Tournoy Kurt G, Praet Marleen M, Van Maele Georges, Van Meerbeeck Jan P
Department of Pulmonary Diseases, Endoscopy Unit, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
Chest. 2005 Oct;128(4):3004-9. doi: 10.1378/chest.128.4.3004.
To analyze the accuracy of esophageal endoscopic ultrasound (EUS) with real-time, guided fine-needle aspiration (EUS-FNA) with an on-site cytopathologist in patients with (presumed) lung cancer presenting with mediastinal lymphadenopathy (ML) or a suspect left adrenal gland (LAG).
A single-center prospective study.
Sixty-seven outpatients with (presumed) lung cancer with ML or a suspect LAG on either CT and/or positron emission tomography with 18F-fluorodeoxyglucose (FDG-PET) scan.
All patients underwent EUS-FNA under conscious sedation. A cytopathologist was present during all procedures.
EUS with and without fine-needle aspiration (FNA) as compared to FDG-PET was evaluated for accuracy in diagnosing cancer, safety, and rate of avoidance for further surgery.
Of 67 consecutive patients (56 men; median age, 64 years), malignant ML or LAG were found in 47 patients (70.1%). In 20 patients (29.9%) without EUS-FNA proof of malignancy, confirmation was obtained by surgical procedure in 13 patients (sarcoidosis [n = 5], infection [n = 1], lung cancer [n = 7]) or by clinical follow-up in 5 patients suggesting benign disease. Sixty-five patients were included in the calculation of test characteristics. With malignancy as an end point, the accuracy for EUS-FNA was 100%. This was better than EUS without FNA (accuracy, 75.4%; p < 0.001) or FDG-PET (accuracy, 75.0% [n = 28]; p = 0.0011). When using final histopathologic diagnosis as an end point, the accuracy of EUS-FNA was 92.3%, since EUS-FNA was unable to show noncaseating granulomas in those patients with sarcoidosis diagnosed after mediastinoscopy. Related to the presence of the in situ cytopathologist, there were no inconclusive samples. No adverse events were recorded, and 67.7% of surgical interventions were avoided following EUS-FNA.
The accuracy in this series of EUS-FNA with cytopathologist-assisted rapid on-site evaluation is high. The technique is safe and greatly reduces the number of surgical interventions.
分析在伴有纵隔淋巴结肿大（ML）或可疑左肾上腺（LAG）的（疑似）肺癌患者中，由现场细胞病理学家进行实时引导下细针穿刺的食管内镜超声检查（EUS-FNA）的准确性。
单中心前瞻性研究。
67例在CT和/或18F-氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）上有ML或可疑LAG的（疑似）肺癌门诊患者。
所有患者在清醒镇静下接受EUS-FNA检查。所有操作过程均有细胞病理学家在场。
将有和没有细针穿刺（FNA）的EUS与FDG-PET进行比较，评估其在癌症诊断准确性、安全性以及避免进一步手术发生率方面的表现。
67例连续患者（56例男性；中位年龄64岁）中，47例（70.1%）发现有恶性ML或LAG。20例（29.9%）患者经EUS-FNA未证实为恶性，其中13例（结节病[n = 5]、感染[n = 1]、肺癌[n = 7]）经手术确诊，5例经临床随访提示为良性疾病。65例患者纳入检测特征计算。以恶性肿瘤为终点，EUS-FNA的准确率为100%。这优于未进行FNA的EUS（准确率75.4%；p < 0.001）或FDG-PET（准确率75.0%[n = 28]；p = 0.0011）。以最终组织病理学诊断为终点时，EUS-FNA的准确率为92.3%，因为在纵隔镜检查后诊断为结节病的患者中，EUS-FNA无法显示非干酪样肉芽肿。与现场细胞病理学家的存在相关，没有不确定的样本。未记录到不良事件，EUS-FNA后67.7%的手术干预得以避免。
在本系列研究中，由细胞病理学家辅助进行快速现场评估的EUS-FNA准确性高。该技术安全且大大减少了手术干预的数量。
