气管内超声引导下针吸活检术联合经支气管镜肺活检术对肺结节病诊断效能的分析

Diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration combined with transbronchial lung biopsy in pulmonary sarcoidosis

目的:评估气管内超声引导下针吸活检术(EBUS-TBNA)联合经支气管镜肺活检术(TBLB)对肺结节病的诊断效能。方法:回顾性分析2018年1月至2023年7月就诊于东南大学附属中大医院高度疑诊为肺结节病患者的临床资料,所有患者均取得病理结果并结合临床综合评估最终诊断明确。评价EBUS-TBNA联合TBLB诊断肺结节病的效能以及弹性成像在诊断中的作用,并探讨胸部CT对于肺结节病分期的价值。结果:在131例高度疑诊为肺结节病的患者中,最终明确诊断为肺结节病的患者共有123例。其中105例患者单用EBUS-TBNA获得阳性的病理结果(阳性率为80.2%),58例患者通过单用TBLB获得阳性的病理结果(阳性率为44.3%);两者联合使用的诊断阳性率是89.3%。131例患者均进行胸部CT分期,其中Ⅰ期患者78例,Ⅱ期患者53例。在通过EBUS-TBNA及TBLB最终明确病理诊断后,根据是否出现上皮样肉芽肿浸润这一表现定义累及范围,发现根据胸部CT分类为Ⅰ期的患者中38.5%肺实质中检出上皮样肉芽肿浸润。结论:EBUS-TBNA联合TBLB可明显提高对肺结节病的诊断效能。单纯依靠胸部CT扫描进行肺结节病的分期并不可靠,会导致对患者病情严重程度估计不足。建议使用EBUS-TBNA诊断可疑结节病时,即使没有肺部浸润,也推荐常规联合TBLB,可以进一步提高诊断率和更充分地评估病情。

Objective:To evaluate the diagnostic yield of EBUS-TBNA combined with TBLB in pulmonary sarcoidosis.Methods:The clinical data of pulmonary sarcoidosis patients admitted to Zhongda Hospital affiliated to Southeast University were retrospectively analyzed from January 2018 to July 2023.All subjects were confirmed by combined pathological and clinical results.The diagnostic yield of EBUS-TBNA combined with TBLB in pulmonary sarcoidosis was evaluated,and the value of elastography in qualitative diagnosis of enlarged lymph nodes was assessed,and the accuracy of staging in pulmonary sarcoidosis by chest CT was explored.Results:Among 131 patients with highly suspected pulmonary sarcoidosis,123 patients were finally diagnosed.105 patients received positive pathological results using EBUS-TBNA alone and 58 patients were confirmed only by TBLB.Chest CT staging was performed in all patients.According to pathological results,38.5%of patients classified by CT as stage I were found to have epithelioid granuloma infiltration in the lung parenchyma.Conclusion:EBUS-TBNA combined with TBLB can significantly improve the diagnostic efficiency for pulmonary sarcoidosis.Chest CT scans are not reliable in staging pulmonary sarcoidosis,and often underestimate the severity of the disease.For improving the diagnostic yield of suspected sarcoidosis patients,we recommend to combine EBUS-TBNA with TBLB during bronchoscopy operation.