Sánchez-Cabral Olivia, Martínez-Mendoza Dina, Fernandez-Bussy Sebastian, Aspuru-García Esmeralda, Rivera-Rosales Rosa, Luna-Rivero César, Martínez-Orozco José Arturo, Reyes-Terán Gustavo
Unidad de Neumología Intervencionista, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico.
Respiration. 2017;93(6):424-429. doi: 10.1159/000465527. Epub 2017 Mar 30.
There are few published studies about the usefulness of endobronchial ultrasound (EBUS) in patients infected with human immunodeficiency virus (HIV). The clinical spectrum of likely diseases in this population is varied and differs from patients not infected with HIV.
The aim of this study was to measure the usefulness of EBUS-guided transbronchial needle aspiration (EBUS-TBNA) in HIV-infected patients with mediastinal lymphadenopathy.
We conducted an observational, cross-sectional, retrospective, descriptive study on patients with HIV infection and mediastinal lymphadenopathy who underwent EBUS-TBNA between September 2014 and April 2016. The patients' final diagnosis, regardless of the sample from which it was obtained, was considered the positive gold standard, and the absence of diagnosis was the negative. The study measured diagnostic accuracy of bronchoalveolar lavage (BAL), transbronchial biopsy (TBB), and EBUS-TBNA.
A total of 43 procedures were performed; 79.1% (34/43) of the patients were male, and the median age was 35 years (range, 22-66). The overall diagnostic yield including all types of samples was 90.7% (39/43); the yield of BAL was 50% (21), that of TBB 61.9% (26), and that of EBUS-TBNA was 60.5% (26). The combined yield of BAL with TBB was 69.8% (30); the yield of BAL with EBUS-TBNA was 86% (37) and that of TBB with EBUS-TBNA was 88.4% (38). The highest diagnostic accuracy was 97.7% for the combination of TBB and EBUS-TBNA.
The most common infectious diagnoses were tuberculosis, with a higher diagnostic accuracy using EBUS-TBNA than BAL. With malignancies, both EBUS-TBNA and TBB were useful. EBUS-TBNA is a minimally invasive diagnostic tool that should be considered in these patients.
关于支气管内超声（EBUS）在感染人类免疫缺陷病毒（HIV）患者中的应用的已发表研究较少。该人群中可能疾病的临床谱各不相同，与未感染HIV的患者不同。
本研究的目的是评估EBUS引导下经支气管针吸活检（EBUS-TBNA）在HIV感染且有纵隔淋巴结肿大患者中的应用价值。
我们对2014年9月至2016年4月期间接受EBUS-TBNA的HIV感染且有纵隔淋巴结肿大的患者进行了一项观察性、横断面、回顾性、描述性研究。患者的最终诊断，无论其来自何种样本，均被视为阳性金标准，未明确诊断则为阴性。本研究测量了支气管肺泡灌洗（BAL）、经支气管活检（TBB）和EBUS-TBNA的诊断准确性。
共进行了43例操作；79.1%（34/43）的患者为男性，中位年龄为35岁（范围22-66岁）。包括所有类型样本的总体诊断率为90.7%（39/43）；BAL的诊断率为50%（21例），TBB为61.9%（26例），EBUS-TBNA为60.5%（26例）。BAL与TBB联合的诊断率为69.8%（30例）；BAL与EBUS-TBNA联合的诊断率为86%（37例），TBB与EBUS-TBNA联合的诊断率为88.4%（38例）。TBB与EBUS-TBNA联合的诊断准确性最高，为97.7%。
最常见的感染性诊断为结核病，EBUS-TBNA诊断准确性高于BAL。对于恶性肿瘤，EBUS-TBNA和TBB均有用。EBUS-TBNA是一种微创诊断工具，应在这些患者中予以考虑。
