背景：经支气管针吸活检术（TBNA）是一种诊断淋巴结（LN）腺病的微创手术。有或没有支气管内超声（EBUS）引导的TBNA对恶性LN肿大有很高的诊断率，但是诊断良性LN肿大的价值还没有得到彻底的研究。
方法：我们回顾性评估了3540例纵隔LN扩大患者接受TBNA治疗。纳入了166例良性纵隔淋巴结病患者，并对293例LN进行了活检。阳性结果定义为特定的组织学异常。常规TBNA（cTBNA）和EBUS-TBNA，以及cTBNA和经支气管钳活检（TBFB），进行了比较。亚组分析按疾病类型和LN大小分层。
结果：EBUS-TBNA的诊断为76.84％，cTBNA的诊断为61.31％（P<0.05）。两种肉芽肿的EBUS-TBNA均优于cTBNA（65.18％vs.45.45%,P<0.05）和非肉芽肿性疾病（96.92%vs.84.06%,P<0.05)。相比之下,对于LNs<20mm，EBUS-TBNA的诊断率高于cTBNA(79.44%vs.64.29%，P<0.05),但对于>20毫米的LN，差异很小。这些发现在一组接受cTBNA加EBUS-TBNA的独立患者中得到证实。cTBNA和TBFB的诊断结果没有差异，但当采用两种模式时，显着增加到76.67％。
结论：EBUS-TBNA是良性纵隔LN疾病的首选微创诊断方法。当EBUS不可用时,组合cTBNA和TBFB是安全且可行的替代方案。
BACKGROUND: Transbronchial needle aspiration (TBNA) is a minimally invasive procedure performed to diagnose lymph node (LN) adenopathy. TBNA with and without endobronchial ultrasound (EBUS) guidance has a high diagnostic yield for malignant LN enlargement, but the value for diagnosing benign LN enlargement has been less thoroughly investigated.
METHODS: We retrospectively evaluated 3540 patients with mediastinal LN enlargement who received TBNA. One hundred sixty-six patients with benign mediastinal lymphadenopathy were included and 293 LNs were biopsied. A positive result was defined as a specific histological abnormality. Conventional TBNA (cTBNA) and EBUS-TBNA, as well as cTBNA and transbronchial forceps biopsy (TBFB), were compared. The subgroup analysis was stratified by disease type and LN size.
RESULTS: A diagnosis was made in 76.84% of the EBUS-TBNA and 61.31% of the cTBNA (P < 0.05). EBUS-TBNA was superior to cTBNA for both granulomatous (65.18% vs. 45.45%, P < 0.05) and non-granulomatous disease (96.92% vs. 84.06%, P < 0.05). In contrast, the diagnostic yield of EBUS-TBNA was higher than that of cTBNA for LNs < 20 mm (79.44% vs. 64.29%, P < 0.05), but for LNs > 20 mm the difference was marginal. These findings were confirmed in a group of independent patients who received cTBNA plus EBUS-TBNA. The diagnostic yield did not differ between cTBNA and TBFB, but significantly increased to 76.67% when both modalities were employed.
CONCLUSIONS: EBUS-TBNA is the preferred minimally invasive diagnostic method for benign mediastinal LN disease. Combined cTBNA and TBFB is a safe and feasible alternative when EBUS is unavailable.
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