Bronchoscopic diagnosis of sarcoidosis
Bronchoscopic diagnosis of sarcoidosis
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DOI：
10.1183/09031936.97.10122722
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发表时间：
1997-12-01
影响因子：
24.3
通讯作者：
Burke, CM
中科院分区：
文献类型：
--
作者：
Leonard, C;Tormey, VJ;Burke, CM
经支气管肺活检（TBLB）、纵隔淋巴结经支气管针吸活检（TBNA）和支气管肺泡灌洗（BAL）通常在纤维支气管镜检查中进行。到目前为止，还没有关于在结节病的支气管镜检查中同时进行所有这三种手术的功效的数据。进行了一项前瞻性研究，比较 TBLB、TBNA 和 BAL 对具有结节病典型临床和放射学特征的患者的诊断率。连续 13 名临床和放射学特征符合 I 期和 II 期结节病的患者接受了 TBLB、TBNA 和 BAL 支气管镜检查。TBLB 在 13 名患者中，有 7 名发现非干酪性肉芽肿（结核杆菌和真菌染色和培养呈阴性），而13 名患者患有 TBNA（其中 4 名患者 TBLB 呈阴性），13 名患者中的 8 名具有典型的“结节病”BAL 结果，即 >12% 淋巴细胞和高 CD4+:CD8+ 淋巴细胞比率，结合 TBLB、TBNA 和 BAL 得出结节病诊断敏感性为 100%（12 名患者中的 12 名）。其余患者进行了非诊断性支气管镜检查，纵隔镜活检显示非霍奇金淋巴瘤，我们的数据表明，同时进行经支气管肺活检、经支气管针吸活检和支气管肺泡灌洗可在结节病的诊断中产生最佳结果。
Transbronchial lung biopsy (TBLB), transbronchial needle aspiration (TBNA) of mediastinal lymph nodes and bronchoalveolar lavage (BAL) are routinely performed at fibreoptic bronchoscopy. Up to the present time, no data have been available on the efficacy of performing all three of these procedures simultaneously in the bronchoscopic work-up of sarcoidosis. A prospective study was undertaken to compare the diagnostic yield from TBLB, TBNA and BAL in patients presenting with clinical and radiological features typical of sarcoidosis.Thirteen consecutive patients with clinical and radiological features consistent with stage I and II sarcoidosis underwent bronchoscopy with TBLB, TBNA and BAL.Noncaseating granulomata (stain and culture negative for tuberculosis bacilli and fungi) were found in seven of the 13 patients by TBLB, and in sis of the 13 patients hv TBNA (of which four patients had negative TBLB), Eight of the 13 patients had classical "sarcoid" BAL findings, i.e. >12% lymphocytes, and high CD4+:CD8+ lymphocyte ratio, Combining TBLB, TBNA and BAL gave a diagnostic sensitivity of 100% (12 out of 12 patients) for sarcoidosis. The remaining patient had nondiagnostic bronchoscopic studies and mediastinoscopy biopsy showed a non-Hodgkin's lymphoma,Our data suggest that performing simultaneous transbronchial lung biopsy, transbronchial needle aspiration and bronchoalveolar lavage produces optimal results in the diagnosis of sarcoidosis.