van der Heijden Erik H F M, Casal Roberto F, Trisolini Rocco, Steinfort Daniel P, Hwangbo Bin, Nakajima Takahiro, Guldhammer-Skov Birgit, Rossi Giulio, Ferretti Maurizio, Herth Felix F J, Yung Rex, Krasnik Mark
Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.
Respiration. 2014;88(6):500-17. doi: 10.1159/000368857. Epub 2014 Nov 5.
Conventional transbronchial needle aspiration (TBNA) and endobronchial ultrasound (EBUS)-TBNA are widely accepted tools for the diagnosis and staging of lung cancer and the initial procedure of choice for staging. Obtaining adequate specimens is key to provide a specific histologic and molecular diagnosis of lung cancer.
To develop practice guidelines on the acquisition and preparation of conventional TBNA and EBUS-TBNA specimens for the diagnosis and molecular testing of (suspected) lung cancer. We hope to improve the global unification of procedure standards, maximize the yield and identify areas for research.
Systematic electronic database searches were conducted to identify relevant studies for inclusion in the guideline [PubMed and the Cochrane Library (including the Cochrane Database of Systematic Reviews)].
The number of needle aspirations with both conventional TBNA and EBUS-TBNA was found to impact the diagnostic yield, with at least 3 passes needed for optimal performance. Neither needle gauge nor the use of miniforceps, the use of suction or the type of sedation/anesthesia has been found to improve the diagnostic yield for lung cancer. The use of rapid on-site cytology examination does not increase the diagnostic yield. Molecular analysis (i.e. EGFR, KRAS and ALK) can be routinely performed on the majority of cytological samples obtained by EBUS-TBNA and conventional TBNA. There does not appear to be a superior method for specimen preparation (i.e. slide staining, cell blocks or core tissue). It is likely that optimal specimen preparation may vary between institutions depending on the expertise of pathology colleagues.
传统经支气管针吸活检术（TBNA）和支气管内超声引导针吸活检术（EBUS-TBNA）是广泛认可的用于肺癌诊断和分期的工具，也是分期的首选初始程序。获取足够的标本是对肺癌进行特异性组织学和分子诊断的关键。
制定关于传统TBNA和EBUS-TBNA标本采集与制备的实践指南，用于（疑似）肺癌的诊断和分子检测。我们希望提高程序标准的全球统一性，最大化标本获取量并确定研究领域。
进行系统的电子数据库检索，以确定纳入指南的相关研究[PubMed和Cochrane图书馆（包括Cochrane系统评价数据库）]。
发现传统TBNA和EBUS-TBNA的针吸次数会影响诊断成功率，最佳操作至少需要3次穿刺。未发现针的规格、使用微型镊子、使用抽吸或镇静/麻醉类型能提高肺癌的诊断成功率。使用快速现场细胞学检查不会提高诊断成功率。分子分析（即EGFR、KRAS和ALK）可常规用于通过EBUS-TBNA和传统TBNA获得的大多数细胞学样本。似乎没有一种标本制备的优越方法（即玻片染色、细胞块或核心组织）。最佳标本制备可能因机构而异，取决于病理科同事的专业知识。
