Aljohaney Ahmed A
Department of Internal Medicine, Faculty of Medicine, King Abdul Aziz University, Jeddah, Saudi Arabia.
Ann Thorac Med. 2018 Apr-Jun;13(2):92-100. doi: 10.4103/atm.ATM_317_17.
The aim of the study was to evaluate the clinical utility and safety of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in patients with mediastinal and hilar lymphadenopathy and to explicitly describe the utility of this procedure in patient's outcome.
A retrospective review and analysis was conducted on 52 patients with mediastinal or hilar lymphadenopathy who underwent EBUS-TBNA from June 2012 to June 2016. All the patients were evaluated by computed tomography (CT) chest with contrast before EBUS examination. Enlarged mediastinal or hilar lymph node was defined as >1 cm short axis on the enhanced CT.
Among the 52 patients studied, 57.7% were presented with mediastinal or hilar lymphadenopathy for diagnosis and 42.3% presented with suspected mediastinal malignancy. Paratracheal stations were the most common site for puncture in 33 lymph nodes (43%). The best diagnostic yield was obtained from subcarinal stations and the lowest yield from the hilar stations. Surgical biopsies confirmed lymphoma in six patients, tuberculosis (TB) in three, sarcoidosis in two and one had metastatic adenocarcinoma of unknown primary. The sensitivity, specificity, positive predictive value, and negative predictive value of EBUS-TBNA for diagnosis of mediastinal and hilar lymph node abnormalities were 78.6%, 100%, 100%, and 80%, respectively. The diagnostic yield of EBUS-TBNA in malignant and benign conditions was 79.0%.
EBUS-TBNA is a safe and efficacious procedure which can be performed using conscious sedation with high yields. It can be used for the staging of malignancies as well as for the diagnosis of inflammatory and infectious conditions such as sarcoidosis and TB.
本研究旨在评估支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）在纵隔和肺门淋巴结肿大患者中的临床应用价值及安全性，并明确该操作对患者预后的作用。
对2012年6月至2016年6月期间接受EBUS-TBNA的52例纵隔或肺门淋巴结肿大患者进行回顾性分析。所有患者在EBUS检查前均接受了胸部增强计算机断层扫描（CT）评估。增强CT上短轴直径>1 cm的纵隔或肺门淋巴结被定义为肿大淋巴结。
在研究的52例患者中，57.7%因纵隔或肺门淋巴结肿大进行诊断，42.3%怀疑纵隔恶性肿瘤。气管旁区域是33个淋巴结（43%）最常见的穿刺部位。隆突下区域的诊断阳性率最高，肺门区域最低。手术活检证实6例为淋巴瘤，3例为结核病（TB），2例为结节病，1例为原发灶不明的转移性腺癌。EBUS-TBNA诊断纵隔和肺门淋巴结异常的敏感性、特异性、阳性预测值和阴性预测值分别为78.6%、100%、100%和80%。EBUS-TBNA在恶性和良性疾病中的诊断阳性率为79.0%。
EBUS-TBNA是一种安全有效的操作，可在清醒镇静下进行，阳性率高。它可用于恶性肿瘤的分期以及结节病和TB等炎症性和感染性疾病的诊断。
