经支气管针吸活检

自 1968年纤维支气管镜 (下称纤支镜 )应用于临床以来 ,对呼吸系统疾病的诊断和治疗起到非常重的作用 ,尤其在纤支镜下可直接窥见病变 ,通过活检、刷检或冲洗等手段进行病理、细胞等病原学检查 ,大多数患者都能得到明确诊断。然而 ,某些患者纤支镜检查不能直接窥见管腔外病变 ,这就给取材带来一定的困难。经支气管针吸活检 ( TBNA)是应用一种特制的带有可弯曲导管的穿刺针 ,通过纤支镜对气管、支气管腔外病变 ,如肿块、肿大淋巴结和管腔闭锁等病变进行经支气管壁针吸活检 ,获取标本进行细胞学或 (和 )病理学检查的一种新技术和新的方法。…     

经支气管镜针吸结合刷片和钳夹活检在支气管壁内和管壁外恶性病变的诊断价值

目的探讨经支气管镜针吸与刷片和钳夹活检技术联合,对支气管壁内和管壁外恶性病变进行病理取材的诊断价值。方法在胸部CT提示肺门、纵隔淋巴结肿大(大于1cm)合并肺部病变、纵隔肿物的32例患者,予常规纤维支气管镜检查经支气管镜针吸活检(TBNA)术并行刷检和钳检,对获取的标本进行细胞学及组织病理学检查。结果 32例最终均确诊为胸部恶性肿瘤,经支气管镜针吸活检(TBNA)、刷检、钳检的阳性检出率分别为59.4%、65.5%和40.0%,三者联合取材的阳性率84.4%(趋势检验χ~2=6.0,P值0.05)。所有患者均无明显的并发症。结论联合取材的方法安全、方便,还具有创伤小,阳性率高等优点,对胸部恶性肿瘤的诊断和分期判定有很大帮助。     

经纤维支气管镜不同取材方法对肺癌的诊断价值

目的评价纤维支气管镜(纤支镜)下不同取材方法对肺癌诊断的价值,探讨纤支镜下联合采用多种取材方法对肺癌诊断的临床意义。方法分析130例肺癌患者的纤支镜检查结果,比较钳检、刷检、经纤支镜肺活检(TBLB)、单纯经纤支镜针吸活检(TBNA)、支气管肺泡灌洗(BAL)及联合取材方法诊断肺癌的阳性率。结果 130例肺癌经纤支镜确诊122例,镜下分为六型:中央增生型、中央浸润型、中央外压型、中央正常型、周围增生浸润型、周围外压正常型;钳检、刷检、TBLB、TBNA、BAL的阳性率分别为83.33%、56.92%、50.00%、67.35%、42.31%,钳检阳性率明显高于另4种单一方法取材(P0.05);不同镜下类型分别采用刷检联合其他4种方法检查的总阳性率为93.85%(122/130),平均阳性率为89.99%;不同取材方法对不同镜下类型肺癌的检出不同。结论根据镜下特点的不同采取不同经纤支镜取材方法、重视钳检、积极开展TBLB、TBNA、联合多种取材方法可提高肺癌的病理学诊断率。     

纤维支气管镜下联合取材对肺癌的诊断价值

目的　探讨纤维支气管镜下联合取材对肺癌的诊断价值。方法　采用回顾性分析法 ,分别统计钳检、刷检、冲洗及针吸活检 4种不同取材方法对肺癌的检出情况。结果　确诊的 2 60例肺癌患者镜下分为四型 :增生型、浸润型、外压型、正常型 ;钳检、刷检、冲洗、针吸活检的阳性率分别为 83 7%、72 3 %、65 0 %、62 3 % ,联合后总阳性率为 93 8%。结论　纤维支气管镜对肺癌的诊断有重要价值 ;不同取材方法对镜下不同类型肺癌的诊断价值不同 ;4种取材方法中钳检的检出率最高 ,联合运用多种取材方法可明显提高肺癌的诊断准确率     

不同取材方法对病理诊断肺癌的价值回顾性分析

目的探讨不同取材方法对病理确诊肺癌的诊断价值。方法回顾性分析我科在2002-2006年8月间病理确诊为肺癌的临床资料。根据肺癌时取材方法不同进行分类统计和分析。取材方法分为胸膜活检法、胸水查脱落细胞、CT引导下经皮肺穿刺法、经纤维支气管镜（简称纤支镜）单纯钳夹活检、单纯刷检、钳夹活检加刷检、针吸活检、针吸活检加刷检、纤支镜肺活检（TBLB）、TBLB加“盲刷”、经纤支镜检查前后痰细胞学涂片。对其诊断肺癌的阳性率进行分析。结果按上述方法中所列顺序,其阳性率分别为35．71％、69．05％、100％、78．3％、52．08％、93．02％、32％、62．86％、30．77％、65．52％、19．06％、56．12％。结论根据肺癌情况不同,采取不同取材方法,对肺癌均有很高的诊断价值。联合不同取材方法比用单一取材方法诊断肺癌的阳性率高。     

超声内镜引导下经气管针吸活检的临床应用

超声内镜引导下经气管针吸活检在原发性支气管肺癌、肺转移癌的诊断与治疗以及结节病、纵隔肿瘤、肺内病变的诊断方面发挥了重要的作用.超声内镜引导下经气管针吸活检并发症少,特异性和敏感性高,是一项非常有用的检查手段.     

超声内镜引导下经气管针吸活检的临床应用

超声内镜引导下经气管针吸活检在原发性支气管肺癌、肺转移癌的诊断与治疗以及结节病、纵隔肿瘤、肺内病变的诊断方面发挥了重要的作用.超声内镜引导下经气管针吸活检并发症少,特异性和敏感性高,是一项非常有用的检查手段.     

超声内镜引导下经气管针吸活检的临床应用

超声内镜引导下经气管针吸活检在原发性支气管肺癌、肺转移癌的诊断与治疗以及结节病、纵隔肿瘤、肺内病变的诊断方面发挥了重要的作用.超声内镜引导下经气管针吸活检并发症少,特异性和敏感性高,是一项非常有用的检查手段.     

经气管镜针吸活检术和经气管镜超声引导针吸活检术在结节病诊断中的价值

目的探讨经气管镜针吸活检术（TBNA）和经气管镜超声引导针吸活检术（EBUS-TBNA）在结节病诊断中的价值。方法选取15例临床表现和胸部CT检查疑似结节病患者,同时行TBNA和纵隔镜检查。另选取20例疑似结节病的患者行EBUS-TBNA检查。结果 15例同时行TBNA和纵隔镜检查患者中诊断为结节病的12例,TBNA诊断阳性率83.33%（10/12）;20例行EBUS-TBNA患者中诊断为结节病的18例,EBUS-TBNA诊断阳性率为88.89%（16/18）。结论 EBUS-TBNA和TBNA创伤性小、安全性好,在结节病的诊断中有较高的应用价值。     

多种手段在肺部肿瘤诊断中的应用分析

目的探讨纤维支气管镜(纤支镜)刷检/针吸/活检、肺穿刺组织病理学/细胞学与痰液细胞学在肺部肿瘤诊断中的应用。方法纤支镜在病变部位刷片、针吸或活检;CT引导下肺部病变部位穿刺;取晨痰或新鲜痰液涂片作细胞学检查。结果本组617例患者,经临床或病理学确诊为肺癌患者525例,应用纤支镜、肺穿刺及痰液细胞学诊断肺癌432例,占82.3%;其中纤支镜刷检/针吸/活检阳性318例,占60.6%;肺穿刺阳性108例,占20.6%;痰液细胞学阳性104例,占19.8%(其中痰液细胞学单独阳性者6例,占1.1%)。结论纤维支气管镜刷检/针吸/活检与CT引导下肺穿刺组织病理学/细胞学检查,在肺部肿瘤的诊断中有重要的应用价值;痰细胞学检查简便易行,可作为纤支镜检查阴性和不能耐受纤支镜检查的肺癌患者的补充手段,在肺部肿瘤的筛查中有重要的意义。多种手段联合检查,可进一步提高肺部肿瘤诊断的阳性率。     

多种技术联合应用对肺癌诊断的临床价值

目的评价多种技术联合应用对肺癌诊断的临床价值。方法 884例痰脱落细胞学、细菌学、常规支气管镜等检查均无阳性发现的疑似肺癌的患者行经支气管镜针吸活检术（TBNA）和活检刷检、经支气管镜超声引导针吸活检术（EBUS-TB-NA）、纵隔镜、超声或CT引导经皮肺穿刺活检术、PET-CT和内科电子胸腔镜胸膜活检术。结果 215例患者TBNA、刷检、活检的阳性率分别为81.58%、29.47%和16.84%。15例EBUS-TBNA的阳性率为91.67%,20例超声或CT引导经皮肺穿刺活检术阳性率为65%,10例PET-CT阳性率为80%,628例患者胸腔镜检查的总体阳性率为94.6%。结论多种技术联合应用可明显提高肺癌的早期诊断率。     

Real-time endobronchial ultrasound-guided transbronchial needle aspiration is useful for diagnosing sarcoidosis

BACKGROUND AND OBJECTIVE: Several studies of real-time endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) have reported a sensitivity of approximately 90% in the diagnosis of mediastinal and hilar malignancies. However, few studies have addressed its role in the diagnosis of sarcoidosis. The aim of the present study was to assess the utility of EBUS-TBNA in confirming a pathological diagnosis of sarcoidosis. METHODS: Fifteen consecutive patients with suspected sarcoidosis and mediastinal and/or hilar lymphadenopathy were investigated prospectively. EBUS-TBNA with an echo-bronchoscope and a dedicated echogenic 22-gauge needle was carried out in patients under conscious sedation, followed by conventional TBNA of the same lesion using a 19-gauge needle. RESULTS: EBUS-TBNA and/or TBNA demonstrated non-caseating epithelioid cell granulomas in 14 of 15 patients (93%). All 14 patients with a pathological diagnosis of sarcoidosis were considered to have sarcoidosis based on subsequent clinical assessments. The single patient with a negative EBUS-TBNA and TBNA had a malignant melanoma diagnosed following surgical biopsy. EBUS-TBNA confirmed a diagnosis of sarcoidosis in 13 of the 14 patients (93%) by identifying non-caseating epithelioid cell granulomas in 18 of 23 lymph nodes (78%) sampled. When two needle aspirates of one or two lymph nodes were carried out, the percentage positive pathological diagnosis for sarcoidosis for (i) EBUS-TBNA; (ii) TBNA; and (iii) the combination of EBUS-TBNA and TBNA were 93% (13 of 14 patients), 93% (13 of 14 patients) and 100% (14 of 14 patients), respectively. There were no complications associated with the procedures. CONCLUSION: EBUS-TBNA is less invasive and acceptably sensitive as a method for obtaining pathological confirmation of sarcoidosis.     

超声支气管镜引导下经支气管针吸活检70例临床分析

目的 评价超声支气管镜引导下的经支气管针吸活检(EBUS-TBNA)对纵隔和肺门淋巴结肿大和肺内肿块的诊断价值和安全性.方法 对2009年7月至2010年1月上海市肺科医院胸部CT检查显示胸腔内肿物和(或)纵隔-肺门淋巴结肿大的门诊或住院患者行EBUS-TBNA,观察诊治效果.结果 入选患者70例,男47例,女23例,年龄22～84岁,平均55.7岁.其中门诊患者25例,住院患者45例.穿刺肺门淋巴结120组,肺内肿块11例次.70例患者中,在没有采用现场细胞学诊断的条件下,46例初诊肺癌患者通过EBUS-TBNA明确诊断44例,假阴性2例,诊断肺癌的敏感度为96%,特异度为100%,阳性预测值为100%,阴性预测值为92%,准确率为97%;10例临床诊断为结节病的患者中,5例镜下可见上皮细胞形成的非干酪样肉芽肿改变;4例结核患者中,1例淋巴结涂片中找到抗酸杆菌,淋巴结活枪病理示凝固性坏死.所有患者手术期间未发生并发症.结论 EBUS-TBNA是诊断肺癌和其他不明因纵隔-肺门淋巴结肿大的一种安全、有效的方法.     

Transbronchial and transoesophageal (ultrasound-guided) needle aspirations for the analysis of mediastinal lesions.

A tissue diagnosis of mediastinal nodes is frequently needed for accurate lung cancer staging as well as the assessment of mediastinal masses. Transbronchial needle aspiration (TBNA) is a safe procedure that is performed during routine bronchoscopy. Provided mediastinal metastases are confirmed, TBNA has a high impact on patient management. Unfortunately, TBNA remains underused in current daily practice, mainly due to the lack of real-time needle visualisation. The introduction of echo-endoscopes has overcome this problem. Endobronchial ultrasound-guided TBNA (EBUS-TBNA) allows real-time controlled tissue sampling of paratracheal, subcarinal and hilar lymph nodes. Mediastinal lymph nodes located adjacent to the oesophagus can be assessed by transoesophageal ultrasound-guided fine needle aspiration (EUS-FNA). Owing to the complementary reach of EBUS-TBNA and EUS-FNA in assessing different regions of the mediastinum, recent studies suggest that complete and accurate mediastinal staging can be achieved by the combination of both procedures. It is expected that implementation of minimally invasive endoscopic methods of endobronchial ultrasound-guided transbronchial needle aspiration and transoesophageal ultrasound-guided fine needle aspiration will reduce the need for surgical staging of lung cancer significantly.     

Combination of endobronchial ultrasound-guided transbronchial needle aspiration with standard bronchoscopic techniques for the diagnosis of stage I and stage II pulmonary sarcoidosis

Background and objective: Standard bronchoscopic techniques (transbronchial lung biopsy and endobronchial biopsy) provide a diagnosis in 70% of patients with pulmonary sarcoidosis. Previous data suggest that endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) has a high sensitivity in patients with sarcoidosis. The feasibility and utility of combining EBUS‐TBNA with standard bronchoscopic techniques is unknown. The aim of this study was to evaluate the feasibility, safety and efficacy of combined EBUS‐TBNA and standard bronchoscopic techniques in patients with suspected sarcoidosis and enlarged mediastinal or hilar lymphadenopathy. Methods: Forty consecutive patients with suspected pulmonary sarcoidosis and enlarged mediastinal or hilar lymph nodes (radiographical stage I and stage II) underwent EBUS‐TBNA followed by transbronchial biopsies and endobronchial biopsies under conscious sedation. Results: Thirty‐nine out of 40 patients successfully underwent combined EBUS‐TBNA and standard bronchoscopy. Twenty‐seven patients were diagnosed with sarcoidosis, eight had tuberculosis, two had reactive lymphadenopathy, two had lymphoma and one had metastatic adenocarcinoma. In patients with sarcoidosis, the sensitivity of EBUS‐TBNA for detection of non‐caseating granulomas was 85%, compared with a sensitivity of 35% for standard bronchoscopic techniques (P < 0.001). The diagnostic yield of combined EBUS‐TBNA and bronchoscopy was 93% (P < 0.0001). Conclusions: Combination of EBUS‐TBNA with standard bronchoscopic techniques is safe and feasible, and optimizes the diagnostic yield in patients with pulmonary sarcoidosis and enlarged intrathoracic lymphadenopathy.     

常规经支气管镜针吸活检与超声引导下经支气管镜针吸活检对纵隔病变诊断的比较

目的 比较常规经支气管镜针吸活检(TBNA)和超声引导下经支气管镜肺活检(EBUS-TBNA)在同等条件下对纵隔病变的诊断的准确率及并发症的发生率等.方法 收集2008年10月至2009年10月广东省顺德第一人民医院呼吸科因胸部CT提示纵隔病变进行活检的患者95例,其中男65例,女30例,年龄13～85岁,平均(56±16)岁.所有患者于局部麻醉下行支气管镜,对172组纵隔病变先进行常规TBNA,后进行EBUS-TBNA,比较两者穿刺活检的阳性率、组织标本获取率及血管损伤率.结果 95例中确诊为恶性病变者71例,其中常规TBNA确诊65例,诊断阳性率为92%;EBUS-TBNA确诊68例,诊断阳性率为96%.172组病灶中,常规TBNA穿刺阳性结果为108组,总阳性率为63%(108/172),而EBUS-TBNA阳性结果为112组,总阳性率为65%(112/172).常规TBNA和EBUS-TBNA对纵隔良、恶性病变的诊断无明显差异,但EBUS-TBNA获取组织标本的成功率(39/95)高于常规TBNA(22/95).常规TBNA误伤血管7例,略高于EBUS-TBNA(3例).但差异无统计学意义.结论 在熟练掌握操作技术和方法后,两种方法均可获得满意的穿刺结果,操作者可选择性应用两种方法,做到优势互补.

Abstract：

Objective To compare the diagnostical yields and complication of conventional transbronchial needle aspiration ( TBNA ) and endobronchial ultrasound guided transbronchial needle aspiration ( EBUS-TBNA ) for the mediastium lesions under the same condition. Method Ninty-five patients with mediastinal lesions on chest CT were included. Bronchoscopy was performed under the local anesthesia, TBNA, EBUS-TBNA performed sequentially as a single combined procedure. Results Of the71 patients comfirmed to be malignant, the positive rate of TBNA was 92% ( 65/71 ), and 96% ( 68/71 )by EBUS-TBNA. There was no difference in malignant and benign lesions between conventional TBNA and EBUS-TBNA, but the success rate for obtaining adequate samples was higher by EBUS-TBNA ( 39/95 ) as compared to TBNA( 22/95 ). Accidental injury of the blood vessels occurred in 7 cases by TBNA as compared to 3 cases by EBUS-TBNA, but the difference was not significant. Conclusion Satisfactory diagnostic yields can be obtained by either conventional TBNA or EBUS-TBNA in skilled hands.     

Endobronchial ultrasound-guided transbronchial needle aspiration

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an advance in bronchoscopy. It is a staging tool for nonsmall cell lung cancer (NSCLC) but also allows diagnosis of unexplained mediastinal lymphadenopathy due to malignant and benign disease. It is a minimally invasive procedure that is used to stage suspected NSCLC with hilar nodes, discrete N2 or N3 disease, or bulky mediastinal disease. After a negative EBUS-TBNA result, if the pretest probability of lung cancer is high, a mediastinoscopy is still recommended, although in the light of recent trial data this is likely to change. EBUS-TBNA is expensive, which may limit its development in resource-rationed health care systems. Conventional (without ultrasound) transbronchial needle aspiration (TBNA) still has a useful role in lung cancer staging, especially where EBUS-TBNA is not available; it can help avoid unnecessary mediastinoscopies.     

EBUS-TBNA相关并发症及其处理方法的研究进展

超声引导下经支气管针吸活检术(EBUS-TBNA)是近年来发展的新技术,气管内实时超声引导可提高经支气管针吸术对纵隔和肺门病变的诊断率,且安全性高.EBUS-TBNA目前主要用于肺癌的诊断、临床分期以及纵隔病变如结节病、结核的诊断,尚有报道其用于纵隔病变如纵隔囊肿、纵隔脓肿等的治疗.随着其应用范围的推广,相关的并发症报道也逐渐增多.本文将对EBUS-TBNA相关的并发症发生率、类别、危险因素、预防与处理等进行介绍,对相关文献进行回顾.     

Endobronchial ultrasound for the diagnosis of pulmonary sarcoidosis

BACKGROUND: The diagnosis of pulmonary sarcoidosis can be established by a variety of techniques. Transbronchial lung biopsy is often the preferred approach, but it is frequently nondiagnostic and carries a risk of pneumothorax and bleeding. Mediastinoscopy is often suggested as the next diagnostic step but entails significant cost and associated morbidity. Endobronchial ultrasound (EBUS) with transbronchial needle aspiration (TBNA) is emerging as a safe, minimally invasive tool for the primary diagnosis of mediastinal and hilar lymphadenopathy. The purpose of this study was to assess the utility of EBUS-TBNA for pulmonary sarcoidosis. METHODS: Fifty consecutive patients who had been referred for EBUS-TBNA for suspected pulmonary sarcoidosis were included in the study. On-site cytology was used to assess the adequacy of the samples. The presence of noncaseating granulomas without necrosis in the appropriate clinical setting was deemed to be adequate for the diagnosis of pulmonary sarcoidosis. Patients with a negative EBUS-TBNA underwent further histologic biopsy or clinical follow-up to determine the final diagnosis. RESULTS: Eighty-two lymph nodes with a median size of 16 mm (range, 4 to 40 mm) were punctured. EBUS-TBNA demonstrated noncaseating granulomas without necrosis in 41 of 48 patients (85%) with a final diagnosis of sarcoidosis. EBUS-TBNA, therefore, has a sensitivity of 85% for the primary diagnosis of pulmonary sarcoidosis. CONCLUSIONS: EBUS-TBNA is a safe, minimally invasive tool for the primary diagnosis of pulmonary sarcoidosis that has a high diagnostic yield. EBUS-TBNA should be considered an appropriate alternative diagnostic technique for patients with suspected pulmonary sarcoidosis.