Department of Pathology, Cleveland Clinic.
Department of Pathology, Hospital del Mar.
Am J Surg Pathol. 2019 Apr;43(4):497-503. doi: 10.1097/PAS.0000000000001197.
Biopsy site changes in mediastinal lymph nodes (LNs) attributable to prior endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) have not been studied in a systematic manner. Twenty-four contributors from 14 institutions in 5 countries collaborated via social media (Twitter) to retrospectively review consecutive cases of resected mediastinal LNs from patients with prior EBUS-TBNA. Resected LNs were reexamined by submitting pathologists for changes attributable to EBUS-TBNA. Patients who received neoadjuvant therapy were excluded. Cases with suspected biopsy site changes underwent central review by 5 pathologists. A total of 297 mediastinal LN resection specimens from 297 patients (183 male/114 female, mean age: 65 y, range: 23 to 87) were reviewed. Biopsy site changes were most common in station 7 (10 cases) followed by 11R, 4R, and 10R, and were found in 34/297 (11.4%) cases, including displacement of tiny cartilage fragments into LN parenchyma in 26, intranodal or perinodal scars in 7, and hemosiderin in 1. Cartilage fragments ranged from 0.26 to 1.03 mm in length and 0.18 to 0.62 mm in width. The mean interval between EBUS-TBNA and LN resection was 38 days (range: 10 to 112) in cases with biopsy site changes. A control group of 40 cases without prior EBUS-TBNA, including 193 mediastinal LN stations, showed no evidence of biopsy site changes. Biopsy site changes are identified in a subset of resected mediastinal LNs previously sampled by EBUS-TBNA. The location of the abnormalities, temporal association with prior EBUS-TBNA, and the absence of such findings in cases without prior EBUS-TBNA support the contention that they are caused by EBUS-TBNA.
先前经支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）取样的纵隔淋巴结（LNs）活检部位发生改变的情况尚未得到系统研究。来自 5 个国家 14 家机构的 24 位贡献者通过社交媒体（Twitter）合作，回顾性分析了先前接受过 EBUS-TBNA 的患者的纵隔 LNs 切除连续病例。将病理学家提交的 LNs 进行重新检查，以确定是否归因于 EBUS-TBNA。排除接受新辅助治疗的患者。疑似活检部位改变的病例由 5 位病理学家进行中心审查。共回顾了 297 例纵隔 LN 切除标本（297 例患者，男 183 例，女 114 例，平均年龄 65 岁，范围 23 至 87 岁）。最常见的活检部位改变位于 7 区（10 例），其次是 11R、4R 和 10R，共 34 例（11.4%），包括 26 例微小软骨碎片移位至 LN 实质内、7 例 LN 内或周围疤痕、1 例含铁血黄素。软骨碎片的长度范围为 0.26 至 1.03 毫米，宽度为 0.18 至 0.62 毫米。有活检部位改变的病例中，EBUS-TBNA 与 LN 切除之间的平均间隔为 38 天（范围 10 至 112 天）。无 EBUS-TBNA 病史的 40 例对照病例，包括 193 个纵隔 LN 部位，均未见活检部位改变的证据。先前经 EBUS-TBNA 取样的纵隔 LN 切除标本中有一部分出现了活检部位改变。异常的位置、与先前 EBUS-TBNA 的时间关联，以及无 EBUS-TBNA 病史的病例中没有这些发现，支持这些改变是由 EBUS-TBNA 引起的观点。
