使用21G超声支气管镜引导针吸活检针进行纵隔淋巴结粗针活检组织学及细胞学采样的诊断价值

Diagnostic value of core biopsy histology and cytology sampling of mediastinal lymph nodes using 21-gauge EBUS-TBNA needle.

作者信息

Vaidya Preyas J, Saha Avinandan, Kate Arvind H, Pandey Kamlesh, Chavhan Vinod B, Leuppi Joerg D, Chhajed Prashant N

机构信息

Institute of Pulmonology, Medical Research and Development, Mumbai; Lung Care and Sleep Centre, Fortis Hiranandani Hospital, Navi Mumbai, Maharashtra, India.

Institute of Pulmonology, Medical Research and Development, Mumbai, Maharashtra, India.

出版信息

J Cancer Res Ther. 2016 Jul-Sep;12(3):1172-1177. doi: 10.4103/0973-1482.197535.

DOI:10.4103/0973-1482.197535

PMID:28054531

Abstract

INTRODUCTION

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the initial modality of choice in sampling mediastinal lymphadenopathy. It is possible to obtain both cytological and histological samples using both 21-gauge and 22-gauge EBUS-TBNA needles. The current study was undertaken to compare the diagnostic yield of cytology and histology samples obtained by the same EBUS-TBNA 21-gauge needle.

PATIENTS AND METHODS

One hundred sixty-six consecutive patients who underwent EBUS-TBNA with a 21-gauge EBUS-TBNA needle over a period of 3 years were included in this retrospective analysis. The diagnostic yields of EBUS-TBNA histology (EBUS-TBNA-H) and EBUS-TBNA cytology (EBUS-TBNA-C) specimens were compared using the McNemar test.

RESULTS

The overall sensitivity and specificity of EBUS-TBNA were 89% and 100%, respectively. The positive predictive value (PPV) and negative predictive value (NPV) of EBUS-TBNA were 100% and 53%, respectively. The overall sensitivity and specificity of EBUS-TBNA-H were 85% and 100%, respectively. The PPV and NPV of EBUS-TBNA-H were 100% and 43%, respectively. The overall sensitivity and specificity of EBUS-TBNA-C were 65% and 100%, respectively. The PPV and NPV of EBUS-TBNA-C were 100% and 14%, respectively. The diagnostic yield of EBUS-TBNA-H over EBUS-TBNA-C was statistically significant (P < 0.0001).

CONCLUSION

EBUS-TBNA-H with 21-gauge needle significantly improves the diagnostic yield of EBUS-TBNA. EBUS-TBNA-H improves the NPV of EBUS-TBNA. The combination of EBUS-TBNA-H and EBUS-TBNA-C improves the overall diagnostic yield of EBUS-TBNA.

摘要

引言

支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）是纵隔淋巴结病变采样的首选初始方法。使用21号和22号EBUS-TBNA针均可获取细胞学和组织学样本。本研究旨在比较同一21号EBUS-TBNA针获取的细胞学和组织学样本的诊断率。

患者与方法

本回顾性分析纳入了在3年期间接受21号EBUS-TBNA针EBUS-TBNA检查的166例连续患者。使用McNemar检验比较EBUS-TBNA组织学（EBUS-TBNA-H）和EBUS-TBNA细胞学（EBUS-TBNA-C）标本的诊断率。

结果

EBUS-TBNA的总体敏感性和特异性分别为89%和100%。EBUS-TBNA的阳性预测值（PPV）和阴性预测值（NPV）分别为100%和53%。EBUS-TBNA-H的总体敏感性和特异性分别为85%和100%。EBUS-TBNA-H的PPV和NPV分别为100%和43%。EBUS-TBNA-C的总体敏感性和特异性分别为65%和100%。EBUS-TBNA-C的PPV和NPV分别为100%和14%。EBUS-TBNA-H的诊断率高于EBUS-TBNA-C，差异有统计学意义（P < 0.0001）。