Mi Song, Cui Na, Wang Jing, Zhang Liming, Huang Kewu
Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
Diagn Cytopathol. 2025 Feb;53(2):83-90. doi: 10.1002/dc.25418. Epub 2024 Dec 2.
The value of lymphocyte profiling (LP) in mediastinal lymph nodes for the differential diagnosis of sarcoidosis has not been extensively studied, and existing literature presents mixed results.
This was a prospective study of patients with intrathoracic lymphadenopathy who underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). LP in lymph node puncture fluid (LNPF) was evaluated using flow cytometry. The results of LP in sarcoidosis patients were compared with tuberculous lymphadenitis (TBLA) patients. Receiver operating characteristic (ROC) analysis was performed to determine the optimal cut-offs of the statistically significant parameters for screening for sarcoidosis. Based on the optimal cut-offs and the final diagnosis of sarcoidosis and TBLA, the sensitivity, specificity, and accuracy of every statistically significant parameter and different combinations of the above three parameters were calculated for the diagnosis of sarcoidosis.
Forty-five cases of sarcoidosis and 33 cases of TBLA were enrolled in this study. Compared with the LP in TBLA patients, in sarcoidosis patients, the proportion of CD4 T cells and CD4/CD8 ratio increased, and the proportion of CD8 T cells and natural killer (NK) cells decreased. Among all single parameters, the CD4/CD8 ratio had high diagnostic sensitivity (84.4%), specificity (81.8%), and accuracy (83.3%) for sarcoidosis. Among all the combinations of three parameters, the combination of CD4, CD8, and NKT/NK ratio had high diagnostic sensitivity (91.1%), specificity (84.8%), and accuracy (87.2%) for sarcoidosis.
Assessment of LP in LNPF may improve the differential diagnostic accuracy of sarcoidosis from TBLA and further strengthen the importance of LP in LNPF in the diagnostic workup of sarcoidosis.
纵隔淋巴结淋巴细胞谱分析（LP）在结节病鉴别诊断中的价值尚未得到广泛研究，现有文献结果不一。
这是一项对接受支气管内超声引导下经支气管针吸活检（EBUS-TBNA）的胸内淋巴结肿大患者的前瞻性研究。使用流式细胞术评估淋巴结穿刺液（LNPF）中的LP。将结节病患者的LP结果与结核性淋巴结炎（TBLA）患者进行比较。进行受试者操作特征（ROC）分析以确定用于筛查结节病的统计学显著参数的最佳临界值。根据最佳临界值以及结节病和TBLA的最终诊断结果，计算每个统计学显著参数以及上述三个参数的不同组合对结节病诊断的敏感性、特异性和准确性。
本研究纳入了45例结节病患者和33例TBLA患者。与TBLA患者的LP相比，结节病患者中CD4 T细胞比例和CD4/CD8比值升高，CD8 T细胞和自然杀伤（NK）细胞比例降低。在所有单一参数中，CD4/CD8比值对结节病具有较高的诊断敏感性（84.4%）、特异性（81.8%）和准确性（83.3%）。在所有三个参数的组合中，CD4、CD8和NKT/NK比值的组合对结节病具有较高的诊断敏感性（91.1%）、特异性（84.8%）和准确性（87.2%）。
评估LNPF中的LP可能提高结节病与TBLA的鉴别诊断准确性，并进一步强化LNPF中的LP在结节病诊断检查中的重要性。
