Miyata Jun, Ogawa Takunori, Tagami Yoichi, Sato Takashi, Nagayama Mikie, Hirano Toshiyuki, Kameyama Naofumi, Fukunaga Koichi, Kawana Akihiko, Inoue Takashi
Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Saitama, Japan.
Department of Pulmonary Medicine, Sano Kosei General Hospital, Sano, Tochigi, Japan.
Sarcoidosis Vasc Diffuse Lung Dis. 2020;37(1):8-16. doi: 10.36141/svdld.v37i1.8313. Epub 2020 Mar 15.
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a widely available diagnostic tool for suspected stage I/II sarcoidosis. Combination of EBUS-TBNA and transbronchial lung biopsy (TBLB) has been proposed as diagnostic procedure in clinical settings.
The aim of this study was to assess the diagnostic yield of combined EBUS-TBNA and TBLB and identify the markers correlated with a high diagnostic rate.
We retrospectively analyzed the data of 37 patients with suspected stage I/II sarcoidosis with enlarged hilar or mediastinal lymph nodes on computed tomography (CT) images. These patients had been scheduled to undergo EBUS-TBNA and TBLB. Serum levels of sarcoidosis markers (angiotensin-converting enzyme [ACE], soluble interleukin-2 receptor [sIL-2R], and lysozyme), CT findings, and examination techniques were evaluated as predictive markers for diagnosis.
Of the 37 patients, 32 had undergone both EBUS-TBNA and TBLB, while the remaining 5 patients had only undergone EBUS-TBNA. The diagnosis was confirmed by TBLB in 16 of the 32 patients (50.0%), EBUS-TBNA in 31 of the 37 patients (83.8%), and combined TBLB and EBUS-TBNA in all patients (100.0%). The serum level of sIL-2R, but not that of ACE or lysozyme, was correlated with successful diagnosis by EBUS-TBNA.
In patients with stage I/II sarcoidosis, the serum level of sIL-2R is a promising and useful marker for predicting the diagnosis by EBUS-TBNA and reducing the burden of additional TBLB and its possible complications. .
支气管内超声引导下经支气管针吸活检术(EBUS-TBNA)是一种广泛应用于疑似Ⅰ/Ⅱ期结节病的诊断工具。EBUS-TBNA与经支气管肺活检(TBLB)联合应用已被提议作为临床诊断方法。
本研究旨在评估EBUS-TBNA与TBLB联合应用的诊断率,并确定与高诊断率相关的标志物。
我们回顾性分析了37例疑似Ⅰ/Ⅱ期结节病患者的数据,这些患者在计算机断层扫描(CT)图像上显示肺门或纵隔淋巴结肿大。这些患者已计划接受EBUS-TBNA和TBLB。评估血清结节病标志物(血管紧张素转换酶[ACE]、可溶性白细胞介素-2受体[sIL-2R]和溶菌酶)水平、CT表现和检查技术作为诊断的预测标志物。
37例患者中,32例接受了EBUS-TBNA和TBLB,其余5例仅接受了EBUS-TBNA。32例患者中16例(50.0%)经TBLB确诊,37例患者中31例(83.8%)经EBUS-TBNA确诊,所有患者经TBLB和EBUS-TBNA联合确诊(100.0%)。sIL-2R血清水平与EBUS-TBNA成功诊断相关,而ACE或溶菌酶血清水平则不然。
在Ⅰ/Ⅱ期结节病患者中,sIL-2R血清水平是预测EBUS-TBNA诊断并减轻额外TBLB负担及其可能并发症的一个有前景且有用的标志物。