在艾滋病毒和结核病负担较高的社区中，支气管内超声引导下经支气管针吸活检术的效用。

The utility of endobronchial ultrasound-guided transbronchial needle aspiration in a community with a high HIV and tuberculosis burden.

作者信息

Eknewir S, John T J, Bennji S M, Koegelenberg C F N

机构信息

Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.

出版信息

Afr J Thorac Crit Care Med. 2022 May 5;28(1). doi: 10.7196/AJTCCM.2022.v28i1.156. eCollection 2022.

DOI:10.7196/AJTCCM.2022.v28i1.156

PMID:35814170

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9255698/

Abstract

BACKGROUND

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become the gold standard in diagnosing and performing nodal staging in patients with suspected lung cancer and diagnosing other malignant and benign diseases. Studies from countries with low tuberculosis (TB) incidence suggest that it has a sensitivity of 90 - 95% and a specificity of 100%.

OBJECTIVES

To investigate the utility of EBUS-TBNA in a community with a high HIV and TB burden.

METHODS

We retrospectively reviewed all patients who underwent EBUS-TBNA to confirm a tissue diagnosis during a 2-year period from January 2017 - December 2018. Only patients with complete medical, pathology and radiology records and follow-up were included.

RESULTS

During the 2 years, a total of 201 patients underwent EBUS-TBNA. Some patients (n=19) had incomplete notes or follow-up and 104 cases were ultimately diagnosed with benign nodal disease. In the 182 patients who were ultimately included in the present study, EBUS-TBNA had a sensitivity of 95.1% (95% confidence interval (CI) 88.6 - 98.2), specificity of 100% (95% CI 94.20 - 100), positive predictive value (PPV) of 100.00% (95% CI 95.3 - 100) and negative predictive value (NPV) of 94.1% (95% CI 86.0 - 97.8) for all diagnoses. The overall diagnostic accuracy was 97.3% (95% CI 93.9 - 99.2). Out of the 64 patients who had lung cancer, EBUS-TBNA had a sensitivity of 95.2% (95% CI 86.7 - 99.0), specificity of 100% (95% CI 5.5 - 100), PPV of 100.0% and NPV of 58.3% (95% CI 31.7 - 80.9). The overall diagnostic accuracy for lung cancer was 95.5% (95% CI 87.2 - 99.1%).

CONCLUSION

EBUS-TBNA has high diagnostic accuracy, even in a population with a high HIV and TB burden.

摘要

背景

支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）已成为疑似肺癌患者进行淋巴结诊断和分期以及诊断其他恶性和良性疾病的金标准。来自结核病（TB）发病率低的国家的研究表明，其敏感性为90%-95%，特异性为100%。

目的

探讨EBUS-TBNA在艾滋病病毒（HIV）和结核病负担较高的社区中的应用价值。

方法

我们回顾性分析了2017年1月至2018年12月期间接受EBUS-TBNA以确诊组织病理学诊断的所有患者。仅纳入具有完整医疗、病理和放射学记录及随访资料的患者。

结果

在这2年期间，共有201例患者接受了EBUS-TBNA。部分患者（n=19）记录或随访不完整，104例最终被诊断为良性淋巴结疾病。在最终纳入本研究的182例患者中，EBUS-TBNA对所有诊断的敏感性为95.1%（95%置信区间（CI）88.6-98.2），特异性为100%（95%CI 94.20-100），阳性预测值（PPV）为100.00%（95%CI 95.3-100），阴性预测值（NPV）为94.1%（95%CI 86.0-97.8）。总体诊断准确率为97.3%（95%CI 93.9-99.2）。在64例肺癌患者中，EBUS-TBNA的敏感性为95.2%（95%CI 86.7-99.0），特异性为100%（95%CI 5.5-1至100），PPV为100.0%，NPV为58.3%（95%CI 31.7-80.9）。肺癌的总体诊断准确率为95.5%（至95%CI 87.2-99.1%）。