| 超声支气管镜引导下针吸活检术与常规支气管镜活检术对结节病诊断价值的比较 |
| |
| 引用本文： | 李慧,曹敏,徐庆庆,黄妹,李蕤,苗立云,肖永龙,孟凡青,蔡后荣,代静泓. 超声支气管镜引导下针吸活检术与常规支气管镜活检术对结节病诊断价值的比较[J]. 中华医学超声杂志(电子版), 2016, 13(2): 144-149. DOI: 10.3877/cma.j.issn.1672-6448.2016.02.013 |
| |
| 作者姓名： | 李慧 曹敏 徐庆庆 黄妹 李蕤 苗立云 肖永龙 孟凡青 蔡后荣 代静泓 |
| |
| 作者单位： | 1. 210008 南京大学医学院附属鼓楼医院呼吸科2. 210008 南京大学医学院附属鼓楼医院病理科 |
| |
| 摘 要： | 目的比较超声支气管镜引导下针吸活检术（EBUS-TBNA）与经支气管镜肺活检术（TBLB）以及支气管黏膜活检术（EBB）对结节病的诊断价值。 方法回顾性分析2010年1月至2015年1月南京大学医学院附属鼓楼医院收治的疑诊结节病患者78例。57例患者实施常规支气管镜活检术（TBLB或EBB），21例患者实施EBUS-TBNA。病理结果阳性为光镜下见非干酪样上皮细胞性肉芽肿形成。采用χ2检验比较2组患者诊断结节病的阳性率差异；采用Fisher确切概率法比较2组患者气胸发生率差异。 结果本组行TBLB或EBB的57例患者中，38例患者获得阳性病理结果，总体阳性率为66.6%（38/57）；5例患者TBLB后发生气胸，经吸氧后气胸自行吸收。行EBUS-TBNA的21例患者中，最终19例患者诊断为结节病，本组EBUS-TBNA诊断结节病的阳性率为90.4%（19/21），高于常规支气管镜活检术诊断结节病的阳性率66.6%，且差异有统计学意义（χ2=4.422，P<0.05）。EBUS-TBNA组无一例患者行EBUS-TBNA后发生气胸。2组患者气胸发生率差异无统计学意义（Fisher确切概率法，P=0.316）。21例患者实施EBUS-TBNA，共穿刺42个淋巴结，平均横径为（1.845±0.418）cm，每例患者对1~3个部位的淋巴结进行穿刺，每个淋巴结穿刺2~3次；20例患者组织病理学光镜下见非干酪样上皮细胞性肉芽肿形成，最终19例患者诊断为结节病；1例患者随访过程中，激素治疗无效，抗结核治疗有效，修正诊断为肺结核。 结论对临床疑诊的1期和2期结节病患者，选择横径1 cm以上的淋巴结进行穿刺，取得可见的组织病理学标本，EBUS-TBNA诊断结节病的阳性率高于常规支气管镜活检术。EBUS-TBNA诊断结节病安全性、准确性、阳性率高，可推荐作为临床1期和2期结节病的首选诊断技术。
|
| 关 键 词： | 超声支气管镜 结节病 淋巴结 |
| 收稿时间： | 2015-07-26 |
Diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration in pulmonary sarcoidosis compared with transbronchial lung biopsy and endobronchial biopsy |
| |
| Hui Li,Min Cao,Qingqing Xu,Mei Huang,Rui Li,Liyun Miao,Yonglong Xiao,Fanqing Meng,Hourong Cai,Jinghong Dai. Diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration in pulmonary sarcoidosis compared with transbronchial lung biopsy and endobronchial biopsy[J]. Chinese Journal of Medical Ultrasound, 2016, 13(2): 144-149. DOI: 10.3877/cma.j.issn.1672-6448.2016.02.013 |
| |
| Authors: | Hui Li Min Cao Qingqing Xu Mei Huang Rui Li Liyun Miao Yonglong Xiao Fanqing Meng Hourong Cai Jinghong Dai |
| |
| Affiliation: | 1. Department of Respiratory Medicine, Nanjing Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing 210008, China2. Department of Pathology, Nanjing Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing 210008, China |
| |
| Abstract: | ObjectiveTo compare the diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and traditional diagnostic approaches of transbronchial lung biopsy (TBLB) and endobronchial biopsy (EBB) in pulmonary sarcoidosis. MethodsTotally 78 patients with clinically and radiographically suspected sarcoidosis in Nanjing Drum Tower Hospital affiliated to Medical School of Nanjing University from January 2010 to January 2015 were retrospectively analyzed. Of them, 57 underwent EBUS-TBNA and 21 underwent traditional diagnostic approaches of TBLB or EBB. Presence of non-caseating epithelioid cell was pathologic evidence of sarcoidosis. ResultsAmong 57 patients who underwent TBLB or EBB, 38 patients had positive pathologic results. The sensitivity of TBLB/EBB was 66.6% (38/57). Five patients had pneumothorax after TBLB. At EBUS-TBNA, 42 mediastinal and hilar lymph nodes in 21 patients were aspirated. The average axis diameter was (1.845±0.418) cm. There were 20 patients with positive results. During follow-up, 19 patients had the final diagnosis of sarcoidosis and 1 patient was diagnosed as pulmonary tuberculosis. The sensitivity of EBUS-TBNA was 90.4% (19/21), which was significantly higher than that of traditional diagnostic approaches of TBLB or EBB. No major procedure-related complications were observed, which was no significant difference compared with traditional diagnostic approaches group (Fisher exact probability method, P=0.316). ConclusionEBUS-TBNA was a safe and effective method for diagnosing pulmonary sarcoidosis and should be considered as the first choice for the histopathologic diagnosis of stage Ⅰ and Ⅱ sarcoidosis. |
| |
| Keywords: | Endobronchial ultrasound Sarcoidosis Lymph nodes |
| 本文献已被 CNKI 等数据库收录！ |
| 点击此处可从《中华医学超声杂志(电子版)》浏览原始摘要信息 |
|
点击此处可从《中华医学超声杂志(电子版)》下载全文 |
|
