Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
J Bras Pneumol. 2020;46(2):e20180183. doi: 10.36416/1806-3756/e20180183. Epub 2020 May 11.
To determine the diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in non-neoplastic patients with isolated intrathoracic lymphadenopathy (IL).
This was a retrospective study of patients with isolated IL referred for EBUS-TBNA. We calculated the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of EBUS-TBNA in the diagnosis of granulomatous, reactive, and neoplastic lymphadenopathy. In cases of nonspecific granulomas, reactive lymphadenopathy, or inconclusive results, a definitive diagnosis was established by other diagnostic procedures or during a follow-up period of at least 18 months.
Among the 58 patients included in the study, EBUS-TBNA established a diagnosis of granulomatous disease in 22 (38%), reactive lymphadenopathy in 15 (26%), cancer in 8 (14%), and other diseases in 3 (5%). Results were inconclusive in 10 (17%), the diagnosis being established by other bronchoscopic procedures in 2 (20%) and by surgical procedures in 8 (80%). A final diagnosis of reactive lymphadenopathy was established in 12. Of those, 11 (92%) had their diagnosis confirmed during follow-up and 1 (8%) had their diagnosis confirmed by mediastinoscopy. In another 3, a final diagnosis of sarcoidosis or neoplasm was established. For the diagnosis of granulomatous disease, neoplasms, and reactive lymphadenopathy, EBUS-TBNA was found to have a sensitivity of 73%, 68%, and 92%, respectively; a specificity of 100%, 100%, and 93%, respectively; an accuracy of 86%, 93%, and 93%, respectively; a PPV of 100%, 100%, and 80%, respectively; and an NPV of 78%, 92%, and 98%, respectively.
In non-neoplastic patients, granulomatous disease and reactive lymphadenopathy appear to be common causes of isolated IL. EBUS-TBNA shows promising results as a first-line minimally invasive diagnostic procedure. The results obtained by EBUS-TBNA can be optimized by examining clinical and radiological findings during follow-up or by comparison with the results obtained with other bronchoscopic methods.
确定经支气管超声引导针吸活检术（EBUS-TBNA）在孤立性胸内淋巴结病（IL）的非肿瘤患者中的诊断效果。
这是一项对因孤立性 IL 而接受 EBUS-TBNA 的患者进行的回顾性研究。我们计算了 EBUS-TBNA 对肉芽肿性、反应性和肿瘤性淋巴结病的诊断的灵敏度、特异性、准确性、阳性预测值（PPV）和阴性预测值（NPV）。在非特异性肉芽肿、反应性淋巴结病或结果不确定的情况下，通过其他诊断程序或至少 18 个月的随访期来确定明确诊断。
在纳入研究的 58 例患者中，EBUS-TBNA 确定 22 例（38%）为肉芽肿性疾病，15 例（26%）为反应性淋巴结病，8 例（14%）为癌症，3 例（5%）为其他疾病。10 例（17%）结果不确定，其中 2 例（20%）通过其他支气管镜检查程序，8 例（80%）通过手术程序确定诊断。最终诊断为反应性淋巴结病 12 例。其中，11 例（92%）在随访中得到确认，1 例（8%）通过纵隔镜检查得到确认。另外 3 例最终诊断为结节病或肿瘤。对于肉芽肿性疾病、肿瘤和反应性淋巴结病的诊断，EBUS-TBNA 的灵敏度分别为 73%、68%和 92%；特异性分别为 100%、100%和 93%；准确性分别为 86%、93%和 93%；PPV 分别为 100%、100%和 80%；NPV 分别为 78%、92%和 98%。
在非肿瘤患者中，肉芽肿性疾病和反应性淋巴结病似乎是孤立性 IL 的常见原因。EBUS-TBNA 作为一种一线微创诊断程序显示出良好的效果。通过在随访过程中检查临床和影像学发现，或与其他支气管镜方法的结果进行比较，可优化 EBUS-TBNA 的结果。
