纵隔肉芽肿性淋巴结病：内镜超声引导下细针抽吸能否区分结核和结节病？

Granulomatous mediastinal adenopathy: can endoscopic ultrasound-guided fine-needle aspiration differentiate between tuberculosis and sarcoidosis?

机构信息

Homerton University Hospital NHS Foundation Trust, London UK.

出版信息

Endoscopy. 2011 Nov;43(11):955-61. doi: 10.1055/s-0031-1271110. Epub 2011 Aug 10.

DOI:10.1055/s-0031-1271110

PMID:21833904

Abstract

BACKGROUND AND STUDY AIMS

Mediastinal lymphadenopathy may indicate diseases such as tuberculosis or sarcoidosis, and it is often difficult to establish a diagnosis when standard medical work-up is inconclusive. In this study we investigated the diagnostic yield of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in the differentiation between tuberculosis and sarcoidosis.

PATIENTS AND METHODS

In this prospective study, 72 consecutive patients with mediastinal lymphadenopathy, negative endoscopic investigations including bronchoscopic procedures, and no radiological evidence of lung cancer or other malignancies on computed tomography were enrolled. EUS-FNA and subsequent cytology, microscopy for acid-fast bacilli, and culture were performed. At least 12 months' follow-up including further investigations was included to exclude tuberculosis.

RESULTS

Adequate samples were obtained from 71/72 patients (36 male; mean age 50.2 years). No complications occurred. The final diagnosis included 30 cases of sarcoidosis, 28 of tuberculosis, four malignancies, one abscess, and nine benign lymphadenopathies. The size of lymph nodes on EUS varied from 0.5 cm to 4.2 cm. Tuberculosis nodes were significantly smaller than those in sarcoidosis. Unrelated nodes were significantly smaller than in either tuberculosis or sarcoidosis. The sensitivity, specificity, and positive and negative predictive values of EUS - FNA for tuberculosis were 86 %, 100 %, 100 %, and 91 %, respectively; those for sarcoidosis were 100 %, 93 %, 91 %, and 100 %, respectively. For culture of tuberculosis, they were 71 %, 100 %, 100 %, and 84 %, respectively. EUS - FNA led to a definite diagnosis in 64/72 cases (89 %) that had not been previously diagnosed by routine methods.

CONCLUSION

EUS - FNA offers a high diagnostic yield for the differential diagnosis of tuberculosis and sarcoidosis that have not been diagnosed by conventional methods.

摘要

背景与研究目的

纵隔淋巴结病可能表明患有结核病或结节病等疾病，当标准的医学检查结果不确定时，通常难以做出诊断。本研究旨在探讨超声内镜引导下细针抽吸活检（EUS-FNA）在区分结核病和结节病方面的诊断效果。

患者与方法

本前瞻性研究纳入了 72 例纵隔淋巴结病患者，这些患者内镜检查（包括支气管镜检查）均为阴性，且计算机断层扫描无肺癌或其他恶性肿瘤的影像学证据。对所有患者均进行了 EUS-FNA 检查，并进行了细胞学检查、抗酸杆菌显微镜检查和培养。至少进行了 12 个月的随访，包括进一步的检查，以排除结核病。

结果

72 例患者中有 71 例（36 例为男性；平均年龄为 50.2 岁）获得了足够的样本。未发生任何并发症。最终诊断包括 30 例结节病、28 例结核病、4 例恶性肿瘤、1 例脓肿和 9 例良性淋巴结病。EUS 显示淋巴结的大小从 0.5 厘米到 4.2 厘米不等。结核病的淋巴结明显小于结节病。无关淋巴结明显小于结核病或结节病。EUS-FNA 对结核病的敏感性、特异性、阳性预测值和阴性预测值分别为 86%、100%、100%和 91%；对结节病的敏感性、特异性、阳性预测值和阴性预测值分别为 100%、93%、91%和 100%。EUS-FNA 对结核病的培养的敏感性、特异性、阳性预测值和阴性预测值分别为 71%、100%、100%和 84%。EUS-FNA 通过常规方法无法诊断的 72 例患者中的 64 例（89%）得出了明确的诊断。