Madan Karan, Dhungana Ashesh, Mohan Anant, Hadda Vijay, Jain Deepali, Arava Sudheer, Pandey Ravindra M, Khilnani Gopi C, Guleria Randeep
Departments of *Pulmonary Medicine and Sleep Disorders †Pathology ‡Biostatistics, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
J Bronchology Interv Pulmonol. 2017 Jan;24(1):48-58. doi: 10.1097/LBR.0000000000000339.
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) as a standalone modality is superior to conventional TBNA (c-TBNA) for the diagnosis of sarcoidosis. However, the overall yield is not different if combined with endobronchial biopsy (EBB) and transbronchial lung biopsy (TBLB). The utility of rapid on-site evaluation (ROSE) in a comparative evaluation of EBUS-TBNA versus c-TBNA for the diagnosis of sarcoidosis has not been previously evaluated.
Eighty patients with suspected sarcoidosis were randomized 1:1:1:1 into 4 groups: c-TBNA without ROSE (TBNA-NR), c-TBNA with ROSE (TBNA-R), EBUS-TBNA without ROSE (EBUS-NR), and EBUS-TBNA with ROSE (EBUS-R). EBB and TBLB were performed in all patients. Primary objective was detection of granulomas for combined procedure. Secondary objectives were individual procedure yields, sedation dose, and procedure duration. Patients without a diagnosis following c-TBNA subsequently underwent EBUS-TBNA.
A total of 74 patients were finally diagnosed with sarcoidosis. Overall, granuloma detection was not significantly different between the 4 groups (68% in TBNA-NR, 89% in TBNA-R, 84% in EBUS-NR, and 83% in EBUS-R groups, P=0.49). The yield of c-TBNA in the TBNA-NR group was lower compared with that in TBNA-R group and EBUS-TBNA in EBUS groups (32%, 72%, 68%, and 67% for TBNA-NR, TBNA-R, EBUS-NR, and EBUS-R groups, respectively, P=0.04). Additional 20% patients were diagnosed when EBUS-TBNA was performed following a nondiagnostic bronchoscopy procedure in the TBNA-NR group. Sedation requirement and procedure duration were significantly lower with c-TBNA as compared with EBUS-TBNA (P<0.001).
When performing TBNA in the setting of suspected sarcoidosis, we found c-TBNA with ROSE and EBUS-TBNA (with or without ROSE) to be superior to c-TBNA alone. Whether c-TBNA with ROSE is equivalent to EBUS-TBNA cannot be determined from our study due to small sample size/low power.
作为一种独立的检查手段，支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）在结节病的诊断方面优于传统经支气管针吸活检术（c-TBNA）。然而，若联合支气管内活检（EBB）和经支气管肺活检（TBLB），总体诊断率并无差异。此前尚未评估快速现场评估（ROSE）在比较EBUS-TBNA与c-TBNA诊断结节病中的作用。
80例疑似结节病患者按1:1:1:1随机分为4组：无ROSE的c-TBNA组（TBNA-NR）、有ROSE的c-TBNA组（TBNA-R）、无ROSE的EBUS-TBNA组（EBUS-NR）和有ROSE的EBUS-TBNA组（EBUS-R）。所有患者均接受EBB和TBLB。主要目标是联合检查中肉芽肿的检出情况。次要目标是各检查方法的诊断率、镇静剂量和操作时间。c-TBNA检查后未明确诊断的患者随后接受EBUS-TBNA检查。
共有74例患者最终被诊断为结节病。总体而言，4组之间肉芽肿检出率无显著差异（TBNA-NR组为68%，TBNA-R组为89%，EBUS-NR组为84%，EBUS-R组为83%，P = 0.49）。TBNA-NR组的c-TBNA诊断率低于TBNA-R组以及EBUS组中的EBUS-TBNA诊断率（TBNA-NR组、TBNA-R组、EBUS-NR组和EBUS-R组分别为32%、72%、68%和67%，P = 0.04）。在TBNA-NR组中，非诊断性支气管镜检查后进行EBUS-TBNA时，另有20%的患者得到诊断。与EBUS-TBNA相比，c-TBNA的镇静需求和操作时间显著更低（P < 0.001）。
在疑似结节病的情况下进行TBNA时，我们发现有ROSE的c-TBNA和EBUS-TBNA（有或无ROSE）均优于单独的c-TBNA。由于样本量小/检验效能低，我们的研究无法确定有ROSE的c-TBNA是否等同于EBUS-TBNA。
