Fritscher-Ravens A, Soehendra N, Schirrow L, Sriram P V, Meyer A, Hauber H P, Pforte A
Department of Endoscopic Surgery, University Hospital Eppendorf, Hamburg, Germany.
Chest. 2000 Feb;117(2):339-45. doi: 10.1378/chest.117.2.339.
Bronchoscopic methods fail to diagnose lung cancer in up to 30% of patients. We studied the role of transesophageal endosonography (EUS)-guided fine-needle aspiration (FNA; EUS-FNA) in such patients.
Prospective study. The final diagnosis was confirmed by cytology, histology, or clinical follow-up.
University hospital.
Thirty-five patients (30 male and 5 female; mean age, 60.9 years; range, 34 to 88 years) with suspected lung cancer in whom bronchoscopic methods failed. Patients with a known diagnosis, recurrence of lung cancer, or mediastinal metastasis from an extrathoracic primary were excluded.
EUS and guided FNA of mediastinal lymph nodes.
The procedure was uneventful, and material was adequate in all. The final diagnosis by EUS-FNA was malignancy in 25 patients (11 adenocarcinoma, 10 small cell, 3 squamous cell, and 1 lymphoma) and benign disease in 9 patients (5 inflammatory, 2 sarcoidosis, and 2 anthracosis). Another patient with a benign result had signet-ring cell carcinoma diagnosed on pleural fluid cytology (probably false-negative in EUS-FNA). The sensitivity, specificity, accuracy, and positive and negative predictive values were 96, 100, 97, 100, and 90%, respectively. There were no complications. Reviewing the EUS morphology, the nodes were predominantly located in levels 7 and 8 of American Thoracic Society mediastinal lymph node mapping (subcarinal and paraesophageal region). In seven patients, the punctured nodes were < 1 cm (four malignant and three benign), which are difficult to sample by other methods. The malignant nodes had a hypoechoic, homogenous echotexture.
EUS-FNA is a safe, reliable, and accurate method to establish the diagnosis of suspected lung cancer when bronchoscopic methods fail, especially in the presence of small nodes.
支气管镜检查方法在高达30%的患者中无法诊断出肺癌。我们研究了经食管超声内镜（EUS）引导下细针穿刺抽吸活检（FNA；EUS-FNA）在此类患者中的作用。
前瞻性研究。最终诊断通过细胞学、组织学或临床随访得以证实。
大学医院。
35例疑似肺癌患者（30例男性，5例女性；平均年龄60.9岁；范围34至88岁），支气管镜检查方法未能确诊。已知诊断、肺癌复发或胸外原发性纵隔转移的患者被排除。
对纵隔淋巴结进行EUS及引导下FNA。
操作顺利，所有病例均获取了足够的标本。EUS-FNA最终诊断为恶性肿瘤的有25例（11例腺癌、10例小细胞癌、3例鳞癌和1例淋巴瘤），良性疾病9例（5例炎症、2例结节病和2例煤尘肺）。另1例结果为良性的患者在胸腔积液细胞学检查中诊断为印戒细胞癌（EUS-FNA可能为假阴性）。敏感性、特异性、准确性以及阳性和阴性预测值分别为96%、100%、97%、100%和90%。无并发症发生。回顾EUS形态，淋巴结主要位于美国胸科学会纵隔淋巴结图谱的第7和第8组（隆突下和食管旁区域）。7例患者穿刺的淋巴结直径<1 cm（4例恶性，3例良性），这些淋巴结用其他方法难以取材。恶性淋巴结呈低回声、均匀的回声纹理。
当支气管镜检查方法失败时，EUS-FNA是一种安全、可靠且准确的方法，可用于确诊疑似肺癌，尤其是存在小淋巴结时。
