Bangpattanasiri Kittima, Sangsayunh Piamlarp, Panjapornpon Kanlaya, Wichitsanguan Chompunuch
Department of Pulmonary Medicine, Central Chest Institute of Thailand, Nonthaburi, Thailand.
J Med Assoc Thai. 2012 Aug;95 Suppl 8:S19-23.
To evaluate the efficacy of Endobronchial ultrasound guided-transbronchial needle aspiration (EBUS-TBNA) for biopsy specimens with adequate evaluable lymphocytes and mediastinal lymph node diagnosis.
Prospective cohort study. Over 18 year old patients with mediastinal or hilar lymphadenopathy, with short axis diameter greater than 10 mm on chest CT were indicated to undergo EBUS-TBNA. When a node was detected, an aspiration was performed under ultrasound guided. The primary end point was the percentage of biopsy specimen with adequate evaluable lymphocytes that had been evaluated by cytopathologist. Secondary endpoint was the percentage of EBUS-TBNA diagnosis result.
82 patients with mediastinal or hilar lymphadenopathy underwent EBUS-TBNA. Average size of lymph node was 1.57 x 1.49 cm. The overall of the diagnostic accuracy was a percentage of biopsy specimen with adequate evaluable lymphocytes as 97.7%. For mediastinal lymph node diagnosis, the cytological evaluation demonstrated that the positive for malignancy, atypical or suspicious for malignancy, negative for malignancy and non-diagnosis were 37.2%, 9.3%, 2.3% and 51.2%, respectively. In case of positive for malignancy, non-small cell carcinoma, adenocarcinoma, bronchoalveolar cell carcinoma and small cell carcinoma were found 62.5%, 15.6%, 3.1% and 18.8%, respectively. Additionally, the pathological examination showed that positive for malignancy, atypical or suspicious for malignancy, negative for malignancy and non-diagnosis were found 35.4%, 7.3%, 3.6% and 53.7%, respectively. There were no complications during all of the procedures.
High percentage of biopsy specimen with adequate evaluable lymphocytes can be obtained in EBUS-TBNA. This finding suggested that this method should be considered for mediastinal lymph node diagnosis.
评估支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）用于获取具有足够可评估淋巴细胞的活检标本及纵隔淋巴结诊断的疗效。
前瞻性队列研究。纳入年龄超过18岁、患有纵隔或肺门淋巴结肿大且胸部CT显示短轴直径大于10mm的患者，进行EBUS-TBNA。检测到淋巴结后，在超声引导下进行针吸。主要终点是经细胞病理学家评估的具有足够可评估淋巴细胞的活检标本的百分比。次要终点是EBUS-TBNA诊断结果的百分比。
82例纵隔或肺门淋巴结肿大患者接受了EBUS-TBNA。淋巴结平均大小为1.57×1.49cm。具有足够可评估淋巴细胞的活检标本的总体诊断准确率为97.7%。对于纵隔淋巴结诊断，细胞学评估显示恶性阳性、非典型或可疑恶性、恶性阴性及未诊断分别为37.2%、9.3%、2.3%和51.2%。在恶性阳性病例中，非小细胞癌、腺癌、细支气管肺泡癌和小细胞癌分别占62.5%、15.6%、3.1%和18.8%。此外，病理检查显示恶性阳性、非典型或可疑恶性、恶性阴性及未诊断分别为35.4%、7.3%、3.6%和53.7%。所有操作过程中均无并发症发生。
EBUS-TBNA可获得高比例具有足够可评估淋巴细胞的活检标本。这一发现提示该方法可用于纵隔淋巴结诊断。
