Wagner E D, Ramzy I, Greenberg S D, Gonzalez J M
Department of Pathology, Baylor College of Medicine, Houston, Texas 77030.
Am J Clin Pathol. 1989 Jul;92(1):36-41. doi: 10.1093/ajcp/92.1.36.
Transbronchial needle aspiration is a new method of sampling pulmonary, paratracheal, and mediastinal masses. A total of 116 aspirations of the lung performed during a two-and-a-half-year period were reviewed. The results were compared with those of bronchial wash, bronchial brush, sputum, transbronchial forceps biopsy, and histologic material subsequently obtained during surgery or at autopsy. Clinical information was also reviewed. Transbronchial needle aspiration was performed on 104 patients, yielding 116 specimens. With the use of a combination of aspiration, wash, brush, sputum, and forceps biopsy, malignancy was detected in 48 patients. Open biopsy, mediastinoscopy, and transcutaneous needle aspiration increased the number of malignant neoplasms detected to 72. The tumors were detected in 67% of these 72 cases by a combination of all bronchoscopic methods. Transbronchial aspiration correctly identified 36% of malignant cases compared with 35% identified by wash, 39% by brush, 25% by sputum, and 59% by forceps biopsy. The overall accuracy of the techniques was 56% for aspiration, 48% for wash, 56% for brush, 35% for sputum, and 71% for forceps biopsy. Malignant cases were associated with cellular transbronchial aspirates, good preservation of cell detail, and a high degree of cytologic/histologic correlation regarding cell type. Transbronchial fine-needle aspiration has the potential for improving the diagnostic ability of bronchoscopy. However, the high incidence of false negative diagnoses is the main limitation for the technique, and the responsible factors are discussed.
经支气管针吸活检术是一种对肺部、气管旁及纵隔肿块进行取样的新方法。回顾了在两年半时间内进行的116例肺部针吸活检病例。将结果与支气管冲洗、支气管刷检、痰液检查、经支气管钳取活检以及随后手术或尸检时获得的组织学材料的结果进行了比较。还回顾了临床信息。对104例患者进行了经支气管针吸活检，获取了116份标本。通过联合使用针吸活检、冲洗、刷检、痰液检查和钳取活检，在48例患者中检测到恶性肿瘤。开放性活检、纵隔镜检查和经皮针吸活检使检测到的恶性肿瘤数量增加到72例。在这72例病例中，67%的肿瘤是通过所有支气管镜检查方法联合检测到的。经支气管针吸活检正确识别了36%的恶性病例，相比之下，支气管冲洗为35%，支气管刷检为39%，痰液检查为25%，钳取活检为59%。这些技术的总体准确率分别为：针吸活检56%，冲洗48%，刷检56%，痰液检查35%，钳取活检71%。恶性病例与经支气管针吸获得的细胞样本、细胞细节的良好保存以及细胞类型方面高度的细胞学/组织学相关性有关。经支气管细针吸活检有提高支气管镜诊断能力的潜力。然而，假阴性诊断的高发生率是该技术的主要局限性，并对相关因素进行了讨论。
