纵隔的诊断方法及支气管镜检查在纵隔评估中的作用：一项叙述性综述
Diagnostic modalities in the mediastinum and the role of bronchoscopy in mediastinal assessment: a narrative review.
作者信息
Dollin Yonatan, Munoz Pineda Jorge A, Sung Lily, Hasteh Farnaz, Fortich Monica, Lopez Amanda, Van Nostrand Keriann, Patel Niral M, Miller Russell, Cheng George
机构信息
Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, San Diego, CA, USA.
Departement of Radiology, University of California San Diego, San Diego, CA, USA.
出版信息
Mediastinum. 2024 Dec 6;8:51. doi: 10.21037/med-24-32. eCollection 2024.
BACKGROUND AND OBJECTIVE
Diagnosis of pathology in the mediastinum has proven quite challenging, given the wide variability of both benign and malignant diseases that affect a diverse array of structures. This complexity has led to the development of many different non-invasive and invasive diagnostic modalities. Historically, diagnosis of the mediastinum has relied on different imaging modalities such as chest X-ray, computed tomography (CT), magnetic resonance imaging, and positron emission topography. Once a suspicious lesion was identified with one of these techniques, the gold standard for diagnosis was mediastinoscopy for diagnosis and staging of disease. More recently, many minimally invasive techniques such as CT-guided biopsy, endobronchial ultrasound with transbronchial needle aspiration, and endoscopic ultrasound with fine needle aspiration have revolutionized the diagnosis of the mediastinum. This review provides a comprehensive analysis of all the modalities available for diagnosing mediastinal disease with an emphasis on bronchoscopic techniques.
METHODS
Literature search was performed via the PubMed database. We included all types of articles and study designs, including original research, meta-analyses, reviews, and abstracts.
KEY CONTENT AND FINDINGS
Minimally invasive techniques such as endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound-fine needle aspiration (EUS-FNA) have demonstrated high diagnostic yield and low complication rate and have made a significant difference in the time to diagnosis and lives of patients. There continues to be innovation in the field of bronchoscopy with the development of new technologies such as confocal laser endomicroscopy, optical coherence tomography, and artificial intelligence.
CONCLUSIONS
Bronchoscopy is and will continue to be an integral modality in minimally invasive diagnosis of the mediastinum.
背景与目的
鉴于影响多种结构的良性和恶性疾病具有广泛的变异性，纵隔病变的诊断颇具挑战性。这种复杂性促使了许多不同的非侵入性和侵入性诊断方法的发展。从历史上看，纵隔疾病的诊断依赖于不同的成像方式，如胸部X线、计算机断层扫描（CT）、磁共振成像和正电子发射断层扫描。一旦通过这些技术之一发现可疑病变，疾病诊断和分期的金标准是纵隔镜检查。最近，许多微创技术，如CT引导下活检、支气管内超声引导下经支气管针吸活检以及内镜超声引导下细针穿刺活检，彻底改变了纵隔疾病的诊断方式。本综述对所有可用于诊断纵隔疾病的方法进行了全面分析，重点是支气管镜技术。
方法
通过PubMed数据库进行文献检索。我们纳入了所有类型的文章和研究设计，包括原创研究、荟萃分析、综述和摘要。
关键内容与发现
支气管内超声引导下经支气管针吸活检（EBUS-TBNA）和内镜超声引导下细针穿刺活检（EUS-FNA）等微创技术已显示出高诊断率和低并发症发生率，并在诊断时间和患者生命方面产生了重大影响。随着共聚焦激光显微内镜、光学相干断层扫描和人工智能等新技术的发展，支气管镜领域不断有创新。
结论
支气管镜检查过去是、将来也仍将是纵隔微创诊断中不可或缺的一种方法。
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