Lim Christopher E, Steinfort Daniel P, Irving Louis B
Department of Respiratory Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia.
Clin Respir J. 2020 Sep;14(9):800-805. doi: 10.1111/crj.13198. Epub 2020 May 10.
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) represents a minimally invasive approach in the evaluation of mediastinal/hilar lymphadenopathy. Diagnostic performance of EBUS-TBNA in lymphoma using standard 22-gauge (22G) needle is limited by sample volumes that are often inadequate for histopathological assessment.
To evaluate the diagnostic utility of 19-gauge (19G) EBUS-TBNA needle in the evaluation of suspected lymphoma.
We prospectively collected clinical and procedural information for patients undergoing EBUS-TBNA with 19G needle at Royal Melbourne Hospital for investigation of mediastinal/hilar lymphadenopathy, where lymphoma was considered in the differential diagnosis. All consecutive patients between June 15, 2016 and July 10, 2019 were included. If definitive diagnosis was not achieved on EBUS-TBNA, final diagnosis was determined through subsequent investigation or a minimum of 6 months radiologic surveillance.
Thirty-nine patients underwent EBUS-TBNA using 19G needle for evaluation of suspected lymphoma. Thirteen patients had a prior diagnosis of lymphoma (33%). Lymphoma was ultimately diagnosed in 23 patients (59%). Of these, 10 had a prior diagnosis of lymphoma (43%). 19G EBUS-TBNA demonstrated lymphoma in 19 patients, with a sensitivity of 83% (95% CI 66-93) for detection of lymphoma. Four patients required surgical biopsy to definitively characterise lymphoma subtype. Therefore, sensitivity of 19G EBUS-TBNA for definitive diagnosis of lymphoma was 65% (95% CI 45-81). In patients with a prior diagnosis of lymphoma, sensitivity for definitive diagnosis of lymphoma was 80% (95% CI 48-95).
Diagnostic performance of 19G EBUS-TBNA appears similar to standard 22G needle in detection and definitive diagnosis of lymphoma. Further invasive testing remains necessary following non-diagnostic EBUS-TBNA procedures.
支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）是评估纵隔/肺门淋巴结肿大的一种微创方法。使用标准22号（22G）针进行EBUS-TBNA诊断淋巴瘤时，其诊断性能受到样本量的限制，这些样本量往往不足以进行组织病理学评估。
评估19号（19G）EBUS-TBNA针在疑似淋巴瘤评估中的诊断效用。
我们前瞻性收集了在皇家墨尔本医院接受19G针EBUS-TBNA检查以评估纵隔/肺门淋巴结肿大的患者的临床和操作信息，其中淋巴瘤被纳入鉴别诊断。纳入了2016年6月15日至2019年7月10日期间的所有连续患者。如果EBUS-TBNA未达成明确诊断，则通过后续检查或至少6个月的影像学监测确定最终诊断。
39例患者接受了19G针EBUS-TBNA以评估疑似淋巴瘤。13例患者先前已诊断为淋巴瘤（33%）。最终有23例患者被诊断为淋巴瘤（59%）。其中，10例患者先前已诊断为淋巴瘤（43%）。19G EBUS-TBNA在19例患者中显示为淋巴瘤，检测淋巴瘤的敏感性为83%（95%CI 66-93）。4例患者需要手术活检以明确淋巴瘤亚型。因此，19G EBUS-TBNA对淋巴瘤明确诊断的敏感性为65%（95%CI 45-81）。在先前已诊断为淋巴瘤的患者中，淋巴瘤明确诊断的敏感性为80%（95%CI 48-95）。
19G EBUS-TBNA在淋巴瘤的检测和明确诊断方面的诊断性能似乎与标准22G针相似。在EBUS-TBNA检查未明确诊断后，仍需要进一步的侵入性检查。
