Schenk D A, Chambers S L, Derdak S, Komadina K H, Pickard J S, Strollo P J, Lewis R E, Patefield A J, Henderson J H, Tomski S M
Department of Pulmonary/Critical Care Medicine, Wilford Hall U.S. Air Force Medical Center, Lackland Air Force Base, TX 78236-5300.
Am Rev Respir Dis. 1993 May;147(5):1251-8. doi: 10.1164/ajrccm/147.5.1251.
Transbronchial needle aspiration (TBNA) offers the unique opportunity to pathologically stage patients with lung cancer at the time of diagnostic bronchoscopy. The purpose of this study was to compare the staging sensitivities of the Wang 22-gauge and 19-gauge needles. We studied 64 patients with bronchogenic carcinoma and mediastinal adenopathy. Before bronchoscopy each patient underwent chest CT. Three to four aspirates were obtained with each needle from endotracheal sites adjacent to paratracheal lymphadenopathy. In 47 patients malignant mediastinal adenopathy was confirmed by the 19-gauge needle. A total of 29 patients had malignant 22-gauge needle aspirates. Of the 64 patients, 9 had benign, reactive mediastinal lymph nodes. There were 20 patients in whom only the 19-gauge needle demonstrated malignancy and 2 patients with malignant 22-gauge needle aspirates as the sole identifier of paratracheal malignancy. As a staging tool, the 19-gauge needle was significantly more sensitive than the 22-gauge needle, 85.5 versus 52.7% (p = 0.0001). Overall, in 49 of 55 patients (89.1%) with malignant mediastinal lymphadenopathy paratracheal tumor was confirmed by TBNA. The 19-gauge TBNA staging of the mediastinum is an effective, safe, and cost-saving alternative to surgical mediastinal exploration that can be performed during initial diagnostic bronchoscopy.
经支气管针吸活检术（TBNA）为在诊断性支气管镜检查时对肺癌患者进行病理分期提供了独特的机会。本研究的目的是比较王式22号针和19号针的分期敏感性。我们研究了64例患有支气管源性癌和纵隔淋巴结肿大的患者。在支气管镜检查前，每位患者均接受胸部CT检查。用每根针从气管旁淋巴结肿大附近的气管内部位获取三到四次针吸样本。19号针在47例患者中确诊为恶性纵隔淋巴结肿大。共有29例患者22号针针吸样本为恶性。在这64例患者中，9例有良性、反应性纵隔淋巴结。有20例患者仅19号针显示为恶性，2例患者22号针针吸样本为恶性是气管旁恶性肿瘤的唯一标识。作为一种分期工具，19号针的敏感性显著高于22号针，分别为85.5%和52.7%（p = 0.0001）。总体而言，在55例恶性纵隔淋巴结肿大患者中，49例（89.1%）通过TBNA确诊气管旁肿瘤。19号针TBNA对纵隔进行分期是一种有效、安全且节省成本的替代手术纵隔探查的方法，可在初次诊断性支气管镜检查时进行。
