Gnass Maciej, Szlubowski Artur, Soja Jerzy, Kocoń Piotr, Rudnicka Lucyna, Ćmiel Adam, Sładek Krzysztof, Kużdżał Jarosław
Pol Arch Med Wewn. 2015;125(5):321-8. doi: 10.20452/pamw.2828. Epub 2015 Mar 20.
Endoscopic biopsy techniques are useful in the diagnosis of sarcoidosis. There is a need for randomized trials to establish where these procedures fit in the diagnosis of sarcoidosis.
The aim of the study was to compare the diagnostic yield of conventional transbronchial needle aspiration (TBNA) with endobronchial ultrasound-guided TBNA (EBUS-TBNA) and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in stages I and II of pulmonary sarcoidosis.
Patients suspected of sarcoidosis were randomized to undergo TBNA or EBUS-TBNA or EUS-FNA. Patients with negative TBNA and EBUS-TBNA results underwent EUS-FNA and those with negative EUS-FNA results—EBUS-TBNA. If both tests were negative, patients in stage I were scheduled for mediastinoscopy (MS) and those in stage II—for transbronchial lung biopsy (TBLB).
In 100 patients, 34 TBNA, 30 EBUS-TBNA, and 36 EUS-FNA procedures were performed at baseline. TBNA was positive in 20 patients (58.8%); EBUS-TBNA, in 23 (76.7%); and EUS-FNA, in 31 patients (86.1%). In patients with negative biopsy results, the second procedure was performed. The results of EUS-FNA were positive in 9 patients and of EBUS-TBNA—in none. Of 17 patients with negative results of both procedures, MS was performed in 6 patients and was positive in 2. In the remaining 11 patients, sarcoidosis was confirmed by TBLB. Sensitivity and accuracy of TBNA compared with EBUS-TBNA and EUS-FNA were 62.5% and 64.7%, 79.3% and 80%, and 88.6% and 88.9%, respectively. Sensitivity and accuracy of EBUS-TBNA were higher (P = 0.139) and of EUS-FNA were significantly higher compared with TBNA (P = 0.012).
In stages I and II of pulmonary sarcoidosis, endoscopic ultrasound is a reasonable approach but EUS-FNA seems to be the method of choice.
内镜活检技术在结节病的诊断中很有用。需要进行随机试验来确定这些检查方法在结节病诊断中的适用情况。
本研究旨在比较传统经支气管针吸活检术（TBNA）、支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）和内镜超声引导下细针穿刺活检术（EUS-FNA）在肺结节病Ⅰ期和Ⅱ期的诊断效能。
疑似结节病的患者被随机分配接受TBNA、EBUS-TBNA或EUS-FNA检查。TBNA和EBUS-TBNA结果为阴性的患者接受EUS-FNA检查，EUS-FNA结果为阴性的患者接受EBUS-TBNA检查。如果两项检查均为阴性，Ⅰ期患者安排进行纵隔镜检查（MS），Ⅱ期患者安排进行经支气管肺活检（TBLB）。
100例患者在基线时分别进行了34例TBNA、30例EBUS-TBNA和36例EUS-FNA检查。TBNA检查结果阳性的有20例患者（58.
8%）；EBUS-TBNA检查结果阳性的有23例（76.7%）；EUS-FNA检查结果阳性的有31例患者（86.1%）。活检结果为阴性的患者进行了第二项检查。EUS-FNA检查结果阳性的有9例患者，EBUS-TBNA检查结果均为阴性。两项检查结果均为阴性的17例患者中，6例患者进行了MS检查，其中2例结果为阳性。其余11例患者经TBLB确诊为结节病。与EBUS-TBNA和EUS-FNA相比，TBNA的敏感性和准确性分别为62.5%和64.7%、79.3%和80%、88.6%和88.9%。EBUS-TBNA的敏感性和准确性更高（P = 0.139），与TBNA相比，EUS-FNA的敏感性和准确性显著更高（P = 0.012）。
在肺结节病Ⅰ期和Ⅱ期，内镜超声是一种合理的检查方法，但EUS-FNA似乎是首选方法。
