Division of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut.
Division of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut; Department of Pulmonary Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
Ann Thorac Surg. 2020 Mar;109(3):894-901. doi: 10.1016/j.athoracsur.2019.08.106. Epub 2019 Oct 5.
Endobronchial ultrasound (EBUS) transbronchial needle aspiration (TBNA) has a high diagnostic yield when evaluating mediastinal and hilar lymphadenopathy (LAD). Having previously demonstrated the safety of EBUS-guided cautery-assisted transbronchial nodal forceps biopsy (ca-TBFB), we report disease-specific improvements in diagnostic yield and tissue acquisition when supplementing the EBUS-TBNA-based standard of care (SOC) with ca-TBFB.
We retrospectively reviewed 213 patients who sequentially underwent SOC and ca-TBFB during the same procedure. We determined 3 clinical scenarios of interest based on preprocedural imaging: isolated mediastinal/hilar LAD, LAD associated with a nodule or mass suspicious for malignancy, and LAD associated with parenchymal findings suggestive of sarcoidosis. Using validated methods, we assessed diagnostic yield on a per-patient basis and specimen quality on a per-node basis on the 136 patients meeting diagnostic criteria.
Administration of disease-specific SOC with ca-TBFB yielded gains that varied by diagnosis. Diagnostic yields of SOC and its supplementation with ca-TBFB were 91.8% and 93.4% (P = .50) of the 61 patients diagnosed with solid-organ malignancy, 62.7% and 94.9% (P < .001) of the 59 patients diagnosed with sarcoidosis, and 62.5% and 93.8% (P = .042) of the 16 patients diagnosed with lymphoma, the. For each disease process, specimens obtained with ca-TBFB exhibited statistically higher quality.
We suggest that relative to SOC, ca-TBFB improves diagnostic yield for sarcoidosis and lymphoma while providing uniformly better tissue quality and cellularity. We propose a protocol for use of this innovative technique.
支气管内超声（EBUS）经支气管针吸活检（TBNA）在评估纵隔和肺门淋巴结病（LAD）时具有较高的诊断率。我们之前已经证明了 EBUS 引导下电灼辅助经支气管淋巴结活检钳（ca-TBFB）的安全性，我们报告了当在 EBUS-TBNA 为基础的标准治疗（SOC）的基础上补充 ca-TBFB 时，诊断率和组织采集的疾病特异性改善。
我们回顾性分析了 213 例在同一程序中先后接受 SOC 和 ca-TBFB 的患者。我们根据术前影像学确定了 3 种感兴趣的临床情况：孤立性纵隔/肺门 LAD、LAD 伴可疑恶性的结节或肿块、LAD 伴提示结节病的实质发现。使用验证方法，我们根据符合诊断标准的 136 例患者，在每位患者的基础上评估诊断率，在每个节点的基础上评估标本质量。
根据疾病特异性 SOC 进行治疗，并结合 ca-TBFB，诊断率因诊断而异。SOC 和 SOC 联合 ca-TBFB 的诊断率分别为 61 例实体器官恶性肿瘤患者的 91.8%和 93.4%（P=0.50），59 例结节病患者的 62.7%和 94.9%（P<0.001），16 例淋巴瘤患者的 62.5%和 93.8%（P=0.042）。对于每种疾病过程，ca-TBFB 获得的标本质量均较高。
我们认为，与 SOC 相比，ca-TBFB 提高了结节病和淋巴瘤的诊断率，同时提供了更均匀的组织质量和细胞性。我们提出了一种使用这种创新技术的方案。
