Wang Lei, Wu Weihua, Teng Jiajun, Zhong Runbo, Han Baohui, Sun Jiayuan
Department of Ultrasound, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
Ultrasound Med Biol. 2016 Dec;42(12):2785-2793. doi: 10.1016/j.ultrasmedbio.2016.07.019. Epub 2016 Sep 7.
Endobronchial ultrasound (EBUS) features have been found to be a useful tool in differentiating malignant from benign lymph nodes, but the use of these features to distinguish benign intrathoracic lymphadenopathies, including tuberculosis, sarcoidosis and reactive lymphadenitis, has not been established. The goal of this study was to evaluate the use of EBUS features in predicting tuberculosis, sarcoidosis, and non-specific inflammation. One hundred eighty-eight patients with suspected benign lymphadenopathy were included in the study. The EBUS features studied were short axis, shape, calcification, central hilar structure, necrosis sign, margins, echogenicity, clustered formation and vascular patterns. The sonographic findings were confirmed by clinicopathologic results. EBUS-Guided transbronchial needle aspiration was performed on 452 lymph nodes. Thirty-seven tuberculous nodes, 193 sarcoid nodes and 150 reactive nodes were retrospectively analyzed. Excluded were 72 nodes. Multivariate analysis revealed that presence of the necrosis sign and absence of the clustered formation are independent factors predictive of tuberculous nodes. Short axis >1 cm, absence of central hilar structure, distinct margins, presence of clustered formation and non-hilar perfusion were predictive of sarcoid nodes. Presence of central hilar structure, absence of clustered formation and vascular pattern (hilar perfusion or avascularity) were predictive of reactive lymphadenitis. The sum score model of these combined predictive factors indicated that the best diagnostic accuracies for predicting tuberculous nodes, sarcoid nodes and reactive lymphadenitis were 77.1%, 89.2% and 87.1%, respectively. Sonographic features could be helpful in differentiating the type of benign intrathoracic lymphadenopathy during EBUS examination.
支气管内超声（EBUS）特征已被证明是区分恶性与良性淋巴结的有用工具，但利用这些特征来鉴别包括结核病、结节病和反应性淋巴结炎在内的良性胸内淋巴结病，尚未得到证实。本研究的目的是评估EBUS特征在预测结核病、结节病和非特异性炎症方面的应用。188例疑似良性淋巴结病患者纳入本研究。所研究的EBUS特征包括短轴、形状、钙化、中央肺门结构、坏死征、边缘、回声性、簇状形成和血管模式。超声检查结果经临床病理结果证实。对452个淋巴结进行了EBUS引导下经支气管针吸活检。对37个结核性淋巴结、193个结节病性淋巴结和150个反应性淋巴结进行了回顾性分析。排除72个淋巴结。多因素分析显示，坏死征的存在和簇状形成的缺失是结核性淋巴结的独立预测因素。短轴>1 cm、中央肺门结构缺失、边缘清晰、簇状形成的存在和非肺门灌注是结节病性淋巴结的预测因素。中央肺门结构的存在、簇状形成的缺失和血管模式（肺门灌注或无血管）是反应性淋巴结炎的预测因素。这些联合预测因素的总分模型表明，预测结核性淋巴结、结节病性淋巴结和反应性淋巴结炎的最佳诊断准确率分别为77.1%、89.2%和87.1%。超声特征有助于在EBUS检查期间鉴别良性胸内淋巴结病的类型。
