评估 19 号和 21 号 EBUS-TBNA 针的产量：一项前瞻性研究。

Evaluating Yield of 19 Versus 21 G EBUS-TBNA Needles: A Prospective Study.

机构信息

Faculty in the Pulmonary and Critical Care Divisions.

Critical Care Research Center, Regions Hospital, St. Paul.

出版信息

J Bronchology Interv Pulmonol. 2021 Jan 1;28(1):29-33. doi: 10.1097/LBR.0000000000000674.

DOI:10.1097/LBR.0000000000000674

PMID:32243274

Abstract

BACKGROUND

Controversy remains regarding the effect of needle size on the diagnostic yield of endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration. We conducted a prospective study comparing the diagnostic yield of 19 and 21 G EBUS needles and hypothesized that the 19 G have a greater EBUS-guided transbronchial needle aspiration diagnostic yield as compared with the 21 G needle.

METHODS

A total of 60 patients undergoing EBUS-guided transbronchial needle aspiration were enrolled with informed consent. Both 19 and 21 G needles were used at each lymph node station in alternating fashion, we randomized which needle, to begin with. Two rapid on-site cytology evaluation stations were present and assigned to one of the 2 needles. They reported sample adequacy and prepared a separate cell block per lymph node sampled for their assigned needle.

RESULTS

A total of 141 lymph nodes were analyzed. Diagnosis included 69 benign lymph nodes, 47 malignant lymph nodes, 22 noncaseating granulomas, and 3 infected lymph nodes. Five hundred seventy-three passes (average: 4.1 passes/lymph node) were done with 19 G and 581 passes with 21 G needles (average: 4.1 passes/lymph node). Diagnostic yield was similar between 19 and 21 G needles overall (89.4% vs. 88.7%, P=0.71). The 19 G needles showed higher smear cellularity (32.6% vs. 13.0%, P=0.05), and rapid on-site cytology evaluation adequacy (84.8% vs. 63.0%, P=0.004) in lymph nodes with cancer diagnosis. In 7 of the 141 lymph nodes, samples from only one of the needles provided the final diagnosis.

CONCLUSION

There is no difference in the overall diagnostic yield between 19 and 21 G needles. Further studies are needed to confirm the trend of the superiority of 19 G in cancerous lymph nodes.

摘要

背景

关于针的大小对支气管内超声（EBUS）引导下经支气管针吸活检术的诊断效果的影响仍存在争议。我们进行了一项前瞻性研究，比较了 19 和 21G EBUS 针的诊断效果，并假设 19G 比 21G 针具有更高的 EBUS 引导下经支气管针吸活检术诊断效果。

方法

共纳入 60 例经 EBUS 引导下经支气管针吸活检术的患者，均签署知情同意书。在每个淋巴结站交替使用 19 和 21G 针，我们随机选择首先使用哪种针。设有 2 个快速现场细胞学评估站，并分配给其中 1 根针。他们报告了样本充足性，并为每个采样的淋巴结制备了单独的细胞块。

结果

共分析了 141 个淋巴结。诊断结果包括 69 个良性淋巴结、47 个恶性淋巴结、22 个非干酪样肉芽肿和 3 个感染性淋巴结。使用 19G 进行了 573 次穿刺（平均每个淋巴结 4.1 次穿刺），使用 21G 进行了 581 次穿刺（平均每个淋巴结 4.1 次穿刺）。总体而言，19G 和 21G 针的诊断效果相似（89.4%对 88.7%，P=0.71）。在诊断为癌症的淋巴结中，19G 针的涂片细胞密度更高（32.6%对 13.0%，P=0.05），快速现场细胞学评估充足性更高（84.8%对 63.0%，P=0.004）。在 141 个淋巴结中，有 7 个淋巴结仅从一根针中获得最终诊断。