Agarwal Banke, Gogia Sudhanshu, Eloubeidi Mohamad A, Correa Arlene M, Ho Linus, Collins Brian T
Division of Gastroenterology and Hepatology and Department of Pathology, Saint Louis University School of Medicine, St. Louis, Missouri 63110, USA.
Gastrointest Endosc. 2005 Jun;61(7):849-53. doi: 10.1016/s0016-5107(05)00318-4.
In patients with pancreatic cancer, the presence of malignant mediastinal lymphadenopathy (MML) would preclude definitive resection. A recent study suggested routine evaluation for mediastinal lymph-node metastases in all patients being evaluated for pancreaticobiliary masses. In our practice, we routinely assess for mediastinal lymph-node metastases in all patients undergoing EUS for pancreaticobiliary cancer.
We retrospectively evaluated the presence of MML by EUS-guided FNA (EUS-FNA) in 160 consecutive patients with a definite diagnosis of pancreaticobiliary cancer (pancreatic and periampullary cancers) who underwent EUS-FNA by a single operator from 2000 to 2004. Lymph nodes that were round and hypoechoic with sharp margins were considered suspicious and were sampled by FNA.
Of the 160 patients included in this study, 78 had peripancreatic lymph nodes (49%: 95% CI[41%, 58%]), 25 had celiac lymph nodes (16%: 95% CI[10%, 22%]), and 14 patients had mediastinal lymph nodes (9%: 95% CI[4%, 13%]) that were suspicious for malignancy by morphologic criteria. In 8 of 14 patients with suspicious mediastinal lymph nodes, FNA documented MML in 5%: 95% CI[2%, 8%]. Only one of these 8 patients with MML had other sites of documented distant metastases by CT and/or positron emission tomography scans. However, 7 of 8 patients had locally advanced cancers.
MML is detected by staging EUS-FNA in 5% of patients with pancreaticobiliary cancer. Because of its important implications, endosonographers should routinely assess for MML in patients who undergo staging EUS for pancreaticobiliary malignancy.
在胰腺癌患者中，存在恶性纵隔淋巴结肿大（MML）会妨碍进行根治性切除术。最近一项研究建议，对所有接受胰胆管肿块评估的患者进行纵隔淋巴结转移的常规评估。在我们的临床实践中，我们对所有因胰胆管癌接受超声内镜检查（EUS）的患者常规评估纵隔淋巴结转移情况。
我们回顾性评估了2000年至2004年期间由一名操作者对160例确诊为胰胆管癌（胰腺癌和壶腹周围癌）的连续患者进行EUS引导下细针穿刺活检（EUS-FNA）时MML的存在情况。圆形、低回声且边界清晰的淋巴结被视为可疑，并通过FNA进行采样。
在本研究纳入的160例患者中，78例有胰周淋巴结（49%：95%可信区间[41%，58%]），25例有腹腔淋巴结（16%：95%可信区间[10%，22%]），14例患者有纵隔淋巴结（9%：95%可信区间[4%，13%]），根据形态学标准怀疑为恶性。在14例可疑纵隔淋巴结患者中的8例中，FNA证实MML的比例为5%：95%可信区间[2%，8%]。这8例有MML的患者中只有1例通过CT和/或正电子发射断层扫描有其他部位远处转移的记录。然而，8例患者中有7例为局部进展期癌症。
在5%的胰胆管癌患者中，通过分期EUS-FNA可检测到MML。鉴于其重要意义，内镜超声检查者应对接受胰胆管恶性肿瘤分期EUS检查的患者常规评估MML。
