Wang Zhongli, Xu Peng, Wan Nansheng, Feng Jing
Department of Respiratory and Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China.
Department of Respiratory and Critical Care Medicine, Shandong Second Provincial General Hospital, Jinan, Shandong, China.
Br J Hosp Med (Lond). 2024 Dec 30;85(12):1-19. doi: 10.12968/hmed.2024.0470. Epub 2024 Dec 9.
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the standard method for sampling mediastinal/hilar lymph node disease. However, the smaller samples obtained via needle aspiration have a lower diagnostic rate for benign compared to malignant diseases. The low diagnostic rates have been reported to be improved through using endobronchial ultrasound-guided intranodal forceps biopsy (EBUS-IFB), but the implementation of IFB presents technical challenges, as described with variable results in certain studies. The main objective of this study was to investigate the diagnostic value and safety of EBUS-IFB for mediastinal/hilar lymph node disease. A retrospective analysis was conducted on 150 patients with mediastinal/hilar lymph node disease at Tianjin Medical University General Hospital. EBUS-TBNA was performed using a rigid bronchoscope on the same lymph node of each patient under general anesthesia, with rapid on-site evaluation (ROSE) conducted to determine the presence of pathological tissue. Following this, a tunnel was established, and a 1.5 mm biopsy forceps was employed for EBUS-IFB. Subsequently, diagnostic rates and safety of the methods used were determined. EBUS-IFB + EBUS-TBNA (the combined strategy) exhibited the highest diagnostic rates, with the addition of bronchial mucosa biopsy/transbronchial lung biopsy/neoplasm biopsy contributing to a successful diagnostic rate of 97.2% (139/143). The combined strategy (90.2%) and EBUS-IFB alone (88.1%) contributed to successful diagnosis for all diseases, with rates significantly higher than that of EBUS-TBNA (60.1%) ( < 0.001). The diagnostic rates for malignant disease detected with the combined strategy (97.4%) and EBUS-IFB alone (93.6%) were significantly higher than that with EBUS-TBNA alone (71.8%) ( < 0.001). Both the diagnostic rates for sarcoidosis detected with the combined strategy and EBUS-IFB alone were 87.8%, which was significantly higher than that with EBUS-TBNA alone (46.9%) ( < 0.001). The procedures implemented did not engender major complications. Routine EBUS-TBNA followed by ROSE to acquire pathological tissue, followed by tunnel formation and EBUS-IFB, can enhance the overall diagnostic rate for mediastinal/hilar lymph node lesions. This approach is particularly valuable for diagnosing malignant diseases and sarcoidosis. EBUS-IFB serves as a safe and feasible complement to EBUS-TBNA, despite the fact that the procedure was extended in duration.
支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）是对纵隔/肺门淋巴结疾病进行取样的标准方法。然而，与恶性疾病相比，经针吸获得的较小样本对良性疾病的诊断率较低。据报道，通过使用支气管内超声引导下淋巴结内钳取活检术（EBUS-IFB）可提高低诊断率，但IFB的实施存在技术挑战，在某些研究中结果不一。本研究的主要目的是探讨EBUS-IFB对纵隔/肺门淋巴结疾病的诊断价值和安全性。对天津医科大学总医院150例纵隔/肺门淋巴结疾病患者进行了回顾性分析。在全身麻醉下，使用硬支气管镜对每位患者的同一淋巴结进行EBUS-TBNA，并进行快速现场评估（ROSE）以确定是否存在病理组织。在此之后，建立通道，并使用1.5毫米活检钳进行EBUS-IFB。随后，确定所使用方法的诊断率和安全性。EBUS-IFB+EBUS-TBNA（联合策略）的诊断率最高，加上支气管黏膜活检/经支气管肺活检/肿瘤活检后，成功诊断率为97.2%（139/143）。联合策略（90.2%）和单独使用EBUS-IFB（88.1%）对所有疾病的诊断成功率均显著高于EBUS-TBNA（60.1%）（<0.001）。联合策略（97.4%）和单独使用EBUS-IFB（93.6%）检测恶性疾病的诊断率显著高于单独使用EBUS-TBNA（71.8%）（<0.001）。联合策略和单独使用EBUS-IFB检测结节病的诊断率均为87.8%，显著高于单独使用EBUS-TBNA（46.9%）（<0.001）。所实施的操作未引发重大并发症。常规进行EBUS-TBNA后行ROSE获取病理组织，随后形成通道并进行EBUS-IFB，可提高纵隔/肺门淋巴结病变的总体诊断率。这种方法对诊断恶性疾病和结节病特别有价值。EBUS-IFB是EBUS-TBNA安全可行的补充方法，尽管该操作时间延长。
