A Randomized Controlled Trial of Standard vs Endobronchial Ultrasonography-Guided Transbronchial Needle Aspiration in Patients With Suspected Sarcoidosis
A Randomized Controlled Trial of Standard vs Endobronchial Ultrasonography-Guided Transbronchial Needle Aspiration in Patients With Suspected Sarcoidosis
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DOI：
10.1378/chest.08-2768
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发表时间：
2009-08-01
期刊：
影响因子：
9.6
通讯作者：
Field, Stephen K.
中科院分区：
文献类型：
--
作者：
Tremblay, Alain;Stather, David R.;Field, Stephen K.
背景资料：在恶性肿瘤的情况下，经支气管超声（EBUS）引导的经支气管针吸活检（TBNA）纵隔淋巴结比标准TBNA更准确。对于疑似结节病的患者，较小的超声针可能产生的材料不足以对肉芽肿性炎症进行组织学诊断。本研究的目的是比较EBUS引导下TBNA与标准19号针进行TBNA对纵隔淋巴结病和临床疑似结节病患者的诊断率。方法：在一所大学的医学中心进行了一项随机对照试验，招募了50名患者（在61例筛选的患者中，2例拒绝，9例不符合入选标准），患有肺门和/或纵隔淋巴结病，临床疑似结节病。24例患者随机接受EBUS引导的TBNA和26例接受TBNA使用标准的19-gauge needle.Results：诊断率的主要结局指标为53.8%对83.3%，EBUS引导的TBNA组绝对增加了29.5%（p < 0.05; 95%置信区间[CI]，8.6至55.4%）。在盲态研究病理学审查后，诊断率为73.1% vs 95.8%，EBUS引导TBNA组更有利，绝对增加22.1%（p = 0.05; 95% CI，1.9 - 42.2%）。标准TBNA组的敏感性和特异性分别为60.9%和100%，EBUS引导TBNA组的敏感性和特异性分别为8：3.3%和100（灵敏度的绝对增加，22.5%; p = 0.085; 95% CI，3.2 - 44.9%）。EBUS引导的TBNA的诊断率上级优于使用标准19-用于临床疑似结节病患者纵隔淋巴结取样的针规。（CHEST 2009; 136：340-346）
Background: Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) of mediastinal lymph nodes has been found to be more accurate than standard TBNA in the setting of malignancy. In patients with suspected sarcoidosis, the smaller ultrasound needle may yield inadequate material to make a histologic diagnosis of granulomatous inflammation. The aim of this study was to compare the diagnostic yield of EBUS-guided TBNA to TBNA performed with a standard 19-gauge needle in patients with mediastinal adenopathy and a clinical suspicion of sarcoidosis.Methods: A randomized controlled trial was performed in a university, medical center, enrolling 50 patients (of 61 screened, 2 declined, and 9 did not meet entry criteria) with hilar and/or mediastinal adenopathy and a clinical suspicion of sarcoidosis. Twenty-four patients were randomized to undergo EBUS-guided TBNA and 26 to undergo TBNA using a standard 19-gauge needle.Results: The primary outcome measure of diagnostic yield was 53.8% vs 83.3% in favor of the EBUS-guided TBNA group, an absolute increase of 29.5% (p < 0.05; 95% confidence interval [CI], 8.6 to 55.4%). After blinded research pathology review, diagnostic yield was 73.1% vs 95.8%, in favor of the EBUS-guided TBNA group, an absolute increase of 22.1% (p = 0.05; 95% CI, 1.9 to 42.2%). Sensitivity and specificity were 60.9% and 100%, respectively, in the standard TBNA group, and 8:3.3% and 100%, respectively, in the EBUS-guided TBNA group (absolute increase in sensitivity, 22.5%; p = 0.085; 95% CI, 3.2 to 44.9%).Conclusions: The diagnostic yield of EBUS-guided TBNA is superior to TBNA using standard 19-gauge needle for sampling of mediastinal lymph nodes in patients with a clinical suspicion of sarcoidosis. (CHEST 2009; 136:340-346)