超声引导下经支气管镜针吸活检对结节病的诊断价值

Diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration in pulmonary sarcoidosis

目的 观察超声引导下经支气管镜针吸活检（EBUS-TBNA）对结节病的诊断价值.方法 回顾性分析2010年8月至2011年10月北京大学第一医院因不明原因纵隔淋巴结肿大行EBUS-TBNA的107例患者,其中17例确诊为结节病,其中男2例,女15例,年龄24 ～ 70岁,中位年龄55岁.比较常规支气管镜和EBUS-TBNA的诊断阳性率,观察穿刺针数和阳性率间的关系.结果 经病理诊断确诊结节病的17例患者中,14例针吸涂片阳性;常规支气管镜检查阳性8例（8/17）,常规支气管镜与EBUS-TBNA相结合共确诊15例患者.直径＜2 cm淋巴结穿刺阳性者3例,≥2 cm的淋巴结穿刺阳性者15例.每个淋巴结穿刺4针时细胞学检查结果与最终结果的符合率为100％.结论 EBUS-TBNA诊断结节病安全有效.对于怀疑结节病的患者需要选择肿大最明显的淋巴结进行穿刺,每个淋巴结穿刺4针可以得到足够的标本.

Objective The aim of this study was to observe the diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration （EBUS-TBNA） in sarcoidosis.Methods We retrospectively analyzed the diagnostic efficiency of standard bronchoscopy and EBUS-TBNA in all patients diagnosed as sarcoidosis in Peking University First Hospitals between August 2010 and October 2011.The relationship between biopsy puncture numbers and sensitivity was calculated.Results There were 17 sarcoidosis patients among a total of 107 patients who had received EBUS-TBNA.Forteen patients had a positive TBNA result and the sensitive of EBUS-TBNA was 82％.The sensitivity of standard brochoscopy was 53％ and when combined with EBUS-TBNA,the sensitivity increased to 88％.The sensitivity of EBUS-TBNA was associated with the size of lymph nodes.Lymph nodes with a diameter ≥2 cm showed a higher positive rate.Four punctures for 1 lymph node showed a concordance rate of 100％ with the final results.Conclusions EBUS-TBNA was a safe and effective method in diagnosing pulmonary sarcoidosis.For patients with suspected sarcoidosis EBUS-TBNA should be performed in the largest lymph nodes with at least 4 punctures.