Di Felice Christopher, Young Benjamin, Matta Maroun
University Hospitals Cleveland Medical Center, Department of Pulmonary, Critical Care and Sleep Medicine, Cleveland, Ohio, USA.
J Thorac Dis. 2019 Aug;11(8):3643-3649. doi: 10.21037/jtd.2019.04.20.
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the preferred diagnostic modality for sampling mediastinal and hilar lymph nodes (LNs). The conventional needle used for sampling is either a 21-gauge (21G) or 22-gauge (22G). A 25-gauge (25G) needle has recently been introduced with little known regarding its efficacy.
A retrospective study was conducted on patients referred for EBUS-TBNA who had LNs sampled using a 25G or 22G needle. A propensity score matching analysis was performed. After matching the groups, each LN was assessed for adequacy and final diagnosis. Non-diagnostic and benign lymphoid specimens were compared with repeat biopsy findings or long-term clinical and radiological follow-up.
A total of 158 LNs were included. An adequate sample was obtained in 92.4% (73/79) in the 25G group and 92.4% (73/79) in the 22G group (P=1). The 25G group diagnosed benign lymphoid tissue in 82.3% (65/79), granuloma in 7.6% (6/79) and malignancy in 2.5% (2/79). Six lymph nodes in the 25G group were non-diagnostic (7.6%). The 22G group diagnosed benign lymphoid tissue in 83.5% (66/79), granuloma in 3.8% (3/79) and malignancy in 5.1% (4/79). Six lymph nodes in the 22G group were non-diagnostic (7.6%). The sensitivity, specificity, negative predictive value (NPV) and diagnostic accuracy in the 25G group was 88.9% (95% CI, 51.8-99.7%), 100% (95% CI, 92.1-100%), 97.8% (95% CI, 87.6-99.7%) and 98.2% (95% CI, 90.1-100%), respectively. The sensitivity, specificity, NPV and diagnostic accuracy in the 22G group was 77.8% (95% CI, 40-97.2%), 100% (95% CI, 86.8-100%), 92.9% (95% CI, 79.3-97.8%) and 94.3% (95% CI, 80.8-99.3%), respectively. The 25G and 22G group were comparable in diagnostic accuracy (P=0.7).
The 25G and 22G needle achieve comparable specimen adequacy and diagnostic accuracy in EBUS-TBNA.
支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）是纵隔和肺门淋巴结（LN）采样的首选诊断方式。用于采样的传统针具为21号（21G）或22号（22G）。最近引入了一种25号（25G）针，但其疗效鲜为人知。
对因EBUS-TBNA就诊且使用25G或22G针进行LN采样的患者进行回顾性研究。进行倾向评分匹配分析。匹配组后，评估每个LN的采样充分性和最终诊断。将非诊断性和良性淋巴标本与重复活检结果或长期临床及影像学随访结果进行比较。
共纳入158个LN。25G组92.4%（73/79）的标本采样充分，22G组为92.4%（73/79）（P = 1）。25G组诊断为良性淋巴组织的占82.3%（65/79），肉芽肿占7.6%（6/79），恶性肿瘤占2.5%（2/79）。25G组有6个淋巴结为非诊断性（7.6%）。22G组诊断为良性淋巴组织的占83.5%（66/79），肉芽肿占3.8%（3/79），恶性肿瘤占5.1%（4/79）。22G组有6个淋巴结为非诊断性（7.6%）。25G组的敏感性、特异性、阴性预测值（NPV）和诊断准确性分别为88.9%（95%CI，51.8 - 99.7%）、100%（95%CI，92.1 - 100%）、97.8%（95%CI，87.6 - 99.7%）和98.2%（95%CI，90.1 - 100%）。22G组的敏感性、特异性、NPV和诊断准确性分别为77.8%（95%CI，40 - 97.2%）、100%（95%CI，86.8 - 100%）、92.9%（95%CI，79.3 - 97.8%）和94.3%（95%CI，80.8 - 99.3%）。25G组和22G组在诊断准确性方面具有可比性（P = 0.7）。
在EBUS-TBNA中，25G和22G针在标本采样充分性和诊断准确性方面相当。
