超声支气管镜引导的经支气管针吸活检术临床应用进展

doi:10.3969/j.issn.2096-8493.20210036

摘要/Abstract

摘要：

超声支气管镜引导的经支气管针吸活检术(endobronchial ultrasound-guided transbronchial needle aspiration,EBUS-TBNA)可有效鉴别临近于气管或支气管的胸内病变的良恶性,同时也是肺癌的重要分期手段。为了进一步提高EBUS-TBNA的诊断准确率,并减少操作相关并发症,国内外开展了一系列临床应用研究,主要聚焦于负压与导丝的应用与否、穿刺针型号选择、穿刺次数,以及EBUS-TBNA辅助诊断技术(如弹性成像、快速现场细胞学评价等)的应用等。作者将EBUS-TBNA技术在胸部疾病的应用及进展进行综述。

关键词: 支气管镜, 超声检查, 介入性, 活组织检查, 针吸, 肺肿瘤

Abstract:

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) can effectively identify benign and malignant thoracic lesions adjacent to the trachea or bronchus, and it also plays an important role in staging lung cancer. In order to further improve the diagnostic accuracy of EBUS-TBNA and reduce operation related complications, a series of clinical studies have been carried out, mainly focusing on whether to use suction and guide wire, how to decide the needle size, times of aspiration and the application of EBUS-TBNA auxiliary diagnostic techniques (such as elastography, rapid onsite cytological evaluation, etc.). In this paper, the advances in clinical application of EBUS-TBNA on chest diseases are summarized.

Key words: Endobronchial, Ultrasonography, interventional, Biopsy, needle, Lung neoplasms

杨会珍, 张群成, 张晓菊. 超声支气管镜引导的经支气管针吸活检术临床应用进展[J]. 结核与肺部疾病杂志, 2021, 2(3): 267-272. doi: 10.3969/j.issn.2096-8493.20210036

YANG Hui-zhen, ZHANG Qun-cheng, ZHANG Xiao-ju. Advances in clinical application of endobronchial ultrasound-guided transbronchial needle aspiration[J]. Journal of Tuberculosis and Lung Disease, 2021, 2(3): 267-272. doi: 10.3969/j.issn.2096-8493.20210036

参考文献 67

[1]	Yasufuku K, Chiyo M, Sekine Y, et al. Real-time endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal and hilar lymph nodes. Chest, 2004, 126(1):122-128. doi: 10.1378/chest.126.1.122. doi: 10.1378/chest.126.1.122 URL
[2]	Herth FJ, Eberhardt R, Vilmann P, et al. Real-time endobronchial ultrasound-guided transbronchial needle aspiration for sampling mediastinal lymph nodes. Thorax, 2006, 61(9):795-798. doi: 10.1136/thx.2005.047829. doi: 10.1136/thx.2005.047829 pmid: 16738038
[3]	李时悦, 陈小波, 何颖, 等. 气管内超声实时引导经支气管针吸术对肺癌纵隔肺门淋巴结的诊断价值. 中华医学杂志, 2009, 89(24):1672-1675. doi: 10.3760/cma. j. issn. 0376-2491. 2009.24.006. doi: 10.3760/cma. j. issn. 0376-2491. 2009.24.006
[4]	韩宝惠, 孙加源. 超声支气管镜引导下的经支气管针吸活检(EBUS-TBNA)在呼吸疾病的应用. 中华结核和呼吸杂志, 2010, 33(9):641-642. doi: 10.3760/cma. j.issn. 1001-0939.2010.09.001. doi: 10.3760/cma. j.issn. 1001-0939.2010.09.001
[5]	Gu P, Zhao YZ, Jiang LY, et al. Endobronchial ultrasound-guided transbronchial needle aspiration for staging of lung cancer: a systematic review and meta-analysis. Eur J Cancer, 2009, 45(8):1389-1396. doi: 10.1016/j.ejca.2008.11.043. doi: 10.1016/j.ejca.2008.11.043 URL
[6]	Labarca G, Folch E, Jantz M, et al. Adequacy of Samples Obtained by Endobronchial Ultrasound with Transbronchial Needle Aspiration for Molecular Analysis in Patients with Non-Small Cell Lung Cancer. Systematic Review and Meta-Analysis. Ann Am Thorac Soc, 2018, 15(10):1205-1216. doi: 10.1513/AnnalsATS. 201801-045OC. doi: 10.1513/AnnalsATS. 201801-045OC URL
[7]	Wahidi MM, Herth F, Yasufuku K, et al. Technical aspects of endobronchial ultrasound guided transbronchial needle aspiration: CHEST guideline and expert panel report. Chest, 2016, 149(3):816-835. doi: 10.1378/chest.15-1216. doi: 10.1378/chest.15-1216 pmid: 26402427
[8]	Herth FJ, Schuler H, Gompelmann D, et al. Endobronchial ultrasound-guided lymph node biopsy with transbronchial needle forceps: a pilot study. Eur Respir J, 2012, 39(2):373-377. doi: 10.1183/09031936.00033311. doi: 10.1183/09031936.00033311 pmid: 21700609
[9]	Pajares V, Torrego A, Martínnez-Téllez E, et al. Diagnosis and invasive staging: Non-surgical invasive mediastinal staging. Endobronchial ultrasound. J Clin Transl Res, 2020, 6(4):121-126.
[10]	Mehta HJ, Begnaud A, Penley AM, et al. Treatment of isolated mediastinal and hilar recurrence of lung cancer with bronchoscopic endobronchial ultrasound guided intratumoral injection of chemotherapy with cisplatin. Lung Cancer, 2015, 90(3):542-547. doi: 10.1016/j.lungcan.2015.10.009. doi: 10.1016/j.lungcan.2015.10.009 URL
[11]	Casal RF, Schwalk AJ, Fowlkes N, et al. Endobronchial ultrasound-guided injection of NBTXR3 radio-enhancing nanoparticles into mediastinal and hilar lymph nodes: a swine model to evaluate feasibility, injection technique, safety, nanoparticle retention and dispersion. J Thorac Dis, 2020, 12(5):2317-2324. doi: 10.21037/jtd. 2020. 03.100. doi: 10.21037/jtd. 2020. 03.100 URL
[12]	Motooka Y, Fujino K, Gregor A, et al. Endobronchial Ultrasound-Guided Radiofrequency Ablation of Lung Tumors and Mediastinal Lymph Nodes: A Preclinical Study in Animal Lung Tumor and Mediastinal Adenopathy Models. Semin Thorac Cardiovasc Surg, 2020, 32(3):570-578. doi: 10.1053/j.semtcvs.2020.02.003. doi: S1043-0679(20)30015-0 pmid: 32057971
[13]	Li J, Zhi X, Chen J, et al. Deep learning with convex probe endobronchial ultrasound multimodal imaging: A validated tool for automated intrathoracic lymph nodes diagnosis. Endosc Ultrasound, 2021. doi: 10.4103/EUS-D-20-00207. doi: 10.4103/EUS-D-20-00207
[14]	Silvestri GA, Gonzalez AV, Jantz MA, et al. Methods for staging non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2013, 143(5 suppl):e211S-250S. doi: 10.1378/chest.12-2355. doi: 10.1378/chest.12-2355 URL
[15]	Ernst A, Anantham D, Eberhardt R, et al. Diagnosis of mediastinal adenopathy-real-time endobronchial ultrasound guided needle aspiration versus mediastinoscopy. J Thorac Oncol, 2008, 3(6):577-582. doi: 10.1097/JTO.0b013e3181753b5e. doi: 10.1097/JTO.0b013e3181753b5e URL
[16]	Sehgal IS, Dhooria S, Aggarwal AN, et al. Endosonography Versus Mediastinoscopy in Mediastinal Staging of Lung Cancer: Systematic Review and Meta-Analysis. Ann Thorac Surg, 2016, 102(5):1747-1755. doi: 10.1016/j. athoracsur. 2016.05.110. doi: 10.1016/j. athoracsur. 2016.05.110 URL
[17]	Arslan Z, Ilgazli A, Bakir M, et al. Conventional vs. endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of mediastinal lymphadenopathies. Tuberk Toraks, 2011, 59(2):153-157. doi: 10.5578/tt.2403. doi: 10.5578/tt.2403 URL
[18]	Korevaar DA, Crombag LM, Cohen JF, et al. Added value of combined endobronchial and oesophageal endosonography for mediastinal nodal staging in lung cancer: a systematic review and meta-analysis. Lancet Respir Med, 2016, 4(12):960-968. doi: 10.1016/S2213-2600(16)30317-4. doi: 10.1016/S2213-2600(16)30317-4 URL
[19]	El-Osta H, Jani P, Mansour A, et al. Endobronchial Ultrasound for Nodal Staging of Patients with Non-Small-Cell Lung Cancer with Radiologically Normal Mediastinum. A Meta-Analysis. Ann Am Thorac Soc, 2018, 15(7):864-874. doi: 10.1513/AnnalsATS.201711-863OC. doi: 10.1513/AnnalsATS.201711-863OC pmid: 29684288
[20]	Nakajima T, Yasufuku K, Iyoda A, et al. The evaluation of lymph node metastasis by endobronchial ultrasound-guided transbronchial needle aspiration: crucial for selection of surgical candidates with metastatic lung tumors. J Thorac Cardiovasc Surg, 2007, 134(6):1485-1490. doi: 10.1016/j.jtcvs.2007.07.022. doi: 10.1016/j.jtcvs.2007.07.022 URL
[21]	Song JU, Park HY, Jeon K, et al. The role of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of mediastinal and hilar lymph node metastases in patients with extrapulmonary malignancy. Intern Med, 2011, 50(21):2525-2532. doi: 10.2169/internalmedicine.50.5834. doi: 10.2169/internalmedicine.50.5834 URL
[22]	Navani N, Nankivell M, Woolhouse I, et al. Endobronchial ultrasoundguided transbronchial needle aspiration for the diagnosis of intrathoracic lymphadenopathy in patients with extrathoracic malignancy: a multicenter study. J Thorac Oncol, 2011, 6(9):1505-1509. doi: 10.1097/JTO.0b013e318223c3fe. doi: 10.1097/JTO.0b013e318223c3fe pmid: 21792077
[23]	Park J, Jang SJ, Park YS, et al. Endobronchial ultrasound-guided transbronchial needle biopsy for diagnosis of mediastinal lymphadenopathy in patients with extrathoracic malignancy. J Korean Med Sci, 2011, 26(2):274-278. doi: 10.3346/jkms.2011.26.2.274. doi: 10.3346/jkms.2011.26.2.274 URL
[24]	Tournoy KG, Govaerts E, Malfait T, et al. Endobronchial ultrasound-guided transbronchial needle biopsy for M1 staging of extrathoracic malignancies. Ann Oncol, 2011, 22(1):127-131. doi: 10.1093/annonc/mdq311. doi: S0923-7534(19)37774-9 pmid: 20603434
[25]	Sanz-Santos J, Cirauqui B, Sanchez E, et al. Endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of intrathoracic lymph node metastases from extrathoracic malignancies. Clin Exp Metastasis, 2013, 30(4):521-528. doi: 10.1007/s10585-012-9556-3. doi: 10.1007/s10585-012-9556-3 URL
[26]	Ozgul MA, Cetinkaya E, Tutar N, et al. Endobronchial ultrasoundguided transbronchial needle aspiration for the diagnosis of intrathoracic lymphadenopathy in patients with extrathoracic malignancy: A study in a tuberculosis-endemic country. J Cancer Res Ther, 2013, 9(3):416-421. doi: 10.4103/0973-1482.119323. doi: 10.4103/0973-1482.119323 URL
[27]	孙加源, 鲍亮, 滕家俊, 等. 气管内超声引导下经支气管针吸活检在肺外肿瘤胸内转移中的诊断价值. 中国肺癌杂志, 2015, 18(5):295-300. doi: 10.3779/j.issn.1009-3419.2015.05.07. doi: 10.3779/j.issn.1009-3419.2015.05.07
[28]	Kennedy MP, Jimenez CA, Bruzzi JF, et al. Endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of lymphoma. Thorax, 2008, 63(4):360-365. doi: 10.1136/thx.2007.084079. doi: 10.1136/thx.2007.084079 pmid: 17965071
[29]	Steinfort DP, Conron M, Tsui A, et al. Endobronchial ultrasound-guided transbronchial needle aspiration for the evaluation of suspected lymphoma. J Thorac Oncol, 2010, 5(6):804-809. doi: 10.1097/jto.0b013e3181d873be. doi: 10.1097/jto.0b013e3181d873be pmid: 20521347
[30]	Kheir F, Itani A, Assasa O, et al. The utility of endobronchial ultrasound-transbronchial needle aspiration in lymphoma. Endosc Ultrasound, 2016, 5(1):43-48. doi: 10.4103/2303-9027.175884. doi: 10.4103/2303-9027.175884 URL
[31]	Lim CE, Steinfort DP, Irving LB. Diagnostic performance of 19-gauge endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in suspected lymphoma: A prospective cohort study. Clin Respir J, 2020, 14(9):800-805. doi: 10.1111/crj.13198. doi: 10.1111/crj.13198
[32]	李辑伦, 赵辉, 隋锡朝, 等. 支气管内超声引导针吸活检术在Ⅰ、Ⅱ期胸部结节病诊断中的应用价值. 中国微创外科杂志, 2015, 15(4):324-328. doi: 10.3969/j.issn.1009-6604.2015.04.011. doi: 10.3969/j.issn.1009-6604.2015.04.011
[33]	Sun J, Yang H, Teng J, et al. Determining factors in diagnosing pulmonary sarcoidosis by endobronchial ultrasound-guided transbronchial needle aspiration. Ann Thorac Surg, 2015, 99(2):441-445. doi: 10.1016/j.athoracsur.2014.09.029. doi: 10.1016/j.athoracsur.2014.09.029 URL
[34]	中华医学会结核病学分会, 《中华结核和呼吸杂志》编辑委员会. 气管支气管结核诊断和治疗指南(试行). 中华结核和呼吸杂志, 2012, 35(8):581-587. doi: 10.3760/cma.j.issn.1001-0939.2012.08.007. doi: 10.3760/cma.j.issn.1001-0939.2012.08.007
[35]	Navani N, Molyneaux PL, Breen RA, et al. Utility of endobronchial ultrasound-guided transbronchial needle aspiration in patients with tuberculous intrathoracic lymphadenopathy: a multicentre study. Thorax, 2011, 66(10):889-893. doi: 10.1136/thoraxjnl-2011-200063. doi: 10.1136/thoraxjnl-2011-200063 pmid: 21813622
[36]	姜洪斌, 汪浩, 姜格宁, 等. 超声支气管镜引导下的经支气管针吸活检术诊断菌阴肺结核. 中华胸心血管外科杂志, 2011, 27(9):526-528. doi: 10.3760/cma.j.issn.1001-4497.2011.09.005. doi: 10.3760/cma.j.issn.1001-4497.2011.09.005
[37]	Sun J, Teng J, Yang H, et al. Endobronchial ultrasound-guided transbronchial needle aspiration in diagnosing intrathoracic tuberculosis. Ann Thorac Surg, 2013, 96(6):2021-2027. doi: 10.1016/j.athoracsur.2013.07.005. doi: 10.1016/j.athoracsur.2013.07.005 URL
[38]	孙加源, 滕家俊, 钟润波, 等. 支气管内超声引导下经支气管针吸活检诊断胸内结核. 中华胸心血管外科杂志, 2014, 30(11):653-656. doi: 10.3760/cma.j.issn.1001-4497.2014.11.004. doi: 10.3760/cma.j.issn.1001-4497.2014.11.004
[39]	Chopra A, Modi A, Chaudhry H, et al. Assessment of Mediastinal Lymph Node Size in Pneumococcal Pneumonia with Bacteremia. Lung, 2018, 196(1):43-48. doi: 10.1007/s00408-017-0071-9. doi: 10.1007/s00408-017-0071-9 pmid: 29147774
[40]	Wang L, Wu W, Teng J, et al. Sonographic features of endobronchial ultrasound in differentiation of benign lymph nodes. Ultrasound Med Biol, 2016, 42(12):2785-2793. doi: 10.1016/j.ultrasmedbio.2016.07.019. doi: S0301-5629(16)30178-8 pmid: 27612871
[41]	Yang H, Wang S, Teng J, et al. Utility of endobronchial ultrasound guided transbronchial needle aspiration in diagnosing non-specific inflammatory intrathorcacic lymphadenitis. Clin Respir J, 2018, 12(2):691-698. doi: 10.1111/crj.12580. doi: 10.1111/crj.12580 URL
[42]	Takeda S, Miyoshi S, Minami M, et al. C1inica1 spectrum of mediastinal cysts. Chest, 2003, 124(1):125-132. doi: 10.1378/chest.124.1.125. doi: 10.1378/chest.124.1.125 URL
[43]	Anantham D, Phua GC, Low SY, et al. Role of endobronchial ultrasound in the diagnosis of bronchogenic cysts. Diagn Ther Endosc, 2011, 2011:468237. doi: 10.1155/2011/468237. doi: 10.1155/2011/468237
[44]	Maturu VN, Dhooria S, Agarwal R. Efficacy and Safety of Transbronchial Needle Aspiration in Diagnosis and Treatment of Mediastinal Bronchogenic Cysts: Systematic Review of Case Reports. J Bronchology Interv Pulmonol, 2015, 22(3):195-203. doi: 10.1097/LBR.0000000000000174. doi: 10.1097/LBR.0000000000000174 URL
[45]	Bukamur HS, Alkhankan E, Mezughi HM, et al. The role and safety of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis and management of infected bronchogenic mediastinal cysts in adults. Respir Med Case Rep, 2018, 24:46-49. doi: 10.1016/j.rmcr.2018.04.002. doi: 10.1016/j.rmcr.2018.04.002 pmid: 29977757
[46]	Uzbeck MH, Eapen GA, Jimenez CA, et al. Randomized clinical trial of endobronchial ultrasound needle biopsy with and without aspiration. Chest, 2012, 142(3):568-573. doi: 10.1378/chest.11-0692. doi: 10.1378/chest.11-0692 URL
[47]	Harris K, Maroun R, Attwood K, et al. Comparison of cytologic accuracy of endobronchial ultrasound transbronchial needle aspiration using needle suction versus no suction. Endosc Ultrasound, 2015, 4(2):115-119. doi: 10.4103/2303-9027.156737. doi: 10.4103/2303-9027.156737 URL
[48]	Lin X, Ye M, Li Y, et al. Randomized controlled trial to evalu-ate the utility of suction and inner-stylet of EBUS-TBNA for mediastinal and hilar lymphadenopathy. BMC Pulm Med, 2018, 18(1):192. doi: 10.1186/s12890-018-0751-0. doi: 10.1186/s12890-018-0751-0 URL
[49]	Jagan N, Landeen CA, Moore DR, et al. Waste not, want not: diagnostic material found in suction syringe aspirate during endobronchial ultrasound guided transbronchial needle aspiration. J Thorac Dis, 2019, 11(8):3270-3275. doi: 10.21037/jtd.2019.08.55. doi: 10.21037/jtd.2019.08.55 URL
[50]	Gounant V, Ninane V, Janson X, et al. Release of metal particles from needles used for transbronchial needle aspiration. Chest, 2011, 139(1):138-143. doi: 10.1378/chest.11-1965. doi: 10.1378/chest.11-1965 URL
[51]	Scholten EL, Semaan R, Illei P, et al. Stylet Use Does Not Improve Diagnostic Outcomes in Endobronchial Ultrasonographic Transbronchial Needle Aspiration: A Randomized Clinical Trial. Chest, 2017, 151(3):636-642. doi: 10.1016/j.chest.2016.10.005. doi: S0012-3692(16)60774-2 pmid: 27769775
[52]	Giri S, Pathak R, Yarlagadda V, et al. Meta-analysis of 21- versus 22-G aspiration needle during endobronchial ultrasound-guided transbronchial needle aspiration. J Bronchology Interv Pulmonol, 2015, 22(2):107-113. doi: 10.1097/LBR. 0000000000000159. doi: 10.1097/LBR. 0000000000000159 URL
[53]	Wolters C, Darwiche K, Franzen D, et al. A Prospective, Randomized Trial for the Comparison of 19-G and 22-G Endobronchial Ultrasound-Guided Transbronchial Aspiration Needles; Introducing a Novel End Point of Sample Weight Corrected for Blood Content. Clin Lung Cancer, 2019, 20(3):e265-e273. doi: 10.1016/j.cllc.2019.02.019. doi: 10.1016/j.cllc.2019.02.019
[54]	Elmufdi FS, Peterson MK, Niccum D, et al. Evaluating Yield of 19 Versus 21 G EBUS-TBNA Needles: A Prospective Study. J Bronchology Interv Pulmonol, 2021, 28(1):29-33. doi: 10.1097/LBR.0000000000000674. doi: 10.1097/LBR.0000000000000674 URL
[55]	Minami D, Ozeki T, Okawa S, et al. Comparing the Clinical Performance of the New 19-G ViziShot FLEX and 21- or 22-G ViziShot 2 Endobronchial Ultrasound-guided Transbronchial Needle Aspiration Needles. Intern Med, 2018, 57(24):3515-3520. doi: 10.2169/internalmedicine.0967-18. doi: 10.2169/internalmedicine.0967-18 URL
[56]	Oki M, Saka H, Ando M, et al. How Many Passes Are Needed for Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Sarcoidosis? A Prospective Multicenter Study. Respiration, 2018, 95(4):251-257. doi: 10.1159/000485661. doi: 10.1159/000485661 URL
[57]	Zhang Y, Xie F, Mao X, et al. Determining factors of endobronchial ultrasound-guided transbronchial needle aspiration specimens for lung cancer subtyping and molecular testing. Endosc Ultrasound, 2019, 8(6):404-411. doi: 10.4103/eus.eus_8_19. doi: 10.4103/eus.eus_8_19 URL
[58]	Xie F, Zheng X, Mao X, et al. Next-Generation Sequencing for Genotyping of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration Samples in Lung Cancer. Ann Thorac Surg, 2019, 108(1):219-226. doi: 10.1016/j.athoracsur. 2019.02.010. doi: 10.1016/j.athoracsur. 2019.02.010 URL
[59]	Trosini-Désert V, Jeny F, Taillade L, et al. Bronchial endoscopic ultrasound elastography: preliminary feasibility data. Eur Respir J, 2013, 41(2):477-479. doi: 10.1183/09031936.00124812. doi: 10.1183/09031936.00124812 pmid: 23370804
[60]	毛晓伟, 杨俊勇, 郑筏轩, 等. 两种支气管内超声弹性成像定量方法评估胸内良恶性淋巴结的比较. 中华结核和呼吸杂志, 2017, 40(6):431-434. doi: 10.3760/cma.j.issn.1001-0939.2017.06.007. doi: 10.3760/cma.j.issn.1001-0939.2017.06.007
[61]	Izumo T, Sasada S, Chavez C, et al. Endobronchial ultrasound elastography in the diagnosis of mediastinal and hilar lymph nodes. Jpn J ClinOncol, 2014, 44(10):956-962. doi: 10.1093/jjco/hyu105. doi: 10.1093/jjco/hyu105
[62]	Jiang JH, Turner JJ, Huang JA. Endobronchial ultrasound elastography: a new method in endobronchial ultrasound-guided transbronchial needle aspiration. J Thorac Dis, 2015, 7(Supp14):S272-S278. doi: 10.3978/j.issn.2072-1439. doi: 10.3978/j.issn.2072-1439
[63]	Dietrich CF, Jenssen C, Herth FJ. Endobronchial ultrasound elastography. Endosc Ultrasound, 2016, 5(4):233-238. doi: 10.4103/2303-9027.187866. doi: 10.4103/2303-9027.187866 URL
[64]	Guarino C, Mollica M, Cesaro C, et al. Diagnostic yield of rapid on-site evaluation transbronchial needle aspiration versus conventional transbronchial needle aspiration: a single center experience. Monaldi Arch Chest Dis, 2020, 90(1):73-77. doi: 10.4081/monaldi.2020.1144. doi: 10.4081/monaldi.2020.1144
[65]	Oki M, Saka H, Kitagawa C, et al. Rapid on-site cytologic evaluation during endobronchial ultrasound-guided transbronchial needle aspiration for diagnosing lung cancer: a randomized study. Respiration, 2013, 85(6):486-492. doi: 10.1159/000346987. doi: 10.1159/000346987 URL
[66]	Gianella P, Soccal PM, Plojoux J, et al. Utility of Rapid On-Site Cytologic Evaluation during Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in Malignant and Nonmalignant Disease. Acta Cytol, 2018, 62(5-6):380-385. doi: 10.1159/000493334. doi: 10.1159/000493334 pmid: 30244239
[67]	Sehgal IS, Dhooria S, Aggarwal AN, et al. Impact of Rapid On-Site Cytological Evaluation (ROSE) on the Diagnostic Yield of Transbronchial Needle Aspiration During Mediastinal Lymph Node Sampling: Systematic Review and Meta-Analysis. Chest, 2018, 153(4):929-938. doi: 10.1016/j.chest.2017.11.004. doi: 10.1016/j.chest.2017.11.004 URL