经支气管针吸活检术联合与不联合超声引导用于诊断良性淋巴结肿大的比较。

Comparison of transbronchial needle aspiration with and without ultrasound guidance for diagnosing benign lymph node adenopathy.

机构信息

Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310009, China.

Department of Respiratory and Critical Care Medicine, Huzhou Central Hospital, Huzhou, Zhejiang, 313000, China.

出版信息

Diagn Pathol. 2020 Apr 15;15(1):36. doi: 10.1186/s13000-020-00958-4.

DOI:10.1186/s13000-020-00958-4

PMID:32293480

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7158000/

Abstract

BACKGROUND

Transbronchial needle aspiration (TBNA) is a minimally invasive procedure performed to diagnose lymph node (LN) adenopathy. TBNA with and without endobronchial ultrasound (EBUS) guidance has a high diagnostic yield for malignant LN enlargement, but the value for diagnosing benign LN enlargement has been less thoroughly investigated.

METHODS

We retrospectively evaluated 3540 patients with mediastinal LN enlargement who received TBNA. One hundred sixty-six patients with benign mediastinal lymphadenopathy were included and 293 LNs were biopsied. A positive result was defined as a specific histological abnormality. Conventional TBNA (cTBNA) and EBUS-TBNA, as well as cTBNA and transbronchial forceps biopsy (TBFB), were compared. The subgroup analysis was stratified by disease type and LN size.

RESULTS

A diagnosis was made in 76.84% of the EBUS-TBNA and 61.31% of the cTBNA (P < 0.05). EBUS-TBNA was superior to cTBNA for both granulomatous (65.18% vs. 45.45%, P < 0.05) and non-granulomatous disease (96.92% vs. 84.06%, P < 0.05). In contrast, the diagnostic yield of EBUS-TBNA was higher than that of cTBNA for LNs < 20 mm (79.44% vs. 64.29%, P < 0.05), but for LNs > 20 mm the difference was marginal. These findings were confirmed in a group of independent patients who received cTBNA plus EBUS-TBNA. The diagnostic yield did not differ between cTBNA and TBFB, but significantly increased to 76.67% when both modalities were employed.

CONCLUSIONS

EBUS-TBNA is the preferred minimally invasive diagnostic method for benign mediastinal LN disease. Combined cTBNA and TBFB is a safe and feasible alternative when EBUS is unavailable.

摘要

背景

经支气管针吸活检（TBNA）是一种微创程序，用于诊断淋巴结（LN）肿大。在诊断恶性 LN 肿大方面，TBNA 联合或不联合支气管内超声（EBUS）引导具有较高的诊断率，但对诊断良性 LN 肿大的价值研究还不够充分。

方法

我们回顾性评估了 3540 例纵隔 LN 肿大患者，他们均接受了 TBNA。纳入 166 例良性纵隔淋巴结肿大患者，对 293 个 LN 进行了活检。阳性结果定义为存在特定的组织学异常。比较了常规 TBNA（cTBNA）和 EBUS-TBNA，以及 cTBNA 和经支气管活检钳（TBFB）。对疾病类型和 LN 大小进行了分层亚组分析。

结果

EBUS-TBNA 的诊断率为 76.84%，cTBNA 的诊断率为 61.31%（P<0.05）。EBUS-TBNA 对于肉芽肿性疾病（65.18%比 45.45%，P<0.05）和非肉芽肿性疾病（96.92%比 84.06%，P<0.05）均优于 cTBNA。相比之下，EBUS-TBNA 对直径小于 20mm 的 LN 的诊断率高于 cTBNA（79.44%比 64.29%，P<0.05），而对于直径大于 20mm 的 LN，两者差异较小。在一组接受 cTBNA 联合 EBUS-TBNA 的独立患者中，这些发现得到了证实。cTBNA 和 TBFB 的诊断率没有差异，但联合使用两种方法时，诊断率显著提高至 76.67%。