Dept of Respiratory Medicine, Building 7K12 I.E., Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
Eur Respir J. 2010 Jun;35(6):1329-35. doi: 10.1183/09031936.00111509. Epub 2009 Nov 6.
A clinicoradiological presentation of thoracic sarcoidosis requires histopathology in order to establish the diagnosis. Flexible bronchoscopy has a reasonable diagnostic yield and is the procedure of first choice for diagnosis. Endoscopic ultrasound (endoscopic ultrasound-guided fine needle aspiration/endobronchial ultrasound-guided transbronchial needle aspiration) can help in the diagnosis of sarcoidosis. An implementation strategy of endoscopic ultrasound for the diagnosis of sarcoidosis following negative flexible bronchoscopy results was examined prospectively in 15 clinics. A total of 137 patients (92 males; median age 43 yrs) were included, and sarcoidosis was found in 115 (84%). Alternative diagnoses were tuberculosis, lymphangitis carcinomatosa, pneumoconiosis and alveolitis. All patients were sent for flexible bronchoscopy, which was performed in 121 (88%), resulting in a definite diagnosis in 57 (42%). A total of 80 patients were sent for endoscopic ultrasound, which could be performed in 72 (90%), yielding a definite diagnosis in 47 (59%). Endoscopic ultrasound following negative flexible bronchoscopy avoided a surgical procedure in 47 out of 80 patients. The sensitivity of flexible bronchoscopy for sarcoidosis was 45% (95% confidence interval 35-54%), but 62% (50-72%) if biopsy specimens were taken. The sensitivity of endoscopic ultrasound following negative flexible bronchoscopy results was 71% (58-82%). With this strategy, 97 out of 115 (84% (76-90%)) of proven sarcoidosis was diagnosed using endoscopy. This large prospective implementation study (trial number NCT00888212; ClinicalTrials.gov) shows that endoscopic ultrasound is valuable for diagnosing sarcoidosis after negative flexible bronchoscopy results.
胸门氏肉瘤的临床放射学表现需要组织病理学检查才能确诊。纤维支气管镜检查具有合理的诊断效果，是诊断的首选方法。内镜超声（内镜超声引导下细针抽吸/支气管内超声引导下经支气管针吸活检）有助于诊断门氏肉瘤。本前瞻性研究在 15 个诊所中检查了内镜超声在阴性纤维支气管镜检查结果后的门氏肉瘤诊断实施策略。共纳入 137 例患者（92 例男性；中位年龄 43 岁），115 例（84%）发现门氏肉瘤。其他诊断包括肺结核、淋巴管癌、尘肺和肺泡炎。所有患者均行纤维支气管镜检查，其中 121 例（88%）进行了检查，57 例（42%）获得明确诊断。共 80 例患者行内镜超声检查，其中 72 例（90%）可进行检查，47 例（59%）获得明确诊断。内镜超声检查避免了 80 例患者中的 47 例进行手术。纤维支气管镜检查对门氏肉瘤的敏感性为 45%（95%置信区间 35-54%），但如果进行活检，敏感性为 62%（50-72%）。阴性纤维支气管镜检查结果后内镜超声的敏感性为 71%（58-82%）。采用这种策略，115 例确诊的门氏肉瘤中有 97 例（84%（76-90%））通过内镜检查确诊。这项大型前瞻性实施研究（试验编号 NCT00888212；ClinicalTrials.gov）表明，在纤维支气管镜检查结果为阴性后，内镜超声对诊断门氏肉瘤具有重要价值。
