Endosonography-guided fine-needle aspiration in the diagnosis of sarcoidosis: a randomized study
Endosonography-guided fine-needle aspiration in the diagnosis of sarcoidosis: a randomized study
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DOI：
10.20452/pamw.3934
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发表时间：
2017-01-01
影响因子：
4.8
通讯作者：
Tomaszewska, Romana
中科院分区：
文献类型：
--
作者：
Kocon, Piotr;Szlubowski, Artur;Tomaszewska, Romana
前言结节病的诊断目前还没有被广泛接受的标准。结论本研究的目的是评估支气管内超声细针穿刺的相对诊断率（EBUS-FNA）和内镜超声细针抽吸（EUS-FNA），并将其与标准诊断技术，如支气管内活检（EBB），经支气管肺活检（TBLB），经支气管针吸（TBNA），和纵膈镜检查。患者和方法这是一项前瞻性随机研究，包括临床诊断为I期或II期结节病的连续患者。所有患者均在基线时进行EBB、TBLB和TBNA。随后，患者被随机分配至A组（EBUS-FNA）或B组（EUS-FNA）。接下来，进行交叉对照试验：A组中所有阴性结果的患者接受EUS-FNA，B组中所有阴性结果的患者接受EBUS-FNA。如果结节病没有得到证实，纵隔镜检查进行。结果我们招募了106例患者，其中100人可用于最终分析。标准内镜方法的总体敏感性和准确性分别为64%。当分别分析每种标准内镜检查方法时，12例患者（12%）的EBB确诊，42例患者（42%）的TBLB确诊，44例患者（44%）的TBNA确诊。结论EBUS-FNA和EUS-FNA的敏感性和准确性明显高于标准内镜检查方法，EBB+TBLB+TBNA的敏感性和准确性明显高于EBB+TBLB+TBNA（P = 0.0112 vs P = 0.0134）。此外，EUS-FNA的敏感性和准确性往往高于EBUS-FNA。
INTRODUCTION There are no widely accepted standards for the diagnosis of sarcoidosis.OBJECTIVES The aim of this study was to assess the relative diagnostic yield of endobronchial ultrasound fine-needle aspiration (EBUS-FNA) and endoscopic ultrasound fine-needle aspiration (EUS-FNA), and to compare them with standard diagnostic techniques such as endobronchial biopsy (EBB), transbronchial lung biopsy (TBLB), transbronchial needle aspiration (TBNA), and mediastinoscopy.PATIENTS AND METHODS This was a prospective randomized study including consecutive patients with clinical diagnosis of stage I or II sarcoidosis. EBB, TBLB, and TBNA were performed at baseline in all patients. Subsequently, patients were randomized to group A (EBUS-FNA) or group B (EUS-FNA). Next, a crossover control test was performed: all patients with negative results in group A underwent EUS-FNA and all patients with negative results in group B underwent EBUS-FNA. If sarcoidosis was not confirmed, mediastinoscopy was performed.RESULTS We enrolled 106 patients, of whom 100 were available for the final analysis. The overall sensitivity and accuracy of standard endoscopic methods were 64% each. When analyzing each of the standard endoscopic methods separately, the diagnosis was confirmed with EBB in 12 patients (12%), with TBLB in 42 patients (42%), and with TBNA in 44 patients (44%). The sensitivity and accuracy of each endosonographic technique were significantly higher than those of EBB+TBLB+TBNA (P = 0.0112 vs P = 0.0134).CONCLUSIONS The sensitivity and accuracy of EBUS-FNA and EUS-FNA are significantly higher than those of standard endoscopic methods. Moreover, the sensitivity and accuracy of EUS-FNA tend to be higher than those of EBUS-FNA.