目的:支气管内超声引导下经支气管针吸活检术(EBUS-TBNA)是一种具有足够性能的诊断程序;然而,为晚期肺癌的治疗决策提供足够质量和数量的标本的能力可能有限,主要是由于血液污染。使用0.96毫米微型镊子活检(MFB)可以进行真实的组织学采样,但由此产生的小标本不适合预期的应用。因此,我们引入了1.9毫米标准大小的镊子活检(SFB),并将其实用性与MFB进行了比较。
方法:我们前瞻性招募了来自三个机构的患者,这些患者表现为肺门/纵隔淋巴结肿大和疑似晚期肺癌,或已确诊但需要额外组织标本进行生物标志物分析的患者.每位患者在同一淋巴结(LN)上使用22号针通过TBNA产生的管道进行了3或4次MFB,然后进行SFB。两名病理学家使用虚拟载玻片系统评估每个标本的质量和大小,并比较MFB和SFB组的诊断性能。
结果:在60名患者中,70.0%被诊断为腺癌。最常见的目标部位是下气管旁LN,其次是叶间LN。TBNA的诊断产量,MFB和SFB分别为91.7%,93.3%和96.7%,分别。SFB组优质标本的采样率明显高于对照组。此外,SFB的平均样本量是MFB的三倍。
结论:SFB可用于获得足够的定性和定量标本。
OBJECTIVE: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a diagnostic procedure with adequate performance; however, its ability to provide specimens of sufficient quality and quantity for treatment decision-making in advanced-stage lung cancer may be limited, primarily due to blood contamination. The use of a 0.96-mm miniforceps biopsy (MFB) permits true histological sampling, but the resulting small specimens are unsuitable for the intended applications. Therefore, we introduced a 1.9-mm standard-sized forceps biopsy (SFB) and compared its utility to that of MFB.
METHODS: We prospectively enrolled patients from three institutions who presented with hilar/mediastinal lymphadenopathy and suspected advanced-stage lung cancer, or those who were already diagnosed but required additional tissue specimens for biomarker analysis. Each patient underwent MFB followed by SFB three or four times through the tract created by TBNA using a 22-gauge needle on the same lymph node (LN). Two pathologists assessed the quality and size of each specimen using a virtual slide system, and diagnostic performance was compared between the MFB and SFB groups.
RESULTS: Among the 60 enrolled patients, 70.0% were diagnosed with adenocarcinoma. The most frequently targeted sites were the lower paratracheal LNs, followed by the interlobar LNs. The diagnostic yields of TBNA, MFB and SFB were 91.7%, 93.3% and 96.7%, respectively. The sampling rate of high-quality specimens was significantly higher in the SFB group. Moreover, the mean specimen size for SFB was three times larger than for MFB.
CONCLUSIONS: SFB is useful for obtaining sufficient qualitative and quantitative specimens.