迈向非小细胞肺癌的微创分期策略：通过超声内镜引导下细针穿刺活检对PET阳性纵隔病变进行分析

Towards a minimally invasive staging strategy in NSCLC: analysis of PET positive mediastinal lesions by EUS-FNA.

作者信息

Annema J T, Hoekstra O S, Smit E F, Veseliç M, Versteegh M I M, Rabe K F

机构信息

Department of Pulmonary Medicine, Leiden University Medical Center, PO Box 9600, Albinusdreef 2, 2300 RC Leiden, The Netherlands.

出版信息

Lung Cancer. 2004 Apr;44(1):53-60. doi: 10.1016/j.lungcan.2003.10.013.

DOI:10.1016/j.lungcan.2003.10.013

PMID:15013583

Abstract

STUDY OBJECTIVE

To asses the value of endoscopic ultrasound guided fine needle aspiration (EUS-FNA) in the nodal staging of patients with (suspected) non-small cell lung cancer (NSCLC) and a (18)FDG positron emission tomography (PET) scan suspect for N2/N3 mediastinal lymph node (MLN) metastases.

BACKGROUND

Due to the imperfect specificity of positron emission tomography, PET positive MLN should be biopsied in order to confirm or rule out metastasis. Currently, invasive surgical diagnostic techniques such as mediastinoscopy/-tomy are standard procedures to obtain MLN tissue. The minimally invasive technique of EUS-FNA has a high diagnostic accuracy (90-94%) for the analysis of MLN in patients with enlarged MLN on computed tomography of the chest (CT).

DESIGN AND PATIENTS

Thirty-six patients with proven n=26 or suspected n=10 non-small cell lung cancer and a PET scan suspect for N2/N3 lymph node metastases underwent EUS-FNA. When EUS-FNA did not confirm metastasis and the PET lesion was within reach of mediastinoscopy, a mediastinoscopy was performed. EUS-FNA negative patients with PET lesions beyond the reach of mediastinoscopy or those with a negative mediastinoscopy were referred for surgical resection of the tumour and MLN sampling or dissection.

RESULTS

EUS-FNA confirmed N2/N3 disease in 25 of the 36 patients (69%) and was highly suspicious in one. In the remaining 10 patients, one PET positive and one PET negative N2 metastasis was detected at thoracotomy. The PPV, NPV, sensitivity, specificity and accuracy of EUS-FNA in analysing PET positive MLN were 100%, 80%, 93%, 100% and 94%, respectively. No complications of EUS-FNA were recorded.

CONCLUSIONS AND SIGNIFICANCE

EUS-FNA yields minimally invasive confirmation of MLN metastases in 69% of the patients with potential mediastinal involvement at FDG PET. The combination of PET and EUS-FNA might qualify as a minimally invasive staging strategy for NSCLC.

摘要

研究目的

评估内镜超声引导下细针穿刺活检（EUS-FNA）在（疑似）非小细胞肺癌（NSCLC）患者以及（18）氟脱氧葡萄糖正电子发射断层扫描（PET）怀疑有N2/N3纵隔淋巴结（MLN）转移患者的淋巴结分期中的价值。

背景

由于正电子发射断层扫描的特异性不完善，PET阳性的MLN应进行活检以确认或排除转移。目前，诸如纵隔镜检查/纵隔切开术等侵入性手术诊断技术是获取MLN组织的标准程序。对于胸部计算机断层扫描（CT）显示MLN肿大的患者，EUS-FNA这种微创技术在分析MLN方面具有较高的诊断准确性（90-94%）。

设计与患者

36例经证实（n=26）或疑似（n=10）非小细胞肺癌且PET扫描怀疑有N2/N3淋巴结转移的患者接受了EUS-FNA。当EUS-FNA未证实转移且PET病变在纵隔镜检查范围内时，进行纵隔镜检查。EUS-FNA结果为阴性且PET病变超出纵隔镜检查范围的患者或纵隔镜检查结果为阴性的患者被转至外科进行肿瘤切除及MLN取样或清扫。

结果

36例患者中，25例（69%）经EUS-FNA确诊为N2/N3疾病，1例高度可疑。其余10例患者中，开胸手术时发现1例PET阳性和1例PET阴性的N2转移。EUS-FNA分析PET阳性MLN的阳性预测值、阴性预测值、敏感性、特异性和准确性分别为100%、80%、93%、100%和94%。未记录到EUS-FNA的并发症。