Department of Pulmonary Medicine, Center for Interstitial and Rare Lung Diseases, Ruhrlandklinik University Hospital Essen, Essen, Germany.
Department of Pulmonary Medicine, Section for Interventional Pneumology, Ruhrlandklinik University Hospital Essen, Tüschener Weg 40, 45239, Essen, Germany.
Lung. 2022 Oct;200(5):633-641. doi: 10.1007/s00408-022-00562-x. Epub 2022 Sep 1.
Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is a standard procedure in cases of enlarged mediastinal lymph nodes. Recently, new tools were developed aiming to improve the diagnostic yield. A novel crown-cut needle is considered to obtain tissue cores which can be beneficial for the evaluation by the pathologist. This study aimed to compare the novel 22G crown-cut needle with a conventional 22G needle with EBUS guidance in the diagnosis of sarcoidosis.
We designed a single-center prospective randomized clinical trial between March 2020 and January 2021 with 30 patients with mediastinal lymphadenopathy and suspected sarcoidosis.
24 patients (mean age 49.5 vs 54.1, mean FVC 73.7% vs 86.7%, mean DLCO 72.4% vs 72.5% for crown-cut needle vs conventional needle, respectively) were diagnosed with sarcoidosis. In the remaining six patients, sarcoidosis was reasonably excluded. The diagnostic yield for sarcoidosis was 77% with the crown-cut needle vs. 82% with the conventional needle (p > 0.05). In patients with histopathologic hallmarks typical of sarcoidosis (n = 19), the crown-cut needle was superior in detecting granulomas (8.3 vs 3.8 per cytoblock, p < 0.05) and histiocytes (502 vs 186 per cytoblock, p < 0.05). Four of seven bronchoscopists experienced difficulties passing through the bronchial wall with the crown-cut needle and one episode of bleeding occurred in this group which made interventions necessary.
Despite equivalence in diagnostic accuracy, the crown-cut needle was superior to the conventional needle in detecting granulomas and histiocytes. This indicates greater potential for obtaining higher quality sample material with the crown-cut needle in cases of granulomatous inflammation.
经支气管超声引导针吸活检术（EBUS-TBNA）是纵隔淋巴结肿大病例的标准程序。最近，开发了新的工具旨在提高诊断率。一种新型的冠切针被认为可以获得组织芯，这对病理学家的评估有益。本研究旨在比较新型 22G 冠切针与 EBUS 引导下的常规 22G 针在诊断结节病中的应用。
我们设计了一项单中心前瞻性随机临床试验，纳入 2020 年 3 月至 2021 年 1 月间 30 例纵隔淋巴结病和疑似结节病患者。
24 例患者（平均年龄分别为 49.5 岁和 54.1 岁，平均 FVC 分别为 73.7%和 86.7%，平均 DLCO 分别为 72.4%和 72.5%）被诊断为结节病。在其余 6 例患者中，合理排除了结节病。使用冠切针的诊断率为 77%，而常规针为 82%（p>0.05）。在具有典型结节病组织病理学特征的患者（n=19）中，冠切针在检测肉芽肿（每个细胞块分别为 8.3 个和 3.8 个，p<0.05）和组织细胞（每个细胞块分别为 502 个和 186 个，p<0.05）方面更具优势。7 位支气管镜医师中有 4 位在使用冠切针时遇到穿过支气管壁的困难，该组中有 1 例发生出血，需要进行干预。
尽管诊断准确性相当，但冠切针在检测肉芽肿和组织细胞方面优于常规针。这表明在肉芽肿性炎症病例中，冠切针更有可能获得更高质量的样本材料。
