Fritscher-Ravens A, Sriram P V, Bobrowski C, Pforte A, Topalidis T, Krause C, Jaeckle S, Thonke F, Soehendra N
Department of Interdisciplinary Endoscopy, University Hospital Eppendorf, Hamburg, Germany.
Am J Gastroenterol. 2000 Sep;95(9):2278-84. doi: 10.1111/j.1572-0241.2000.02243.x.
Mediastinal lymphadenopathy (ML) is a cause for concern, especially in patients with previous malignancy. The investigation of choice is thoracic CT with a variable sensitivity and specificity requiring tissue diagnosis. We used endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for cytodiagnosis of ML in patients with and without previous malignancy. The cause, distribution of lesions, and incidence of second cancers were investigated.
Linear echoendoscopes and 22-gauge needles for cytology were used for EUS-FNA. A cytological diagnosis of malignancy was accepted, and histology or consistent follow-up of at least 9 months confirmed benign results.
One hundred fifty-three patients underwent EUS-FNA between November 1997 and November 1999 (mean age, 60 yr; range, 13-82 yr; 105 men). Cytology was adequate in 150 patients. Final diagnosis was malignancy in 84 and benign in 66 patients (sensitivity, specificity, and diagnostic accuracy: 92%, 100%, 95%, respectively). In 101 patients without previous cancer cytology identified 48 malignant (lung, 41; extrathoracic, 7) and 51 benign lesions (inflammation, 35; various, 9; sarcoidosis, 7) (sensitivity, specificity, accuracy: 88%, 100%, 94%). Fifty-two patients had prior malignancy, mostly in extrathoracic sites. Cytology revealed recurrences in 21 patients, second cancer in 9 and benign lesions in 21 patients (inflammatory, 11; sarcoidosis, 8; tuberculosis, 1; abscess, 1) (sensitivity, specificity, accuracy: 97%, 100%, 98%).
In patients without previous cancer malignant ML originates from the lung >80%. In those with previous malignancy recurrence of extrathoracic sites is the major cause. Benign lesions and treatable second cancers occur in a significant frequency, emphasizing the need for tissue diagnosis. EUS-FNA is a safe and minimally invasive alternative for cytodiagnosis in the mediastinum.
纵隔淋巴结肿大（ML）令人担忧，尤其是既往有恶性肿瘤的患者。首选的检查是胸部CT，但其敏感性和特异性各不相同，需要进行组织诊断。我们对有或无既往恶性肿瘤的患者采用超声内镜引导下细针穿刺抽吸术（EUS-FNA）对ML进行细胞诊断。对病因、病变分布及第二原发癌的发生率进行了研究。
使用线性超声内镜和用于细胞学检查的22G针进行EUS-FNA。接受恶性肿瘤的细胞学诊断，组织学检查或至少9个月的一致随访证实为良性结果。
1997年11月至1999年11月期间，153例患者接受了EUS-FNA（平均年龄60岁；范围13-82岁；男性105例）。150例患者的细胞学检查充分。最终诊断为恶性肿瘤84例，良性肿瘤66例（敏感性、特异性和诊断准确性分别为92%、100%、95%）。在101例无既往癌症的患者中，细胞学检查发现48例恶性病变（肺癌41例；胸外7例）和51例良性病变（炎症35例；其他9例；结节病7例）（敏感性、特异性、准确性分别为88%、100%、94%）。52例患者有既往恶性肿瘤，大多位于胸外部位。细胞学检查发现21例复发，9例第二原发癌，21例良性病变（炎症11例；结节病8例；结核1例；脓肿1例）（敏感性、特异性、准确性分别为97%、100%、98%）。
在无既往癌症的患者中，恶性ML起源于肺部的比例>80%。在有既往恶性肿瘤的患者中，胸外部位复发是主要原因。良性病变和可治疗的第二原发癌发生率较高，强调了组织诊断的必要性。EUS-FNA是纵隔细胞诊断的一种安全且微创的替代方法。
