超声支气管镜针吸活检术（EBUS-TBNA）与内镜超声引导下经支气管针吸活检术（EBUS-IFBTLP）诊断纵隔淋巴结病变的对比产量。
Comparative yield of EBUS-TBNA with EBUS-IFBTLP for diagnosis of mediastinal lymphadenopathy.
机构信息
Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Department of Respiratory and Critical Care Medicine, The Henan Provincial People's Hospital, Zhengzhou, Henan, China.
出版信息
Ther Adv Respir Dis. 2024 Jan-Dec;18:17534666241282217. doi: 10.1177/17534666241282217.
BACKGROUND
Patients with mediastinal lymph node enlargement (MLNE) are diagnosed depending on lymph node biopsy. Whereas, how to obtain larger tissue masses from mediastinal lymph nodes and improve the diagnostic yield of the disease remains to be investigated.
OBJECTIVES
Aiming to assess the diagnostic value of endobronchial ultrasound-guided intranodal forceps biopsy via transbronchial laser photoablation (EBUS-IFB-TLP) in patients with MLNE.
DESIGN
A prospective, self-controlled study.
METHODS
This study was conducted on 67 MLNE patients requiring a lymph node biopsy for diagnosis at the Henan Provincial People's Hospital and the Fuwai Central China Cardiovascular Hospital in China, from January 2020 to December 2022. Each patient underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA group) and EBUS-IFB-TLP (EBUS-IFB-TLP group) on the same mediastinal lymph node for biopsies. The operation time, diagnostic efficiency, and complication rates of the two biopsy methods were compared.
RESULTS
The number of diagnosed patients in the EBUS-IFB-TLP and the EBUS-TBNA groups was 65 (97.0%) and 57 (85.1%), respectively ( = 0.021). In the EBUS-IFB-TLP group, 28 cases (96.6%) were diagnosed with lung cancer and were classified into different epithelial types. In the EBUS-TBNA group, there were 27 cases (93.1%) diagnosed with lung cancer, of which 26 (89.7%) were classified into different epithelial types. There were 37 (97.4%) and 30 (78.9%) non-lung cancer patients diagnosed in the EBUS-IFB-TLP and EBUS-TBNA groups, respectively ( = 0.039), while 27 cases (96.4%) of sarcoidosis in the EBUS-IFB-TLP group and 20 cases (71.4%) of sarcoidosis in the EBUS-TBNA group were diagnosed ( = 0.016). The percentages of intraoperative mild to moderate bleeding complications were 23.9% (16/67) and 14.9% (10/67) in the EBUS-IFB-TLP and in the EBUS-TBNA groups, respectively ( = 0.109).
CONCLUSION
This study demonstrated that EBUS-IFB-TLP could be a feasible and effective method in the diagnosis of patients with MLNE, presenting an analogous safety profile compared with EBUS-TBNA. Further studies are needed to verify the diagnostic performance of EBUS-IFB-TLP for MLNE.
背景
纵隔淋巴结肿大（MLNE）患者的诊断取决于淋巴结活检。然而，如何从纵隔淋巴结中获得更大的组织块并提高疾病的诊断率仍有待研究。
目的
旨在评估经支气管超声引导下腔内活检针（EBUS-IFB）联合经支气管激光消融（TLP）在 MLNE 患者中的诊断价值。
设计
前瞻性、自身对照研究。
方法
本研究纳入了 2020 年 1 月至 2022 年 12 月期间在中国河南省人民医院和阜外华中心血管病医院需要进行纵隔淋巴结活检以明确诊断的 67 例 MLNE 患者。每位患者均在同一纵隔淋巴结上进行经支气管超声引导下经支气管针吸活检（EBUS-TBNA 组）和 EBUS-IFB-TLP（EBUS-IFB-TLP 组）活检。比较两种活检方法的操作时间、诊断效率和并发症发生率。
结果
EBUS-IFB-TLP 组和 EBUS-TBNA 组中诊断为患者的例数分别为 65 例（97.0%）和 57 例（85.1%）（ = 0.021）。EBUS-IFB-TLP 组中 28 例（96.6%）诊断为肺癌，并分为不同的上皮类型。EBUS-TBNA 组中，27 例（93.1%）诊断为肺癌，其中 26 例（89.7%）分为不同的上皮类型。EBUS-IFB-TLP 组和 EBUS-TBNA 组中分别有 37 例（97.4%）和 30 例（78.9%）非肺癌患者被诊断（ = 0.039），而 EBUS-IFB-TLP 组中有 27 例（96.4%）和 EBUS-TBNA 组中有 20 例（71.4%）诊断为结节病（ = 0.016）。EBUS-IFB-TLP 组中术中轻度至中度出血并发症的比例为 23.9%（16/67），EBUS-TBNA 组中为 14.9%（10/67）（ = 0.109）。
结论
本研究表明，EBUS-IFB-TLP 可作为 MLNE 患者的一种可行且有效的诊断方法，其安全性与 EBUS-TBNA 相当。需要进一步的研究来验证 EBUS-IFB-TLP 对 MLNE 的诊断性能。
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