Real-time endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal and hilar lymph nodes
Real-time endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal and hilar lymph nodes
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DOI：
10.1378/chest.126.1.122
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发表时间：
2004-07-01
期刊：
影响因子：
9.6
通讯作者：
Fujisawa, T
中科院分区：
文献类型：
--
作者：
Yasufuku, K;Chiyo, M;Fujisawa, T
研究目的：虽然有多种技术可用于从纵隔淋巴结获得病理标本，包括传统的支气管镜经支气管穿刺穿刺（TBNA），经食管超声引导下的穿刺穿刺和纵隔镜检查，但这些技术存在局限性，包括低产量，不易进入，需要全身麻醉或并发症。为了克服这些问题，我们进行了本研究，以评估新开发的超声穿刺支气管镜在直接支气管超声（EBUS）引导下对纵隔和肺门淋巴结进行实时TBNA的临床应用价值。设计：前瞻性患者入组。单位：大学教学医院。患者：2002年3月至2003年9月共纳入70例患者。干预措施：新型凸面探头（CP） EBUS在其尖端集成了一个凸面扫描探头，具有单独的工作通道，从而允许实时EBUS引导的TBNA。CP-EBUS的适应症是诊断为已知或疑似恶性的纵隔和/或肝门淋巴结病变。首先用多普勒模式观察CP-EBUS的淋巴结和周围血管。记录淋巴结的尺寸，然后在EBUS直接引导下进行实时TBNA。最终诊断基于细胞学、手术结果和/或临床随访。结果：CP-EBUS对胸部CT扫描中发现的所有淋巴结均能显示。70例患者行cp - ebus引导下的TBNA，从纵隔淋巴结（58个）和肺门淋巴结（12个）获取样本。cp - ebus引导下TBNA区分良恶性淋巴结的敏感性、特异性和准确性分别为95.7%、100%和97.1%。手术过程很顺利，也没有并发症。结论：实时cp - ebus引导下纵隔及肺门淋巴结TBNA是一种安全、诊断率高的新方法。这种新型超声穿刺支气管镜在辅助介入支气管镜安全和准确诊断方面具有良好的潜力。
Study objectives: Although various techniques are available for obtaining pathology specimens from the mediastinal lymph nodes, including conventional bronchoscopic transbronchial needle aspiration (TBNA), transesophageal ultrasonography-guided needle aspiration, and mediastinoscopy, there are limitations to these techniques, which include low yield, poor access, need for general anesthesia, or complications. To overcome these problems, we undertook the current study to evaluate the clinical utility of the newly developed ultrasound puncture bronchoscope to visualize and perform real-time TBNA of the mediastinal and hilar lymph nodes under direct endobronchial ultrasonography (EBUS) guidance.Design: Prospective patient enrollment.Setting: University teaching hospital.Patients: From March 2002 to September 2003, 70 patients were included in the study.Interventions: The new convex probe (CP) EBUS is integrated with a convex scanning probe on its tip with a separate working channel, thus permitting real-time EBUS-guided TBNA. The indications for CP-EBUS were the diagnosis of mediastinal and/or hilar lymphadenopathy for known or suspected malignancy. Lymph nodes and the surrounding vessels were first visualized with CP-EBUS using the Doppler mode. The dimensions of the lymph nodes were recorded, followed by real-time TBNA under direct EBUS guidance. Final diagnosis was based on cytology, surgical results, and/or clinical follow-up.Results: All lymph nodes that were detected on the chest CT scan could be visualized using CP-EBUS. In 70 patients, CP-EBUS-guided TBNA was performed to obtain samples from mediastinal lymph nodes (58 nodes) and hilar lymph nodes (12 nodes). The sensitivity, specificity, and accuracy of CP-EBUS-guided TBNA in distinguishing benign from malignant lymph nodes were 95.7%, 100%, and 97.1%, respectively. The procedure was uneventful, and there were no complications.Conclusions: Real-time CP-EBUS-guided TBNA of mediastinal and hilar lymph nodes is a novel approach that is safe and has a good diagnostic yield. This new ultrasound puncture bronchoscope has an excellent potential for assisting in safe and accurate diagnostic interventional bronchoscopy.