Filarecka Anna, Gnass Maciej, Obrochta Anna, Szlubowska Sylwia, Kocoń Piotr, Czyżewski Damian, Pankowski Juliusz, Szlubowski Artur
Unit of Endoscopy, Public Specialistic Hospital of Lung Diseases in Zakopane.
Unit of Endoscopy, Public Specialistic Hospital of Lung Diseases in Zakopane; Unit of Endoscopy, Cracow Specialistic Hospital John Paul II.
Pol Merkur Lekarski. 2018 Mar 27;44(261):113-117.
A diagnosis of pulmonary sarcoidosis is based on the assessment of clinical outcome, radiology findings and detection of noncaseating granulomas in cytology or histology specimens. Cytological material obtained from enlarged lymph nodes and/or histological specimens from bronchial mucosa and lung tissue are examined according to sarcoidosis stage. The most available are standard bronchoscopic methods as conventional transbronchial needle aspiration (cTBNA), endobronchial biopsy (EBB) and transbronchial lung biopsy (TBLB) both performed with use of forceps. The new endoscopic techniques introduced to pulmonary diagnostics are: endobronchial ultrasoundguided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) or if used by the ultrasound bronchoscope (EUS-b-FNA) and transbronchial lung cryobiopsy (TBLC). Considering a dynamic improvement in cytology assessment techniques (processed as cytology smears and cell blocks) the endoscopic methods with use of fine needle aspiration biopsy of enlarged lymph nodes became a method of choice in sarcoidosis with lymphadenopathy, and published data suggest a higher diagnostic yield when performed under endosonographic guidance. The optimal approach (transbronchial or transesophageal) and the selection of mediastinal lymph node stations considered for biopsy still need evaluation. Also TBLC, successfully used in the diagnosis of other diffuse parenchymal lung diseases, requires more experiences and trials to establish its role in diagnosis of pulmonary sarcoidosis.
肺结节病的诊断基于临床结果评估、影像学检查结果以及细胞学或组织学标本中无干酪样肉芽肿的检测。根据结节病的分期，对取自肿大淋巴结的细胞学材料和/或支气管黏膜及肺组织的组织学标本进行检查。最常用的标准支气管镜检查方法包括传统的经支气管针吸活检（cTBNA）、支气管内活检（EBB）和经支气管肺活检（TBLB），均使用活检钳进行。引入肺部诊断的新内镜技术包括：支气管内超声引导下经支气管针吸活检（EBUS-TBNA）、内镜超声引导下细针穿刺活检（EUS-FNA）或超声支气管镜引导下细针穿刺活检（EUS-b-FNA）以及经支气管肺冷冻活检（TBLC）。考虑到细胞学评估技术（处理为细胞学涂片和细胞块）的动态改进，使用细针穿刺活检肿大淋巴结的内镜方法已成为结节病伴淋巴结病的首选方法，并且已发表的数据表明在超声内镜引导下进行时诊断率更高。最佳方法（经支气管或经食管）以及用于活检的纵隔淋巴结站的选择仍需评估。此外，TBLC虽已成功用于其他弥漫性实质性肺疾病的诊断，但在确定其在肺结节病诊断中的作用方面还需要更多经验和试验。
