Dept of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Amalienstraße 5, D-69126 Heidelberg, Germany.
Eur Respir J. 2012 Feb;39(2):373-7. doi: 10.1183/09031936.00033311. Epub 2011 Jun 23.
One limitation of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the size of the available needles, frequently yielding only cells for cytological examination. The aim of this pilot study was to evaluate the efficacy and safety of newly developed needle forceps to obtain tissue for the histological diagnosis of enlarged mediastinal lymph nodes. Patients with enlarged, positron emission tomography (PET)-positive lymph nodes were included. The transbronchial needle forceps (TBNF), a sampling instrument combining the characteristics of a needle (bevelled tip for penetrating through the bronchial wall) with forceps (two serrated jaws for grasping tissue) was used through the working channel of the EBUS-TBNA scope. Efficacy and safety was assessed. 50 patients (36 males and 14 females; mean age 51 yrs) with enlarged or PET-positive lymph nodes were included in this pilot study. In 48 (96%) patients penetration of the bronchial wall was possible and in 45 patients tissue for histological diagnosis was obtained. In three patients TBNF provided inadequate material. For patients in whom the material was adequate for a histological examination, a specific diagnosis was established in 43 (86%) out of 50 patients (nonsmall cell lung cancer: n=24; small cell lung cancer: n=7; sarcoidosis: n=4; Hodgkin's lymphoma: n=4; tuberculosis: n=2; and non-Hodgkin's lymphoma: n=2).No clinically significant procedure-related complications were encountered. This study demonstrated that EBUS-TBNF is a safe procedure and provides diagnostic histological specimens of mediastinal lymph nodes.
经支气管超声引导针吸活检术（EBUS-TBNA）的一个局限性在于现有活检针的尺寸，其通常仅能获取用于细胞学检查的细胞。本研究旨在评估新型经支气管针型活检钳（TBNF）获取用于诊断纵隔淋巴结肿大的组织标本的效果和安全性。纳入了经正电子发射断层扫描（PET）检查证实为肿大、且呈阳性的淋巴结的患者。经支气管针型活检钳（TBNF）是一种将活检针（斜面尖端用于穿透支气管壁）和活检钳（两个锯齿状钳口用于抓取组织）的特点相结合的取样仪器，通过 EBUS-TBNA 镜的工作通道进行使用。对其效果和安全性进行了评估。本研究纳入了 50 名（36 名男性，14 名女性；平均年龄 51 岁）经证实为肿大或 PET 阳性的淋巴结的患者。在 48 名（96%）患者中，成功穿透了支气管壁，且在 45 名患者中获取了用于组织学诊断的标本。在 3 名患者中，TBNF 提供的标本量不足。对于标本量足以进行组织学检查的患者，50 名患者中有 43 名（86%）（非小细胞肺癌：24 例；小细胞肺癌：7 例；结节病：4 例；霍奇金淋巴瘤：4 例；肺结核：2 例；非霍奇金淋巴瘤：2 例）患者获得了明确的诊断。未发生与操作相关的任何有临床意义的并发症。本研究表明，EBUS-TBNF 是一种安全的操作方法，可为纵隔淋巴结提供诊断性组织学标本。
