Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, USA.
Cancer Cytopathol. 2010 Oct 25;118(5):278-86. doi: 10.1002/cncy.20103.
Conventional endoscopic transbronchial needle aspiration (TBNA) is a common procedure used to obtain samples for diagnosing and staging lung lesions. Recently, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been developed and increasingly used by clinicians. Clinical data suggest that EBUS-TBNA has higher sensitivity and specificity than conventional TBNA in staging lung cancers. In this study, the authors have investigated the cytological features and compared the diagnostic yield of these procedures in lung cancer patients.
A computer search of the cytopathology archives at The Johns Hopkins Hospital revealed 188 EBUS-TBNA cases (308 lymph nodes; 47 lung lesions) and 74 TBNA cases (106 lymph nodes; 44 lung lesions) over a 28-month period. All cytological material was correlated with available corresponding surgical material.
The most frequently sampled lymph nodes were stations 4R and 7 in both TBNA and EBUS-TBNA; in addition, the EBUS-TBNA showed a wide range of lymph node sampling. EBUS-TBNA had a significantly lower nondiagnostic rate (8.7%) compared with TBNA (28.3%, P < .05) in staging lung cancers. In lymph node sampling, the sensitivity and specificity were 54.5% and 100% in the TBNA group and 85.2% and 100% in the EBUS-TBNA group. In lung specimens, the nondiagnostic rates of TBNA and EBUS-TBNA were 6.8% and 4.3%, respectively (P > .05), and the sensitivity and specificity were 78.9% and 100% in the TBNA group; and 89.5% and 100% in the EBUS-TBNA group.
Findings indicated that EBUS-FNA cytology is an optimal modality for diagnosing and staging in lung cancer patients, in comparison to conventional TBNA.
传统的经支气管镜针吸活检（TBNA）是一种常见的获取样本以诊断和分期肺部病变的方法。最近，支气管内超声引导经支气管针吸活检（EBUS-TBNA）已被临床医生开发并越来越多地使用。临床数据表明，EBUS-TBNA 在分期肺癌方面比传统 TBNA 具有更高的灵敏度和特异性。在这项研究中，作者研究了这些方法在肺癌患者中的细胞学特征，并比较了它们的诊断效果。
对约翰霍普金斯医院的细胞病理学档案进行计算机检索，发现在 28 个月的时间里，有 188 例 EBUS-TBNA 病例（308 个淋巴结；47 个肺部病变）和 74 例 TBNA 病例（106 个淋巴结；44 个肺部病变）。所有细胞学材料均与相应的手术材料进行了对比。
在 TBNA 和 EBUS-TBNA 中，最常取样的淋巴结是 4R 和 7 站；此外，EBUS-TBNA 还显示出广泛的淋巴结取样范围。EBUS-TBNA 在分期肺癌方面的非诊断率明显低于 TBNA（8.7%对 28.3%，P<0.05）。在淋巴结取样中，TBNA 组的灵敏度和特异性分别为 54.5%和 100%，EBUS-TBNA 组分别为 85.2%和 100%。在肺部标本中，TBNA 和 EBUS-TBNA 的非诊断率分别为 6.8%和 4.3%（P>0.05），TBNA 组的灵敏度和特异性分别为 78.9%和 100%，EBUS-TBNA 组分别为 89.5%和 100%。
研究结果表明，与传统 TBNA 相比，EBUS-FNA 细胞学是诊断和分期肺癌患者的最佳方法。
