Gahlot Tanushree, Parakh Ujjwal, Verma Kusum, Bhalotra Bobby, Jain Neeraj
Department of Pulmonary Medicine, Lady Hardinge Medical College and Smt. SK Hospital, New Delhi, India.
Department of Pulmonary Medicine, Sir Ganga Ram Hospital, New Delhi, India.
Lung India. 2017 May-Jun;34(3):241-246. doi: 10.4103/0970-2113.205339.
The diagnosis of mediastinal lymphadenopathy is always a challenge. There always a need of a technique that is highly accurate as well as safe for diagnosis the same.
The aim of the study is to assess the clinical usefulness and safety profile of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in diagnosing the patients with mediastinal lymphadenopathy.
This was an observational prospective study.
One hundred adult patients with mediastinal lymphadenopathy who underwent EBUS-TBNA with aspirate obtained from the most hypoechoic lymph node (with a 22 gauge needle) and its cytopathological analysis were included in the study. Patients were observed for postprocedure complications.
Out of 100, 92 cases were reported as adequate (diagnostic yield = 92%). Among these 92, there were 71 granulomatous lymphadenitis (tuberculosis [TB] = 41 [44.5%], sarcoid-like granuloma = 30 [32.2%]). Malignancy was reported in 16 (17.3%) patients, and 5 (5.43%) were reported to have reactive lymphadenopathy. There was one case each of Mycobacterium avium complex and Mycobacterium abscessus. Out of 16 cases of malignancy, six cases were adenocarcinoma, four cases of squamous cell carcinoma, and two cases of small cell carcinoma. There were three cases of Hodgkin's lymphoma and one case of non-Hodgkin's lymphoma. No major complications were noted, except fever (26), nausea (20), mild bleeding (4), bronchospasm (3), and transient intraprocedural hypoxia (2).
EBUS-TBNA is highly accurate (diagnostic yield 92%) and safe procedure for diagnosing mediastinal lymphadenopathy. In our experience, granulomatous lymphadenitis was most common with TB as the main etiology.
纵隔淋巴结肿大的诊断始终是一项挑战。一直需要一种对其诊断既高度准确又安全的技术。
本研究的目的是评估支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）在诊断纵隔淋巴结肿大患者中的临床实用性和安全性。
这是一项观察性前瞻性研究。
100例成年纵隔淋巴结肿大患者接受了EBUS-TBNA，从最具低回声的淋巴结（使用22号针）获取抽吸物并进行细胞病理学分析，纳入本研究。观察患者术后并发症情况。
100例患者中，92例报告取材充足（诊断率 = 92%）。在这92例中，有71例为肉芽肿性淋巴结炎（结核病[TB] = 41例[44.5%]，类肉瘤样肉芽肿 = 30例[32.2%]）。16例（17.3%）患者报告为恶性肿瘤，5例（5.43%）报告为反应性淋巴结病。各有1例鸟分枝杆菌复合体和脓肿分枝杆菌感染。在16例恶性肿瘤病例中，6例为腺癌，4例为鳞状细胞癌，2例为小细胞癌。有3例霍奇金淋巴瘤和1例非霍奇金淋巴瘤。除发热（26例）、恶心（20例）、轻度出血（4例）、支气管痉挛（3例）和术中短暂缺氧（2例）外未观察到重大并发症。
EBUS-TBNA是诊断纵隔淋巴结肿大的高度准确（诊断率92%）且安全的方法。根据我们的经验，肉芽肿性淋巴结炎最常见，主要病因是结核病。
