Majori Maria, Anghinolfi Miriam, Scarascia Alessandro, Nizzoli Rita, Casalini Angelo Gianni
1 Pulmonology Unit and Thoracic Endoscopy, 2 Respiratory Disease Unit, 3 Medical Oncology Unit, University Hospital of Parma, Parma, Italy.
J Thorac Dis. 2015 Apr;7(4):758-63. doi: 10.3978/j.issn.2072-1439.2015.04.26.
Conventional transbronchial needle aspiration (cTBNA) is a safe and minimally invasive procedure with a high yield for the diagnosis of large lymph nodes (LNs) in favourable locations (LNs >1.5 cm in stations #4R and/or #7). However, it is usually underutilized by pulmonologist. One of the main reasons given for not performing cTBNA is the risk of puncturing vascular structures of the mediastinum. Recently, with the twofold objective of minimize the risk of bleeding and reduce the cTBNA cost, a thinner and less expensive needle has been commercialized. It is a 23 gauge (G) needle that costs 34, 37 €. The aim of our study was to analyze the sample adequacy, diagnostic accuracy and safety of this needle in comparison with 21 and 22 G needles (average cost: 6,400 €).
We retrospectively analysed medical records from patients who underwent bronchoscopy with cTBNA for the diagnosis of LNs >1.5 cm in stations #4R and/or #7 at the Thoracic Endoscopy Unit of the University Hospital of Parma from January 1st, 2007 to October 31(st), 2011. Five hundred patients underwent cTBNA from January 1(st), 2007 to October 31(st), 2011. In order to reduce the technical and personal bias for sampling procedure we analyzed only cases sampled by a single well-trained bronchoscopist, particularly skilful at cTBNA.
A total of 222 patients (186 men; mean age 63 years±12, range 6-89) with LNs >1.5 cm in stations #4R and/or #7 were identified. A 23 G needle was used in 84 patients (38%), a 21 G needle in 88 patients (40%) and a 22 G needle in 50 patients (22%). No statistically significant differences between the 23 G group and the 21 or 22 G group in sample adequacy (P=0.78 and P=0.12, respectively) and diagnostic accuracy (P=0.9 and P=0.4, respectively) were found. There were no intraprocedural or postprocedural complications irrespective of the size of needle used.
Transbronchial 23 G needle is as safe and effective as the 21 and 22 G needle for the sampling of LNs >1.5 cm in stations #4R and/or #7. For this reason, to obtain cytology specimens from large LNs in favourable locations, the 23 G needle may represent an alternative and less expensive choice compared to 21 and 22 G needles, even if our observation needs to be confirmed in a larger prospective study.
传统经支气管针吸活检术（cTBNA）是一种安全且微创的检查方法，对于诊断位于有利部位（4R区和/或7区直径>1.5 cm的淋巴结）的大淋巴结具有较高的阳性率。然而，肺科医生通常较少使用该技术。不进行cTBNA的主要原因之一是存在穿刺纵隔血管结构的风险。最近，为了将出血风险降至最低并降低cTBNA的成本，一种更细且更便宜的针已投入市场。这是一种23号（G）针，价格为34或37欧元。我们研究的目的是将这种针与21G和22G针（平均成本：6400欧元）进行比较，分析其样本充足率、诊断准确性和安全性。
我们回顾性分析了2007年1月1日至2011年10月31日在帕尔马大学医院胸内镜科接受支气管镜检查及cTBNA以诊断4R区和/或7区直径>1.5 cm淋巴结的患者的病历。2007年1月1日至2011年10月31日期间，共有500例患者接受了cTBNA。为了减少采样过程中的技术和个人偏差，我们仅分析了由一名训练有素、尤其擅长cTBNA的支气管镜医师采集样本的病例。
共确定了222例患者（186例男性；平均年龄63岁±12岁，范围6 - 89岁），其4R区和/或7区的淋巴结直径>1.5 cm。84例患者（38%）使用了23G针，88例患者（40%）使用了21G针，50例患者（22%）使用了22G针。23G组与21G或22G组在样本充足率（分别为P = 0.78和P = 0.12）和诊断准确性（分别为P = 0.9和P = 0.4）方面均未发现统计学上的显著差异。无论使用何种尺寸的针，均未出现术中或术后并发症。
对于4R区和/或7区直径>1.5 cm的淋巴结采样，23G经支气管针与21G和22G针一样安全有效。因此，为了从位于有利部位的大淋巴结获取细胞学标本，与21G和22G针相比，23G针可能是一种更经济的选择，尽管我们的观察结果需要在更大规模的前瞻性研究中得到证实。
