Schmulewitz Nathan, Wildi Stephan M, Varadarajulu Shyam, Roberts Stacey, Hawes Robert H, Hoffman Brenda J, Durkalski Valerie, Silvestri Gerard A, Block Mark I, Reed Carolyn, Wallace Michael B
Medical University of South Carolina, Charleston, South Carolina, USA.
Gastrointest Endosc. 2004 Feb;59(2):205-12. doi: 10.1016/s0016-5107(03)02692-0.
EUS with FNA is useful for staging non-small-cell lung cancer. However, benign mediastinal adenopathy is common. The aims of this study were to identify clinical factors, especially primary tumor location, and EUS lymph nodal characteristics predictive of aortopulmonary window and subcarinal lymph node metastases of non-small-cell lung cancer.
Patients with known or suspected non-small-cell lung cancer underwent EUS staging at which EUS-FNA was performed for all identified mediastinal lymph nodes. Clinical characteristics, primary tumor data, EUS findings, and histopathology were reviewed. Exact tests were performed for both aortopulmonary window and subcarinal lymph nodes to identify factors predictive of malignant cytology.
Ninety-two patients with non-small-cell lung cancer were included. Fifty-one had aortopulmonary window, and 73 had subcarinal lymph nodes on EUS. The EUS with FNA specimens were interpreted as suspicious or diagnostic for malignancy for 9 aortopulmonary window and 9 subcarinal lymph nodes. When comparing benign vs. malignant EUS with FNA findings for aortopulmonary window and subcarinal lymph nodes, only lymph node size of 1 cm or greater and sharp lymph nodal edges were associated with malignancy in lymph nodes at both sites, whereas primary tumor site, lymph node shape, and echogenicity were associated with malignant subcarinal nodes. When 4 classic lymph nodal features of malignancy were evaluated, the presence of 3 or more typical features had positive and negative predictive values of, respectively, 41% and 96%.
Although tumor location and EUS lymph nodal characteristics are associated with malignant involvement of lymph nodes, the accuracy of these predictors does not obviate the need for cytologic evaluation. EUS with FNA should be performed for all lymph nodes when an abnormal finding will alter management.
超声内镜引导下细针穿刺活检（EUS-FNA）有助于非小细胞肺癌的分期。然而，良性纵隔淋巴结肿大很常见。本研究的目的是确定临床因素，尤其是原发肿瘤位置，以及超声内镜下淋巴结特征，以预测非小细胞肺癌的主动脉肺动脉窗和隆突下淋巴结转移。
已知或疑似非小细胞肺癌患者接受超声内镜分期检查，对所有发现的纵隔淋巴结进行EUS-FNA。回顾临床特征、原发肿瘤数据、超声内镜检查结果和组织病理学。对主动脉肺动脉窗和隆突下淋巴结进行精确检验，以确定预测恶性细胞学的因素。
纳入92例非小细胞肺癌患者。超声内镜检查发现51例有主动脉肺动脉窗淋巴结，73例有隆突下淋巴结。EUS-FNA标本对9个主动脉肺动脉窗淋巴结和9个隆突下淋巴结的恶性病变诊断为可疑或确诊。比较主动脉肺动脉窗和隆突下淋巴结良性与恶性EUS-FNA结果时，仅淋巴结大小≥1 cm和淋巴结边缘清晰与两个部位的淋巴结恶性病变相关，而原发肿瘤部位、淋巴结形状和回声与隆突下恶性淋巴结相关。评估4种典型的恶性淋巴结特征时，出现3种或更多典型特征的阳性和阴性预测值分别为41%和96%。
尽管肿瘤位置和超声内镜下淋巴结特征与淋巴结恶性受累有关，但这些预测指标的准确性并不能排除细胞学评估的必要性。当异常发现会改变治疗方案时，应对所有淋巴结进行EUS-FNA检查。
