经支气管镜针吸活检术在肺门纵隔淋巴结核诊断中的作用

Transbronchial needle aspiration in diagnosis of trathoracic tuberculous lymphadenitis

摘要:

目的??肺门纵隔淋巴结肿大而无肺部病灶的患者明确诊断常极为困难，该研究总结经气管镜针吸活检术（TBNA）在结核引起的孤立性肺门纵隔淋巴结肿大病变诊断中的作用。方法?对行TBNA检查患者并最终诊断为结核性肺门纵隔淋巴结炎（TBLA）的患者进行回顾性分析。所有患者均进行临床评估和增强CT扫描，记录患者一般资料、病理结果和病原微生物学结果。结果?纳入44例患者，其中TBNA诊断为TBLA者42例（95.4%），2例通过其他方法确诊，仅根据细胞病理学结果有32例（72.7%）诊断为结核，其中1例（2.2%）痰涂片阳性，而结核菌培养显示22例（50.0%）培养阳性，经细胞病理学评价不能确诊的12例患者中10例结核培养阳性。细胞病理学检查联合结核分枝杆菌培养诊断率从72.7%提高到95.4%。结论?TBNA是一种诊断TBLA安全高效的一线方法。细胞病理学检查联合结核分枝杆菌培养提高了TBNA的阳性率。

Abstract:

Objective?To describe the diagnostic utility of transbronchial needle aspiration (TBNA) in patients with isolated intrathoracic lymphadenopathy due to tuberculosis (TB).?Methods?Patients with tuberculous lymphadenitis (TBLA) as the final diagnosis were retrospectively analyzed among patients in whom TBNA had been performed. All patients underwent routine clinical assessment and CT scan prior to TBNA. Demographic data, pathological findings, and microbiological results were recorded.?Results?Fourty-four patients were enrolled. TBNA diagnosed TB intrathoracic lympadenopathy in 42 (95.4 %) patients. In 2 patients, TBNA was not able to confirm a diagnosis and additional procedures were required. Cytopathological findings alone revealed TB in 32 (72.7 %) patients. One of the patients (2.2 %) was smear positive while microbiological investigations provided a positive culture of TB in 22 (50.0 %) patients. TB culture was positive in 10 of 12 patients in whom cytopathologic evaluation was not able to diagnose. Addition of mycobacterium culture to cytopathologic investigation has improved the diagnostic yield from 72.7 % to 95.4 %.?Conclusion?TBNA is a safe and effective first line investigation for evaluating isolated intrathoracic tuberculous lympadenopathy. Addition of mycobacterium culture to cytopathologic investigation improves the sensitivity of TBNA.