Differentiating tuberculosis from sarcoidosis by sonographic characteristics of lymph nodes on endobronchial ultrasonography: A study of 165 patients
Differentiating tuberculosis from sarcoidosis by sonographic characteristics of lymph nodes on endobronchial ultrasonography: A study of 165 patients
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DOI：
10.1016/j.jtcvs.2014.01.028
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发表时间：
2014-08-01
影响因子：
6
通讯作者：
Gupta, Dheeraj
中科院分区：
文献类型：
--
作者：
Dhooria, Sahajal;Agarwal, Ritesh;Gupta, Dheeraj
目的：结节病和结核病的鉴别诊断是困难的，特别是在结核病负担高的国家。我们假设支气管内超声（EBUS）的超声特征有助于鉴别结核病和结节病。在这项研究中，结核病和结节病的内镜超声特征compared.Methods：这是一个前瞻性收集的数据进行EBUS引导下经支气管针吸活检（TBNA），并最终诊断为结节病或结核病的患者进行回顾性分析。超声特征，如大小、形状（圆形或椭圆形），边缘（明显或不明显），回声记录并比较两组的肺门结构（异质性或同质性）、有无中央肺门结构和凝固性坏死征。在研究期间，进行了249例EBUS引导的TBNA手术，165例患者诊断为结节病（n = 118）或结核病（n = 47）。共检查了358个淋巴结。结核性淋巴结的不均匀回声（53.4%比12.6%，P <0.001）和凝固性坏死（26.1%比3.3%; P <0.001）明显高于结核性淋巴结。结核菌素皮试阳性和不均匀回声或凝固性坏死征的结合对结核病的诊断特异性为98%，阳性预测值为91%。结论：EBUS淋巴结不均匀回声或凝固性坏死的超声特征对结核病具有较强的特异性。沿着TST阳性，这些特征更有利于结核病的诊断。
Objective: The differential diagnosis of sarcoidosis and tuberculosis is difficult, especially in countries with a high tuberculosis burden. We hypothesized that sonographic features on endobronchial ultrasonography (EBUS) would help in differentiating tuberculosis from sarcoidosis. In this study, the endosonographic features of tuberculosis and sarcoidosis are compared.Methods: This was a retrospective analysis of prospectively collected data of patients with intrathoracic lymphadenopathy who underwent EBUS-guided transbronchial needle aspiration (TBNA), and were finally diagnosed with sarcoidosis or tuberculosis. Sonographic features such as size, shape (round or oval), margin (distinct or indistinct), echogenicity (heterogeneous or homogeneous), presence or absence of a central hilar structure, and coagulation necrosis sign were recorded and compared in the 2 groups.Results: During the study period, 249 EBUS-guided TBNA procedures were performed and a diagnosis of sarcoidosis (n = 118) or tuberculosis (n = 47) was made in 165 patients. A total of 358 lymph node stations were examined. Heterogeneous echotexture (53.4% vs 12.6%, P < .001) and coagulation necrosis (26.1% vs 3.3%; P < .001) were significantly higher in tuberculous lymph nodes. A combination of a positive tuberculin skin test (TST) and either heterogeneous echotexture or coagulation necrosis sign had specificity of 98% and positive predictive value of 91% for a diagnosis of tuberculosis.Conclusions: Sonographic features of heterogeneous echotexture or coagulation necrosis in the lymph nodes on EBUS are fairly specific for tuberculosis. Along with a positive TST, these features strongly favor a diagnosis of tuberculosis over sarcoidosis.