Endobronşial ultrasonografi (EBUS) yapilan hastalarda ince iğne kapiller örneklemenin katkisi, randomize kontrollü çalişma
Küçük Resim Yok
Tarih
2025
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
İnönü Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Endobronşial ultrasonografi (EBUS) ile alınan örnekleme yöntemlerinde hala standart bir yöntem bulunmamaktadır. Bu nedenle çalışmamızda, EBUS ile mediastinal lenf nodları örneklemesinde transbronşial aspirasyonlu (EBUS-TBNA) ve ince iğne kapiller örnekleme (EBUS-TBNCS) yöntemini; yeterlilik, tanı ve süre yönlerinden karşılaştırmayı amaçladık. Yöntem ve Gereç: Prospektif, tek-kör ve randomize dizayn edilen çalışmamıza 2021-2024 tarihleri arasında, kliniğimizde mediastinal LAP etyolojisi aydınlatmak amacıyla EBUS işlemi yapılan hastalar dahil edildi. EBUS işlemi her lenf noduna TBNA ve TBNCS şeklinde her 2 yöntem kullanılarak yapıldı. Bulgular: Çalışmaya alınan 79 hastadan 114 tane örnekleme alındı. Yaş ortalaması 62,85 ± 11,27 olup, yaş aralığı 21 ile 85 arasında değişmekteydi. Hastaların %65,8'i erkek, %34,2'si kadınlardan oluşmaktaydı. En sık örnekleme yapılan lokalizasyonun 7. istasyon (%36,8) olduğu tespit edilmiştir. EBUS ile alınan örneklerde patolojik yeterlilik açısından EBUS-TBNA ile EBUS-TBNCS yöntemleri arasında istatistiksel olarak anlamlı fark yoktu (p=0.219). Alınan örneklerde patolojik yeterlilik açısından, 103'ü her ikisi için de yeterli, 5'i her ikisi için de yetersiz ve 6'sı uyumsuzdu; genel uyum %94,74 idi; Cohen'in Kappa'sı 0,599 idi ve orta uyumlu tanımlıyordu (%94,74; 95% CI (88,9-92,04), ? = 0,599). Tanısal olarak değerlendirdiğinde, 93'ü her ikisi için de tanısal, 7'si her ikisi için de tanısal değil ve 3'ü uyumsuzdu; genel olarak global uyum %97,09 idi; Cohen'in Kappa'sı 0,808 idi ve önemli uyum tanımlıyordu (%97,09; 95% CI (91,72-99,40), ? = 0,808). Ayrıca tanısal olarak yöntemler arasında istatistiksel olarak anlamlı fark yoktu (p=1). Ana tanı açısından mükemmele yakın uyum tespit edilmiştir (?=0,954, p<0,001). İşlem süreleri açısından EBUS-TBNA ortalama 4,28 ± 0,86 dakika, EBUS-TBNCS 3,07 ± 0,68 dakika olup, aralarında istatistiksel olarak anlamlı fark vardır (p<0,001). Sonuç: EBUS rehberliğinde TBNCS ek eleman gereksinimi olmaması daha kısa sürmesi nedenleriyle daha pratik ve eşit derecede etkili bir tekniktir. Tanı sonuçlarını etkilemediği ve işlem karmaşıklığından kurtardığı için klasik yöntem yerine tercih edilebilir. Anahtar kelimeler: EBUS, Aspirasyon, Kapiller örnekleme
Purpose: There is still no standard method for sampling techniques performed with endobronchial ultrasound (EBUS). Therefore, in our study, we aimed to compare transbronchial needle aspiration (EBUS-TBNA) and fine needle capillary sampling (EBUS-TBNCS) methods in mediastinal lymph node sampling using EBUS in terms of adequacy, diagnosis, and duration Material and methods: Patients who underwent EBUS in our clinic between 2021 and 2024 to elucidate the etiology of mediastinal LAP were included in our prospective, single-blind, and randomized study. EBUS was performed on each lymph node using both methods, TBNA and TBNCS. Results: A total of 114 samples were taken from 79 patients with pathological lymph nodes. The mean age of the patients was 62.85 ± 11.27 years, and the age range was between 21 and 85 years. 65.8% of the patients were male and 34.2% were female. The most frequent sampling localization was found to be the 7th station (36.8%). There was no statistically significant difference between EBUS-TBNA and EBUS-TBNCS methods in terms of pathological adequacy in the samples taken with EBUS (p=0.219). In terms of pathological adequacy of the samples taken, 103 were sufficient for both, 5 were insufficient for both, and 6 were discordant; overall global agreement was 94.74%; Cohen's Kappa was 0.599, defining moderate agreement (94.74%; 95% CI (88.9-92.04), ? = 0.599). When evaluated diagnostically, 93 were diagnostic for both, 7 were non-diagnostic for both, and 3 were discordant; overall global agreement was 97.09%; Cohen's Kappa was 0.808, defining significant agreement (97.09%; 95% CI (91.72-99.40), ? = 0.808). In addition, there was no statistically significant difference between the methods diagnostically (p=1). Near perfect agreement was found in terms of the main diagnosis (?=0.954, p<0.001). In terms of procedure times, the average EBUS-TBNA was 4.28 ± 0.86 minutes and the EBUS-TBNCS was 3.07 ± 0.68 minutes, with a statistically significant difference between them (p<0.001) Conclusion: TBNCS, when performed under EBUS guidance, is a more practical and equally effective technique due to its shorter duration and lack of need for additional equipment. Since it does not affect diagnostic outcomes and reduces procedural complexity, it can be preferred over the conventional method. Keywords: EBUS, Aspiration, Capillery sampling
Purpose: There is still no standard method for sampling techniques performed with endobronchial ultrasound (EBUS). Therefore, in our study, we aimed to compare transbronchial needle aspiration (EBUS-TBNA) and fine needle capillary sampling (EBUS-TBNCS) methods in mediastinal lymph node sampling using EBUS in terms of adequacy, diagnosis, and duration Material and methods: Patients who underwent EBUS in our clinic between 2021 and 2024 to elucidate the etiology of mediastinal LAP were included in our prospective, single-blind, and randomized study. EBUS was performed on each lymph node using both methods, TBNA and TBNCS. Results: A total of 114 samples were taken from 79 patients with pathological lymph nodes. The mean age of the patients was 62.85 ± 11.27 years, and the age range was between 21 and 85 years. 65.8% of the patients were male and 34.2% were female. The most frequent sampling localization was found to be the 7th station (36.8%). There was no statistically significant difference between EBUS-TBNA and EBUS-TBNCS methods in terms of pathological adequacy in the samples taken with EBUS (p=0.219). In terms of pathological adequacy of the samples taken, 103 were sufficient for both, 5 were insufficient for both, and 6 were discordant; overall global agreement was 94.74%; Cohen's Kappa was 0.599, defining moderate agreement (94.74%; 95% CI (88.9-92.04), ? = 0.599). When evaluated diagnostically, 93 were diagnostic for both, 7 were non-diagnostic for both, and 3 were discordant; overall global agreement was 97.09%; Cohen's Kappa was 0.808, defining significant agreement (97.09%; 95% CI (91.72-99.40), ? = 0.808). In addition, there was no statistically significant difference between the methods diagnostically (p=1). Near perfect agreement was found in terms of the main diagnosis (?=0.954, p<0.001). In terms of procedure times, the average EBUS-TBNA was 4.28 ± 0.86 minutes and the EBUS-TBNCS was 3.07 ± 0.68 minutes, with a statistically significant difference between them (p<0.001) Conclusion: TBNCS, when performed under EBUS guidance, is a more practical and equally effective technique due to its shorter duration and lack of need for additional equipment. Since it does not affect diagnostic outcomes and reduces procedural complexity, it can be preferred over the conventional method. Keywords: EBUS, Aspiration, Capillery sampling
Açıklama
Anahtar Kelimeler
Göğüs Hastalıkları, Chest Diseases
