Harrow E M, Oldenburg F A, Lingenfelter M S, Smith A M
Department of Medicine, Eastern Maine Medical Center, Bangor.
Chest. 1989 Dec;96(6):1268-72. doi: 10.1378/chest.96.6.1268.
We conducted a five-year review of our use of TBNA during bronchoscopy in our clinical practice. Out of 1,630 bronchoscopic procedures, 633 patients (39 percent) had TBNA performed as part of the initial examination. Mediastinal nodes were sampled in 86 percent of the patients who had TBNA performed, and 127 (23 percent) of 547 of these aspirates were positive. Other areas of mucosal abnormality of the tracheobronchial tree were also sampled by TBNA under direct vision and showed malignant cells in 44 (25 percent) of 176 aspirates. Of 363 patients first diagnosed as having carcinoma of the lung who had TBNA of N2 nodes, 41 (59 percent) of 70 with small-cell tumors were positive, as were 83 (28 percent) of 293 with non-small-cell malignant neoplasms. Comparison of cytologic results obtained by TBNA with histologic material in 109 cases showed an excellent correlation. In 31 cases (4 percent of all TBNA), the aspirate provided the sole means of establishing the diagnosis of cancer. Two patients were thought to have false-positive aspirates. No complications of therapeutic significance were encountered. We believe that TBNA is a safe and effective way to assess mediastinal lymphatic involvement in the staging of lung cancer and that TBNA can be safely performed as part of the initial bronchoscopic examination in patients suspected of having malignant neoplasms of the chest.
我们对临床实践中支气管镜检查时使用经支气管针吸活检术（TBNA）的情况进行了为期五年的回顾。在1630例支气管镜检查操作中，633例患者（39%）在初始检查时进行了TBNA。在接受TBNA的患者中，86%对纵隔淋巴结进行了采样，其中547份针吸样本中有127份（23%）呈阳性。气管支气管树黏膜异常的其他区域也在直视下通过TBNA进行了采样，176份针吸样本中有44份（25%）发现了恶性细胞。在363例首次诊断为肺癌且对N2淋巴结进行了TBNA的患者中，70例小细胞肿瘤患者中有41例（59%）呈阳性，293例非小细胞恶性肿瘤患者中有83例（28%）呈阳性。109例中TBNA获得的细胞学结果与组织学材料的比较显示出极好的相关性。在31例（占所有TBNA的4%）中，针吸样本是确立癌症诊断的唯一手段。有2例患者被认为出现了假阳性针吸结果。未遇到具有治疗意义的并发症。我们认为，TBNA是评估肺癌分期中纵隔淋巴结受累情况的一种安全有效的方法，并且在怀疑患有胸部恶性肿瘤的患者中，TBNA作为初始支气管镜检查的一部分可以安全地进行。
