Gandotra Sheetal, Dotson Travis, Lamar Zanetta, Bellinger Christina
Department of Pulmonary/Critical Care Medicine.
Department of Hematology and Oncology, Wake Forest Baptist Health, Winston Salem, NC.
J Bronchology Interv Pulmonol. 2018 Apr;25(2):97-102. doi: 10.1097/LBR.0000000000000449.
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) presents a minimally invasive way to evaluate abnormal mediastinal and hilar adenopathy. Although EBUS has been established as an effective modality to diagnose lung cancer, its sensitivity for the diagnosis of lymphoma has been demonstrated to be lower. Because of these lower yields uncertainty persists about the ability of EBUS-TBNA to reliably diagnose lymphoma and questions remain regarding the utility of EBUS-TBNA as a first-line biopsy modality for patients suspected of having lymphoma.
We conducted a review of our database (n=806 EBUS-TBNAs) for patients undergoing EBUS-TBNA for mediastinal and/or hilar lymphadenopathy over an 8-year span to identify patients diagnosed with lymphoma.
Twenty patients (2.3%) who underwent EBUS-TBNA were ultimately diagnosed with lymphoma. In total, 17 of the 20 patients with lymphoma obtained a diagnosis using EBUS-TBNA. The overall sensitivity of EBUS-TBNA for lymphoma was 85%. The sensitivity for de novo diagnosis was 78% (7/9), and sensitivity for recurrence was 91% (10/11). All patients who achieved a diagnosis by EBUS-TBNA could be adequately subtyped, allowing treatment recommendations.
Although the sensitivity of EBUS-TBNA for the diagnosis of lymphoma did not reach values of published data for non-small cell lung cancer, EBUS-TBNA can be considered as a first-line diagnostic tool for patients with mediastinal and/or hilar lymphadenopathy suspected to be lymphoma. Because of the inherent limitations in small volume needle biopsies it is essential that negative samples obtained in the setting of high clinical suspicion warrant further evaluation.
支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）是评估纵隔和肺门淋巴结肿大的一种微创方法。尽管EBUS已被确立为诊断肺癌的有效手段，但其对淋巴瘤的诊断敏感性较低。由于检出率较低，EBUS-TBNA能否可靠诊断淋巴瘤仍存在不确定性，对于疑似淋巴瘤患者，EBUS-TBNA作为一线活检方式的效用也存在疑问。
我们回顾了数据库（806例EBUS-TBNA），该数据库涵盖了8年间因纵隔和/或肺门淋巴结肿大接受EBUS-TBNA的患者，以确定被诊断为淋巴瘤的患者。
20例（2.3%）接受EBUS-TBNA的患者最终被诊断为淋巴瘤。在这20例淋巴瘤患者中，共有17例通过EBUS-TBNA获得诊断。EBUS-TBNA对淋巴瘤的总体敏感性为85%。初诊敏感性为78%（7/9），复发敏感性为91%（10/11）。所有通过EBUS-TBNA获得诊断的患者都能得到充分的亚型分类，从而给出治疗建议。
尽管EBUS-TBNA对淋巴瘤的诊断敏感性未达到已发表的非小细胞肺癌数据值，但对于疑似淋巴瘤的纵隔和/或肺门淋巴结肿大患者，EBUS-TBNA可被视为一线诊断工具。由于小体积针吸活检存在固有局限性，在高度临床怀疑的情况下获得的阴性样本必须进行进一步评估，这一点至关重要。
