内镜超声引导下细针抽吸术（EUS-FNA）和 Gene Xpert 的作用。

Role of endoscopic ultrasound guided fine needle aspiration (EUS-FNA) and Gene Xpert.

机构信息

Department of Gastroenterology, TNMC & BYL NAIR CH. Hospital, Mumbai, Maharashtra, India.

出版信息

Indian J Tuberc. 2024 Jul;71(3):262-268. doi: 10.1016/j.ijtb.2023.05.004. Epub 2023 May 5.

DOI:10.1016/j.ijtb.2023.05.004

PMID:39111933

Abstract

BACKGROUND

Mediastinal tubercular lymphadenitis is form of extrapulmonary tuberculosis [EPTB]. Clinical presentations are non-specific and diagnosis remains great clinical challenge. Microbiological and or histopathological evidences need to be present in order make diagnosis secure before initiation of anti-tubercular therapy (ATT). Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) provides tissue samples and aids management of this difficult to diagnosed entity. Current study describe role of EUS-FNA and Gene Xpert (GXP) in mediastinal tubercular lymphadenitis.

METHODS

Retrospective analysis of 72 patients with mediastinal lymphadenopathy who underwent EUS-FNA were carried out. Linear echoendoscope was used for evaluation mediastinum. EUS echo features of LNs were studied. Twenty two-G needle used was for aspiration tissue sample from pathologic lymph nodes (LNs). FNA samples were analysed by cytology, Acid-Fast Bacilli (AFB) staining and GXP study. All procedures were uneventful without any complications.

RESULTS

Forty two patients were diagnosed as tuberculosis (TB) following first EUS-FNA setting. Six patients underwent repeat EUS-FNA procedure following which another 3 were diagnosed as TB while remaining 3 started on empirical ATT based on additional supportive evidences. Forty five patients showed granulomatous inflammation on cytological analysis, AFB positivity noted in 16 (33.33%) patients while GXP in 26 (57.78%) patients. Rifampicin resistance detected in 3 ((6.25%) patients. All patients were followed clinico-radiologically for response to treatment.

CONCLUSION

Tuberculous lymphadenitis is the most common cause of mediastinal lymphadenopathy in TB endemic countries. EUS-FNA provides microbiological and histopathological/cytological evidences in this difficult to diagnosed EPTB and thereby avoids empirical ATT.

摘要

背景

纵隔结核性淋巴结炎是肺外结核[EPTB]的一种形式。临床表现不具特异性，诊断仍然是一大临床挑战。为了确保在开始抗结核治疗（ATT）之前做出安全的诊断，需要存在微生物学和/或组织病理学证据。内镜超声引导下细针抽吸（EUS-FNA）提供组织样本，并有助于诊断这种难以诊断的实体。本研究描述了 EUS-FNA 和 Gene Xpert（GXP）在纵隔结核性淋巴结炎中的作用。

方法

对 72 例纵隔淋巴结病行 EUS-FNA 的患者进行回顾性分析。线性回声内镜用于评估纵隔。研究淋巴结的 EUS 回声特征。使用 22-G 针从病理性淋巴结（LN）抽吸组织样本。FNA 样本通过细胞学、抗酸杆菌（AFB）染色和 GXP 研究进行分析。所有程序均顺利进行，无任何并发症。

结果

首次 EUS-FNA 检查后，42 例患者被诊断为结核病（TB）。6 例患者在重复 EUS-FNA 检查后，又有 3 例被诊断为 TB，而其余 3 例则根据其他支持性证据开始经验性 ATT。45 例患者的细胞学分析显示为肉芽肿性炎症，16 例（33.33%）患者 AFB 阳性，26 例（57.78%）患者 GXP 阳性。检测到 3 例（6.25%）患者利福平耐药。所有患者均进行临床和放射学随访，以评估治疗反应。