Shure D, Fedullo P F
Chest. 1985 Jul;88(1):49-51. doi: 10.1378/chest.88.1.49.
Although exophytic endobronchial lesions can readily be diagnosed by routine forceps biopsy through the fiberoptic bronchoscope, submucosal or peribronchial tumor can be difficult to diagnose with nonsurgical techniques. We evaluated the utility of transbronchial needle aspiration (TBNA) through the fiberoptic bronchoscope in 31 patients presenting with endoscopic abnormalities suggestive of submucosal or peribronchial tumor. TBNA was performed using a 20 g X 1 cm needle, followed by forceps biopsy of the same area. Forceps biopsy was positive in 17 cases (55 percent) and TBNA in 22 (71 percent) (p = .302). The combination of forceps biopsy and TBNA was positive in 27 cases (89 percent), which was significantly better than forceps biopsy alone (p = .00195). In addition, the wash or the brush detected three additional carcinomas, so the combination of TBNA, forceps biopsy, wash, and brush had a diagnostic yield of 97 percent. We conclude that TBNA significantly increases the yield over forceps biopsy alone in the detection of submucosal or peribronchial bronchogenic carcinoma and that the maximal diagnostic yield is obtained by the combination of TBNA, forceps biopsy, wash, and brush when appropriate endoscopic abnormalities are encountered.
尽管通过纤维支气管镜用常规活检钳可轻易诊断外生性支气管内病变，但对于黏膜下或支气管周围肿瘤，非手术技术可能难以诊断。我们评估了通过纤维支气管镜进行经支气管针吸活检（TBNA）对31例表现为提示黏膜下或支气管周围肿瘤的内镜异常患者的效用。使用20g×1cm的针进行TBNA，随后对同一区域进行活检钳活检。活检钳活检阳性17例（55%），TBNA阳性22例（71%）（p = 0.302）。活检钳活检与TBNA联合阳性27例（89%），显著优于单独使用活检钳活检（p = 0.00195）。此外，冲洗或刷检又检测出3例癌，因此TBNA、活检钳活检、冲洗和刷检联合的诊断阳性率为97%。我们得出结论，在检测黏膜下或支气管周围支气管源性癌时，TBNA比单独使用活检钳活检显著提高了阳性率，并且当遇到合适的内镜异常时，通过TBNA、活检钳活检、冲洗和刷检联合可获得最大诊断阳性率。
