Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Respirology. 2019 Jul;24(7):667-674. doi: 10.1111/resp.13488. Epub 2019 Feb 7.
We evaluated the usefulness of acid-fast bacilli (AFB) culture and Mycobacterium tuberculosis (MTB) polymerase chain reaction (PCR) of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) needle rinse fluid for diagnosing tuberculous lymphadenitis.
EBUS-TBNA needle rinse fluid was routinely used for AFB culture and MTB PCR. The patients were categorized according to the pre-procedural diagnosis (Group A, suspected/histology-confirmed lung cancer; Group B, extrapulmonary malignancy; and Group C, other benign diseases).
Of the 4672 subjects, 104 (2.2%) were diagnosed with tuberculous lymphadenitis; 1.0%, 4.6% and 12.7% of Group A, B and C, respectively. Tuberculous lymphadenitis was diagnosed in 0.2%, 1.0% and 4.5% Group A, B and C patients, respectively, by histopathology. On addition of AFB culture to histopathology, tuberculous lymphadenitis was diagnosed in 1.0%, 4.4% and 10.3% of Group A, B and C patients, respectively (P < 0.001, P = 0.001 and P = 0.005, respectively). On addition of MTB PCR to histopathology, tuberculous lymphadenitis was diagnosed in 0.4%, 1.9% and 8.8%, respectively (Group C; P = 0.029).
Routine AFB culture of needle rinse fluid was useful to increase the diagnostic yield of tuberculous lymphadenitis for all subjects who underwent EBUS-TBNA regardless of pre-procedural diagnosis in an intermediate tuberculosis (TB)-burden country. However, MTB PCR was only useful in subjects with pre-procedural diagnosis of benign pulmonary diseases.
我们评估了支气管内超声引导经支气管针吸活检术（EBUS-TBNA）针吸冲洗液中抗酸杆菌（AFB）培养和结核分枝杆菌（MTB）聚合酶链反应（PCR）在诊断结核性淋巴结炎中的作用。
EBUS-TBNA 针吸冲洗液常规用于 AFB 培养和 MTB PCR。根据术前诊断将患者分为三组（A 组：疑似/组织学确诊肺癌；B 组：肺外恶性肿瘤；C 组：其他良性疾病）。
在 4672 例患者中，104 例（2.2%）被诊断为结核性淋巴结炎；A、B 和 C 组分别为 1.0%、4.6%和 12.7%。组织病理学诊断为结核性淋巴结炎的患者在 A、B 和 C 组中分别为 0.2%、1.0%和 4.5%。在组织病理学的基础上增加 AFB 培养，A、B 和 C 组中诊断为结核性淋巴结炎的患者分别为 1.0%、4.4%和 10.3%（P<0.001、P=0.001 和 P=0.005）。在组织病理学的基础上增加 MTB PCR，A、B 和 C 组中诊断为结核性淋巴结炎的患者分别为 0.4%、1.9%和 8.8%（C 组；P=0.029）。
在结核病负担中等的国家，对所有接受 EBUS-TBNA 检查的患者，无论术前诊断如何，常规进行针吸冲洗液 AFB 培养都有助于提高结核性淋巴结炎的诊断率。然而，MTB PCR 仅对术前诊断为良性肺部疾病的患者有用。
