Madan Karan, Mohan Anant, Ayub Irfan I, Jain Deepali, Hadda Vijay, Khilnani Gopi C, Guleria Randeep
Departments of *Pulmonary Medicine and Sleep Disorders †Pathology, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India.
J Bronchology Interv Pulmonol. 2014 Jul;21(3):208-14. doi: 10.1097/LBR.0000000000000080.
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a widely accepted minimally invasive procedure for the evaluation of mediastinal lymphadenopathy. Most of the published literature on EBUS-TBNA is focused on the diagnostic and staging aspects of lung cancer. Literature on the utility of this modality from developing countries and settings with a high prevalence of tuberculosis (TB) is limited. We herein describe our preliminary experience over 1 year on the utility of EBUS-TBNA from a tertiary care teaching center in North India.
The primary objective was to evaluate the utility of convex probe EBUS-TBNA as a modality for diagnosis in patients with mediastinal lymphadenopathy presenting to our center. EBUS-TBNA was performed under local anesthesia and conscious sedation in the bronchoscopy laboratory. Rapid on-site evaluation was available for most of the procedures. Patients were discharged the same day from the hospital.
A total of 102 patients with mean age of 42.1±14.2 years underwent EBUS-TBNA for a clinical indication of enlarged mediastinal lymph nodes, between September 2012 and September 2013.There were 63 males (61.8%) and 39 females (38.2%). EBUS-TBNA was performed for staging lung cancer in 5 patients.A total of 216 lymph node stations were sampled in 102 patients. Rapid on-site evaluation was performed in 95 patients (93.1%). Adequate/representative samples could be obtained in 98 of 102 patients (96.1%). Overall, EBUS-TBNA was diagnostic in 76 patients (74.5%). EBUS-TBNA was diagnostic in 80.9%, 84.8%, and 75% of patients with sarcoidosis, TB, and lung cancer, respectively. Sensitivity, specificity, positive predictive value, and negative predictive value of EBUS-TBNA were 81.7%, 100%, 100%, and 22.73%, respectively.
EBUS-TBNA is a safe and efficacious procedure for obtaining tissue diagnosis in patients with mediastinal lymph node enlargement. The yield of EBUS-TBNA in diagnosis of mediastinal lymph node enlargement due to TB is especially high.
超声支气管镜引导下经支气管针吸活检术（EBUS-TBNA）是一种广泛应用于评估纵隔淋巴结肿大的微创检查方法。已发表的关于EBUS-TBNA的大部分文献都集中在肺癌的诊断和分期方面。来自发展中国家以及结核病（TB）高流行地区关于该方法实用性的文献有限。在此，我们描述了印度北部一家三级医疗教学中心在1年多时间里使用EBUS-TBNA的初步经验。
主要目的是评估凸阵探头EBUS-TBNA作为诊断手段在我院纵隔淋巴结肿大患者中的实用性。EBUS-TBNA在支气管镜检查实验室局部麻醉和清醒镇静下进行。大多数操作可进行快速现场评估。患者于同日出院。
2012年9月至2013年9月期间，共有102例平均年龄为42.1±14.2岁的患者因纵隔淋巴结肿大的临床指征接受了EBUS-TBNA检查。其中男性63例（61.8%），女性39例（38.2%）。5例患者因肺癌分期进行了EBUS-TBNA检查。102例患者共取样216个淋巴结站。95例患者（93.1%）进行了快速现场评估。102例患者中有98例（96.1%）获得了足够/有代表性的样本。总体而言，EBUS-TBNA对76例患者（74.5%）具有诊断价值。EBUS-TBNA对结节病、结核病和肺癌患者的诊断率分别为80.9%、84.8%和75%。EBUS-TBNA的敏感性、特异性、阳性预测值和阴性预测值分别为81.7%、100%、100%和22.73%。
EBUS-TBNA是一种安全有效的获取纵隔淋巴结肿大患者组织诊断的方法。EBUS-TBNA对因结核病导致的纵隔淋巴结肿大的诊断率尤其高。
