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

Diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration in pulmonary sarcoidosis compared with transbronchial lung biopsy and endobronchial biopsy

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（χ^2=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。

Objective To 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. Methods Totally 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. Results Among 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）. Conclusion EBUS-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.