Advanced Eye Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India.
Departments of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research , Chandigarh , India.
Ocul Immunol Inflamm. 2019;27(7):1041-1048. doi: 10.1080/09273948.2018.1425460. Epub 2018 Feb 8.
: To report the role of CT chest and cytology in suspected tubercular and sarcoid uveitis. : This is a retrospective, interventional case series of 376 uveitis patients with suspected ocular tuberculosis (TB)/sarcoidosis seen between January 2010 and April 2015 at the Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh. All underwent CT chest, and had following inclusion criteria: (1) Presence of active granulomatous anterior/intermediate/posterior uveitis or panuveitis; (2) a documented tuberculin skin test/QuantiFERON-TB Gold test; (3) all other causes of infectious/non-infectious uveitis ruled out. A total of 206 patients had abnormal CT chest, of which 147 patients with minimum four months follow up were studied. Based on CT findings and amenability of involved lymph nodes, conventional transbronchial needle aspiration (TBNA)/endobronchial ultrasoundguided TBNA (EBUS-TBNA) or fine needle aspiration cytology (FNAC) of peripheral nodes was performed by an interventional pulmonologist. All smears were subjected to cytopathological examination, and Ziehl-Neelsen staining for acid-fast bacilli (AFB). The detection of the underlying etiology (TB or sarcoidosis) was the main outcome measure. : CT chest demonstrated mediastinal/hilar lymph nodes in 123/147 (83.7%) patients. Twenty four (16.2%) patients with parenchymal involvement were diagnosed TB ( = 20) or sarcoidosis ( = 4). Sixty nine patients with subcentimetric lymph nodes that were not amenable to biopsy were diagnosed clinico-radiologically as TB (42) and sarcoidosis (27). Fifty-four patients underwent biopsy from various sites that diagnosed TB and sarcoidosis in 21 (38.2%) patients each. Five TBLB/EBUS TBNA smears and seven FNAC smears demonstrated AFB. : In systemically asymptomatic individuals presenting with uveitis, CT chest helped to establish the diagnosis of TB/sarcoidosis in 71.43% cases (105 out of 147) using only the clinico-radiological criteria, while a confirmed diagnosis of TB/sarcoidosis was possible only in 42 cases (28.57%) by EBUS/TBNA guided cytological examination.
报告 CT 胸部和细胞学在疑似结核性和结节病性葡萄膜炎中的作用。这是一项回顾性的、介入性的病例系列研究，共纳入了 2010 年 1 月至 2015 年 4 月在昌迪加尔 PGIMER 高级眼科中心就诊的 376 例疑似眼结核（TB）/结节病葡萄膜炎患者。所有患者均行 CT 胸部检查，并符合以下纳入标准：（1）存在活动性肉芽肿性前/中间/后葡萄膜炎或全葡萄膜炎；（2）有结核菌素皮肤试验/QuantiFERON-TB Gold 试验记录；（3）排除所有其他感染/非感染性葡萄膜炎的原因。共有 206 例患者 CT 胸部异常，其中 147 例至少有 4 个月的随访，进行了研究。根据 CT 发现和受累淋巴结的可操作性，介入肺病学家进行了常规经支气管针吸活检（TBNA）/支气管内超声引导 TBNA（EBUS-TBNA）或外周淋巴结细针抽吸细胞学（FNAC）。所有涂片均进行细胞病理学检查，并进行抗酸杆菌（AFB）Ziehl-Neelsen 染色。主要观察指标为潜在病因（TB 或结节病）的检出。CT 胸部显示 147 例患者中有 123 例（83.7%）存在纵隔/肺门淋巴结肿大。24 例（16.2%）有实质受累的患者被诊断为 TB（=20 例）或结节病（=4 例）。69 例亚厘米淋巴结肿大但无法活检的患者临床和影像学诊断为 TB（42 例）和结节病（27 例）。54 例患者在不同部位进行活检，其中 21 例（38.2%）患者诊断为 TB，21 例（38.2%）患者诊断为结节病。5 例 TBLB/EBUS-TBNA 涂片和 7 例 FNAC 涂片显示 AFB。在系统无症状的葡萄膜炎患者中，仅根据临床和影像学标准，CT 胸部检查有助于诊断 71.43%（105 例中的 71.43%）的 TB/结节病，而通过 EBUS/TBNA 引导的细胞学检查仅能明确诊断 42 例（28.57%）的 TB/结节病。
