Role of the Lymphocyte Profile in Mediastinal Lymph Nodes in the Differential Diagnosis of Sarcoidosis and Tuberculous Lymphadenitis Patients Undergoing EBUS-TBNA

IF 1 4区医学 Q4 MEDICAL LABORATORY TECHNOLOGY Diagnostic Cytopathology Pub Date : 2024-12-02 DOI:10.1002/dc.25418

Song Mi, Na Cui, Jing Wang, Liming Zhang, Kewu Huang

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Abstract

Background

The value of lymphocyte profiling (LP) in mediastinal lymph nodes for the differential diagnosis of sarcoidosis has not been extensively studied, and existing literature presents mixed results.

Methods

This was a prospective study of patients with intrathoracic lymphadenopathy who underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). LP in lymph node puncture fluid (LNPF) was evaluated using flow cytometry. The results of LP in sarcoidosis patients were compared with tuberculous lymphadenitis (TBLA) patients. Receiver operating characteristic (ROC) analysis was performed to determine the optimal cut-offs of the statistically significant parameters for screening for sarcoidosis. Based on the optimal cut-offs and the final diagnosis of sarcoidosis and TBLA, the sensitivity, specificity, and accuracy of every statistically significant parameter and different combinations of the above three parameters were calculated for the diagnosis of sarcoidosis.

Results

Forty-five cases of sarcoidosis and 33 cases of TBLA were enrolled in this study. Compared with the LP in TBLA patients, in sarcoidosis patients, the proportion of CD4 T cells and CD4/CD8 ratio increased, and the proportion of CD8 T cells and natural killer (NK) cells decreased. Among all single parameters, the CD4/CD8 ratio had high diagnostic sensitivity (84.4%), specificity (81.8%), and accuracy (83.3%) for sarcoidosis. Among all the combinations of three parameters, the combination of CD4, CD8, and NKT/NK ratio had high diagnostic sensitivity (91.1%), specificity (84.8%), and accuracy (87.2%) for sarcoidosis.

Conclusions

Assessment of LP in LNPF may improve the differential diagnostic accuracy of sarcoidosis from TBLA and further strengthen the importance of LP in LNPF in the diagnostic workup of sarcoidosis.

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纵隔淋巴结淋巴细胞谱在行EBUS-TBNA的结节病和结核性淋巴结炎鉴别诊断中的作用

背景：纵隔淋巴结淋巴细胞谱（LP）在结节病鉴别诊断中的价值尚未得到广泛研究，现有文献结果不一。方法：这是一项前瞻性研究，对接受支气管超声引导下经支气管针吸术（EBUS-TBNA）的胸内淋巴结病患者进行研究。采用流式细胞术评价淋巴结穿刺液（LNPF）中的LP。将结节病患者的LP结果与结核性淋巴结炎（TBLA）患者进行比较。进行受试者工作特征（ROC）分析，以确定结节病筛查有统计学意义参数的最佳截止值。根据结节病与TBLA的最佳截断值及最终诊断结果，计算各有统计学意义参数及上述3个参数的不同组合对结节病诊断的敏感性、特异性和准确性。结果：本组共纳入结节病45例，TBLA 33例。与TBLA患者的LP相比，结节病患者CD4 T细胞比例和CD4/CD8比值升高，CD8 T细胞和自然杀伤（NK）细胞比例降低。在所有单项参数中，CD4/CD8比值对结节病具有较高的诊断敏感性（84.4%）、特异性（81.8%）和准确性（83.3%）。在所有3个参数的组合中，CD4、CD8和NKT/NK比值的组合对结节病的诊断敏感性（91.1%）、特异性（84.8%）和准确性（87.2%）较高。结论：LNPF中LP的评估可提高结节病与TBLA鉴别诊断的准确性，进一步强化LNPF中LP在结节病诊断中的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diagnostic Cytopathology 医学-病理学

CiteScore

2.60

自引率

7.70%

发文量

163

审稿时长

3-6 weeks

期刊介绍： Diagnostic Cytopathology is intended to provide a forum for the exchange of information in the field of cytopathology, with special emphasis on the practical, clinical aspects of the discipline. The editors invite original scientific articles, as well as special review articles, feature articles, and letters to the editor, from laboratory professionals engaged in the practice of cytopathology. Manuscripts are accepted for publication on the basis of scientific merit, practical significance, and suitability for publication in a journal dedicated to this discipline. Original articles can be considered only with the understanding that they have never been published before and that they have not been submitted for simultaneous review to another publication.