Chen Victor K, Eloubeidi Mohamad A
Department of Medicine, Division of Gastroenterology and Hepatology, The University of Alabama at Birmingham, Birmingham, Alabama 35294-0007, USA.
Am J Gastroenterol. 2004 Apr;99(4):628-33. doi: 10.1111/j.1572-0241.2004.04064.x.
The additional diagnostic value of endoscopic ultrasound-fine needle aspiration (EUS-FNA) over lymph node (LN) echofeatures alone in evaluating lymphadenopathy is unknown. The objectives of this study are (1) to prospectively evaluate the utility of EUS-FNA in evaluating mediastinal or peri-intestinal lymphadenopathy and to compare its yield to that of echofeatures alone and (2) to determine clinical and endosonographic features predictive of malignant involvement of LNs.
All consecutive patients who underwent EUS-FNA of a LN over a 22-month period were prospectively evaluated. Reference standard for final diagnosis included: surgery (n = 76), long-term clinical and/or imaging follow-up (n = 74), or death from disease (n = 26).
One hundred and eighty-three EUS-FNAs of LNs were performed in 137 patients with no major complications. Locations of the biopsied LNs included 31% subcarinal, 21% celiac, 21% peripancreatic, 13% periesophageal, 4.4% aortopulmonary window, 3.2% perigastric, and 3.3% perirectal. Mean LN size was 20.5 mm (SD +/- 11.1) x 13.2 mm (SD +/- 7.97). The mean number of EUS-FNA passes was three (range 1-7). The sensitivity, specificity, PPV, and NPV of EUS-FNA of LNs were 98.3%, 100%, 100%, and 98.4%, respectively. EUS-FNA was more accurate compared to LN echofeatures alone (99.4%vs 75.4%, p < 0.001). Mediastinal LNs were 2.77 times less likely to be malignant as compared to other LN locations. In multivariable analysis, the number of LN echofeatures, site of LN, and patient's age were associated with malignant involvement (p= 0.001).
EUS-FNA is superior to LN echofeatures in evaluating lymphadenopathy. Endosonographic LN features alone are particularly unreliable in the mediastinum, necessitating tissue confirmation. EUS-FNA can safely, reliably, and accurately sample mediastinal and peri-intestinal LNs obviating the need for more invasive testing or surgical intervention.
内镜超声引导下细针穿刺抽吸术（EUS-FNA）相较于单纯依靠淋巴结（LN）回声特征在评估淋巴结病方面的额外诊断价值尚不清楚。本研究的目的是：（1）前瞻性评估EUS-FNA在评估纵隔或肠周淋巴结病中的效用，并将其取材率与单纯回声特征的取材率进行比较；（2）确定预测淋巴结恶性受累的临床和内镜超声特征。
对在22个月期间连续接受LN的EUS-FNA检查的所有患者进行前瞻性评估。最终诊断的参考标准包括：手术（n = 76）、长期临床和/或影像学随访（n = 74）或死于疾病（n = 26）。
137例患者共进行了183次LN的EUS-FNA检查，无严重并发症。活检LN的位置包括31%位于隆突下、21%位于腹腔干、21%位于胰周、13%位于食管周、4.4%位于主动脉肺窗、3.2%位于胃周和3.3%位于直肠周。LN平均大小为20.5 mm（标准差±11.1）×13.2 mm（标准差±7.97）。EUS-FNA的平均穿刺次数为3次（范围1 - 7次）。LN的EUS-FNA的敏感性、特异性、阳性预测值和阴性预测值分别为98.3%、100%、10叭和98.4%。与单纯LN回声特征相比，EUS-FNA更准确（99.4%对75.4%，p < 0.001）。与其他LN位置相比，纵隔LN发生恶性病变的可能性低2.77倍。在多变量分析中，LN回声特征数量、LN部位和患者年龄与恶性受累相关（p = 0.001）。
在评估淋巴结病方面，EUS-FNA优于LN回声特征。单纯内镜超声LN特征在纵隔中尤其不可靠，需要进行组织学确认。EUS-FNA可以安全、可靠且准确地取材于纵隔和肠周LN，无需进行更具侵入性的检查或手术干预。
