Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
School of Medicine, China Medical University, Taichung, Taiwan.
J Ultrasound Med. 2021 Jan;40(1):49-58. doi: 10.1002/jum.15372. Epub 2020 Jun 20.
We hypothesized that specific endobronchial ultrasound (EBUS) features may differentiate sarcoidosis from other causes of lymphadenopathy.
We conducted this retrospective observational study from January 2014 to January 2019 to analyze patients with intrathoracic lymphadenopathy who underwent EBUS-guided transbronchial needle aspiration. Ultrasound features, including nodal size, margin, echogenicity, the presence or absence of calcification, a central hilar structure, the coagulation necrosis sign, nodal conglomeration, and the septal vessel sign in the color Doppler mode were recorded and compared between 3 groups.
Of the 90 included patients, 15 had a diagnosis of tuberculosis; 56 had a diagnosis of sarcoidosis; and 19 had a diagnosis of malignant lymph nodes by EBUS-guided transbronchial needle aspiration. The presence of nodal conglomeration (94.6% versus 60.0% versus 5.3%; P < .001), the septal vessel sign in the color Doppler mode (55.4% versus 13.3% versus 15.8%; P = .002), and a distinct margin (73.2% versus 13.3% versus 47.4%; P < .001) were significantly higher in the sarcoidosis group than in the tuberculosis lymphadenopathy and malignant lymph node groups. The presence of the coagulation necrosis sign (8.9% versus 93.3% versus 31.6%; P < .001) was significantly lower in the sarcoidosis group than in tuberculosis lymphadenopathy and malignant lymph node groups. A multivariate analysis showed that the presence of nodal conglomeration, the absence of coagulation necrosis, and the presence of the septal vessel sign in the color Doppler mode were independent predictive factors for the diagnosis of sarcoidosis.
The presence of nodal conglomeration, the absence of coagulation necrosis, and the presence of the septal vessel sign in the color Doppler mode in lymph nodes on EBUS are predictive of sarcoidosis.
我们假设特定的支气管内超声（EBUS）特征可区分结节病与其他淋巴结病的病因。
本回顾性观察性研究于 2014 年 1 月至 2019 年 1 月进行，分析了接受 EBUS 引导下经支气管针吸活检术的胸腔内淋巴结病患者。记录并比较了超声特征，包括淋巴结大小、边界、回声、有无钙化、中央门结构、凝固性坏死征、淋巴结聚集和彩色多普勒模式下的分隔血管征在 3 组之间的差异。
90 例纳入患者中，15 例诊断为结核病，56 例诊断为结节病，19 例经 EBUS 引导下经支气管针吸活检术诊断为恶性淋巴结。淋巴结聚集的存在（94.6%比 60.0%比 5.3%；P<0.001）、彩色多普勒模式下分隔血管征的存在（55.4%比 13.3%比 15.8%；P=0.002）和明显的边界（73.2%比 13.3%比 47.4%；P<0.001）在结节病组中明显高于结核病性淋巴结病和恶性淋巴结组。凝固性坏死征的存在（8.9%比 93.3%比 31.6%；P<0.001）在结节病组中明显低于结核病性淋巴结病和恶性淋巴结组。多变量分析显示，淋巴结聚集的存在、无凝固性坏死和彩色多普勒模式下分隔血管征的存在是结节病诊断的独立预测因素。
EBUS 上淋巴结聚集的存在、无凝固性坏死和彩色多普勒模式下分隔血管征的存在可预测结节病。
