Annema Jouke T, Versteegh Michel I, Veseliç Maud, Voigt Pieter, Rabe Klaus F
Department of Pulmonary Medicine, Leiden University Medical Center, Leiden, The Netherlands.
J Clin Oncol. 2005 Nov 20;23(33):8357-61. doi: 10.1200/JCO.2005.01.1965. Epub 2005 Oct 11.
The diagnosis and staging of lung cancer critically depends on surgical procedures. Endoscopic ultrasound (EUS) -guided fine-needle aspiration (FNA) is an accurate, safe, and minimally invasive technique for the analysis of mediastinal lymph nodes (LNs) and can additionally detect tumor invasion (T4) in patients with centrally located tumors. The goal of this study was to assess to what extent EUS-FNA could prevent surgical interventions.
Two hundred forty two consecutive patients with suspected (n = 142) or proven (n = 100) lung cancer and enlarged (> 1 cm) mediastinal LNs at chest computed tomography were scheduled for mediastinoscopy/tomy (94%) or exploratory thoracotomy (6%). Before surgery, all patients underwent EUS-FNA. If EUS-FNA established LN metastases, tumor invasion, or small-cell lung cancer (SCLC), scheduled surgical interventions were cancelled. Surgical-pathologic verification occurred when EUS-FNA did not demonstrate advanced disease. Cancelled surgical interventions because of EUS findings was the primary end point.
EUS-FNA prevented 70% of scheduled surgical procedures because of the demonstration of LN metastases in non-small-cell lung cancer (52%), tumor invasion (T4) (4%), tumor invasion and LN metastases (5%), SCLC (8%), or benign diagnoses (1%). Sensitivity, specificity, and accuracy for EUS in mediastinal analysis were 91%, 100% and 93%, respectively. No complications were recorded.
EUS-FNA qualifies as the initial staging procedure of choice for patients with (suspected) lung cancer and enlarged mediastinal LNs. Implementation of EUS-FNA in staging algorithms for lung cancer might reduce the number of surgical staging procedures considerably.
肺癌的诊断和分期严重依赖于外科手术。超声内镜（EUS）引导下细针穿刺抽吸活检（FNA）是一种准确、安全且微创的技术，用于分析纵隔淋巴结（LN），并且还能检测中心型肿瘤患者的肿瘤侵犯情况（T4）。本研究的目的是评估EUS-FNA在多大程度上可以避免外科手术干预。
连续纳入242例怀疑（n = 142）或确诊（n = 100）肺癌且胸部计算机断层扫描显示纵隔LN肿大（> 1 cm）的患者，计划行纵隔镜检查/手术（94%）或 exploratory thoracotomy（6%）。手术前，所有患者均接受EUS-FNA。如果EUS-FNA确定存在LN转移、肿瘤侵犯或小细胞肺癌（SCLC），则取消计划的外科手术干预。当EUS-FNA未显示进展期疾病时，进行手术病理验证。因EUS检查结果而取消的外科手术干预是主要终点。
由于EUS-FNA显示非小细胞肺癌存在LN转移（52%）、肿瘤侵犯（T4）（4%）、肿瘤侵犯合并LN转移（5%）、SCLC（8%）或良性诊断（1%），EUS-FNA避免了70%计划的外科手术。EUS在纵隔分析中的敏感性、特异性和准确性分别为91%、100%和93%。未记录到并发症。
EUS-FNA可作为（疑似）肺癌且纵隔LN肿大患者首选的初始分期检查方法。在肺癌分期算法中实施EUS-FNA可能会显著减少外科分期手术的数量。
