphadenopathy. The purpose of this study was to assess the utility of EBUS-TBNA for pulmonary sarcoidosis.
Fifty consecutive patients who had been referred for EBUS-TBNA for suspected pulmonary sarcoidosis were included in the study. On-site cytology was used to assess the adequacy of the samples. The presence of noncaseating granulomas without necrosis in the appropriate clinical setting was deemed to be adequate for the diagnosis of pulmonary sarcoidosis. Patients with a negative EBUS-TBNA underwent further histologic biopsy or clinical follow-up to determine the final diagnosis.
Eighty-two lymph nodes with a median size of 16 mm (range, 4 to 40 mm) were punctured. EBUS-TBNA demonstrated noncaseating granulomas without necrosis in 41 of 48 patients (85%) with a final diagnosis of sarcoidosis. EBUS-TBNA, therefore, has a sensitivity of 85% for the primary diagnosis of pulmonary sarcoidosis.
EBUS-TBNA is a safe, minimally invasive tool for the primary diagnosis of pulmonary sarcoidosis that has a high diagnostic yield. EBUS-TBNA should be considered an appropriate alternative diagnostic technique for patients with suspected pulmonary sarcoidosis.
肺结节病的诊断可通过多种技术来确立。经支气管肺活检通常是首选方法，但它常常无法得出诊断结果，且存在气胸和出血风险。纵隔镜检查常被建议作为下一步诊断措施，但费用高昂且伴有相关发病率。支气管内超声（EBUS）联合经支气管针吸活检（TBNA）正成为一种用于纵隔和肺门淋巴结病初步诊断的安全、微创工具。本研究的目的是评估EBUS-TBNA在肺结节病中的应用价值。
本研究纳入了连续50例因疑似肺结节病而接受EBUS-TBNA检查的患者。采用现场细胞学检查来评估样本的充分性。在适当的临床背景下，出现无坏死的非干酪样肉芽肿被认为足以诊断肺结节病。EBUS-TBNA结果为阴性的患者接受进一步的组织学活检或临床随访以确定最终诊断。
共穿刺了82个淋巴结，中位大小为16毫米（范围4至40毫米）。在最终诊断为结节病的48例患者中，有41例（85%）的EBUS-TBNA显示无坏死的非干酪样肉芽肿。因此，EBUS-TBNA对肺结节病初步诊断的敏感性为85%。
EBUS-TBNA是一种用于肺结节病初步诊断的安全、微创工具，诊断率高。对于疑似肺结节病的患者，EBUS-TBNA应被视为一种合适的替代诊断技术。
