Johns Hopkins University, Baltimore, MD.
Johns Hopkins University, Baltimore, MD.
Chest. 2013 Apr;143(4):1036-1043. doi: 10.1378/chest.12-1205.
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure originally performed using a 22-gauge (22G) needle. A recently introduced 21-gauge (21G) needle may improve the diagnostic yield and sample adequacy of EBUS-TBNA, but prior smaller studies have shown conflicting results. To our knowledge, this is the largest study undertaken to date to determine whether the 21G needle adds diagnostic benefit.
We retrospectively evaluated the results of 1,299 patients from the American College of Chest Physicians Quality Improvement Registry, Education, and Evaluation (AQuIRE) Diagnostic Registry who underwent EBUS-TBNA between February 2009 and September 2010 at six centers throughout the United States. Data collection included patient demographics, sample adequacy, and diagnostic yield. Analysis consisted of univariate and multivariate hierarchical logistic regression comparing diagnostic yield and sample adequacy of EBUS-TBNA specimens by needle gauge.
A total of 1,235 patients met inclusion criteria. Sample adequacy was obtained in 94.9% of the 22G needle group and in 94.6% of the 21G needle group (P = .81). A diagnosis was made in 51.4% of the 22G and 51.3% of the 21G groups (P = .98). Multivariate hierarchical logistic regression showed no statistical difference in sample adequacy or diagnostic yield between the two groups. The presence of rapid onsite cytologic evaluation was associated with significantly fewer needle passes per procedure when using the 21G needle (P < .001).
There is no difference in specimen adequacy or diagnostic yield between the 21G and 22G needle groups. EBUS-TBNA in conjunction with rapid onsite cytologic evaluation and a 21G needle is associated with fewer needle passes compared with a 22G needle.
经支气管超声引导针吸活检术（EBUS-TBNA）是一种微创操作，最初使用 22 号（22G）针进行。最近引入的 21 号（21G）针可能会提高 EBUS-TBNA 的诊断率和样本充足度，但之前的较小研究结果存在矛盾。据我们所知，这是迄今为止规模最大的研究，旨在确定 21G 针是否具有诊断优势。
我们回顾性评估了美国胸科医师学会质量改进注册、教育和评估（AQuIRE）诊断注册中 1299 例患者的结果，这些患者于 2009 年 2 月至 2010 年 9 月在美国六个中心通过 EBUS-TBNA 进行治疗。数据收集包括患者人口统计学、样本充足度和诊断率。分析包括单变量和多变量分层逻辑回归，比较两种针规的 EBUS-TBNA 标本的诊断率和样本充足度。
共有 1235 例患者符合纳入标准。22G 针组的样本充足度为 94.9%，21G 针组为 94.6%（P=0.81）。22G 组和 21G 组的诊断率分别为 51.4%和 51.3%（P=0.98）。多变量分层逻辑回归显示两组间样本充足度或诊断率无统计学差异。快速现场细胞学评估的存在与使用 21G 针时每例操作的针数显著减少相关（P < 0.001）。
21G 针和 22G 针组的标本充足度或诊断率无差异。与 22G 针相比，EBUS-TBNA 联合快速现场细胞学评估和 21G 针与较少的针数相关。
