Gauchotte Guillaume, Wissler Marie-Pierre, Bressenot Aude, Clément-Duchêne Christelle, Marie Béatrice, Ménard Olivier, Vignaud Jean-Michel
Laboratoire de pathologie, hôpital Central, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France.
Ann Pathol. 2011 Jun;31(3):142-51. doi: 10.1016/j.annpat.2011.02.007. Epub 2011 May 18.
Endobronchial ultrasound-guided transbronchial needle aspiration in mediastinal lymph nodes is a safe method that can be performed for mediastinal and hilar lymph nodes sampling. Because it allows collecting only a small amount of materiel, an optimal processing of the samples is needed.
Based on 150 consecutive procedures, we evaluate the overall diagnostic performances and of each technical methods used for the exploitation of the samples.
The global diagnostic yield is 64.0% for the 50 first exams (learning phase), 88.0% for the next 100 exams. The maximal sensitivity and negative predictive value (NPV) are 79.3%, 96.3% and 92.7%, respectively. The yield, sensitivity and NPV of smears are 68.0%, 75.0% and 66.0%, of monolayer preparation 77.8%, 62.1% and 50.0%, of sections from tissue cores of 65.8%, 94.4% and 86.7%. The combination of the different methods increases the yield comparing to tissue cores and smears when taken alone (P < 0.05), and the sensibility and the NPV comparing to smears (P < 0.0005 and P < 0.01, respectively) and monolayer preparation (P < 0.0001 and P < 0.0005, respectively). The sensitivity of tissue cores is greater than smears (P < 0.005) and monolayer preparations (P < 0.0001). This increase in sensitivity is significant for granuloma (sarcoidosis), but not for carcinoma.
Endobronchial ultrasound-guided transbronchial needle aspiration is an accurate and sensitive technique. Liquid based conditioning of samples and paraffin embedded tissue cores increases the diagnostic performances comparing to smears, notably for the diagnosis of sarcoidosis.
支气管内超声引导下经支气管针吸活检术用于纵隔淋巴结取材是一种安全的方法，可对纵隔和肺门淋巴结进行采样。由于该方法仅能获取少量样本，因此需要对样本进行优化处理。
基于连续150例手术操作，我们评估了整体诊断效能以及用于样本处理的每种技术方法的诊断效能。
前50例检查（学习阶段）的总体诊断率为64.0%，接下来100例检查的诊断率为88.0%。最大敏感性和阴性预测值（NPV）分别为79.3%、96.3%和92.7%。涂片的诊断率、敏感性和NPV分别为68.0%、75.0%和66.0%，单层制片分别为77.8%、62.1%和50.0%，组织芯切片分别为65.8%、94.4%和86.7%。与单独的组织芯和涂片相比，不同方法联合使用可提高诊断率（P < 0.05），与涂片相比，敏感性和NPV也有所提高（分别为P < 0.0005和P < 0.01），与单层制片相比也有提高（分别为P < 0.0001和P < 0.0005）。组织芯的敏感性高于涂片（P < 0.005）和单层制片（P < 0.0001）。这种敏感性的提高在肉芽肿（结节病）中显著，但在癌中不显著。
支气管内超声引导下经支气管针吸活检术是一种准确且敏感的技术。与涂片相比，样本的液基处理和石蜡包埋组织芯可提高诊断效能，尤其对于结节病的诊断。
