Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
Lung. 2013 Aug;191(4):435-40. doi: 10.1007/s00408-013-9480-6. Epub 2013 Jun 1.
Data regarding the effect of aspiration pressure over endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) on the diagnosis of intrathoracic lymphadenopathies is limited. The aim of this study was to compare the effect of three levels of aspiration pressure over EBUS-TBNA on the diagnostic yield and numbers of diagnostic cells.
A prospective study was conducted on 66 patients with enlarged intrathoracic lymph nodes. Three levels of aspiration pressure (0, 20, and 40 mL) were applied after the needle pierced the target and the needle's position was confirmed by EBUS images. The diagnostic yield and the numbers of diagnostic cells attained with each pressure from the same target were compared. The cellularity of the obtained diagnostic cells was classified into four grades (inadequate, minimal, moderate, and numerous) by a cytopathologist in a blinded study.
The mean nodal size was 19.1 ± 6.2 mm. The final diagnoses included 53 malignant and 13 benign lymphadenopathies. Adequate lymph node samples were obtained in 63 patients (95.5%), and EBUS-TBNA revealed definite diagnosis for 58 patients (87.9%). Negative pressure of 40 mL provided a diagnostic yield similar to that of 20 mL (83.3 vs. 75.8%; p = 0.23), but both showed higher diagnostic yields than zero pressure. In terms of cellularity of the specimen, however, high negative pressure (40 mL) gave higher numbers of adequate cells than the comparators (p < 0.001).
Negative pressure should be applied in an EBUS-TBNA procedure. Although the diagnostic yield was not different, high negative pressure was superior to low negative pressure in obtaining numbers of adequate cells.
关于支气管内超声引导经支气管针吸活检术（EBUS-TBNA）过程中抽吸压力对胸腔内淋巴结疾病诊断的影响的数据有限。本研究旨在比较三种不同抽吸压力水平（0、20 和 40 mL）对诊断率和诊断细胞数量的影响。
对 66 例胸腔内淋巴结肿大的患者进行前瞻性研究。在针穿过目标并通过 EBUS 图像确认针的位置后，应用三种不同的抽吸压力水平（0、20 和 40 mL）。比较从同一目标获得的每种压力下的诊断率和诊断细胞数量。细胞病理学家对获得的诊断细胞的细胞结构进行了分类（不充分、最小、中等和丰富）。
平均淋巴结大小为 19.1 ± 6.2 mm。最终诊断包括 53 例恶性和 13 例良性淋巴结疾病。63 例患者（95.5%）获得了足够的淋巴结样本，58 例（87.9%）通过 EBUS-TBNA 明确了诊断。40 mL 的负压力提供的诊断率与 20 mL 相似（83.3% vs. 75.8%；p = 0.23），但两者均高于零压力。然而，就标本的细胞结构而言，高负压力（40 mL）比对照（p < 0.001）获得更多的足够细胞数。
在 EBUS-TBNA 操作中应施加负压力。虽然诊断率没有差异，但高负压力在获得足够细胞数量方面优于低负压力。
