Khan Muzamil, Diab Khalil
Department of Pulmonary Medicine, The George Washington University, School of Medicine and Health Sciences, Washington DC, USA.
Cureus. 2023 Aug 27;15(8):e44226. doi: 10.7759/cureus.44226. eCollection 2023 Aug.
Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) has proven to be highly accurate in lung cancer diagnosis and staging. However, its efficacy in diagnosing lymphoma, especially Hodgkin's lymphoma, remains controversial, mainly due to the need for larger biopsies for definitive diagnosis. This case study presents a 53-year-old HIV-positive man with a controlled viral load, who presented with a large left hilar mass and a left upper lobe nodule, both showing significant uptake on positron emission tomography scans. The patient underwent bronchoscopy with bronchoalveolar lavage, EBUS-TBNA using an Olympus™ Vizishot 2 needle (Center Valley, PA), and EBUS-guided transbronchial forceps biopsies (TBFB) of a left hilar lymph node using a 1.8 mm Boston Scientific™ forceps (Marlborough, MA). The EBUS-TBNA revealed granulomas, while the subsequent EBUS-guided TBFB revealed nodular lymphocyte-predominant Hodgkin's lymphoma. EBUS-TBFB may be a promising technique for obtaining larger tissue samples and enhancing diagnostic yield in cases of mediastinal lymphadenopathy with suspected lymphoma.
经支气管超声（EBUS）引导下经支气管针吸活检术（TBNA）在肺癌诊断和分期方面已被证明具有高度准确性。然而，其在诊断淋巴瘤，尤其是霍奇金淋巴瘤方面的疗效仍存在争议，主要是因为需要更大的活检组织来进行明确诊断。本病例研究介绍了一名53岁的HIV阳性男性，其病毒载量得到控制，该患者出现左肺门巨大肿块和左上叶结节，两者在正电子发射断层扫描中均显示有明显摄取。患者接受了支气管镜检查及支气管肺泡灌洗、使用奥林巴斯™Vizishot 2针（宾夕法尼亚州中心谷）进行EBUS-TBNA，以及使用1.8毫米波士顿科学™活检钳（马萨诸塞州马尔伯勒）对左肺门淋巴结进行EBUS引导下经支气管钳取活检（TBFB）。EBUS-TBNA显示为肉芽肿，而随后的EBUS引导下TBFB显示为结节性淋巴细胞为主型霍奇金淋巴瘤。对于疑似淋巴瘤的纵隔淋巴结肿大病例，EBUS引导下TBFB可能是一种获取更大组织样本并提高诊断率的有前景的技术。
