Herth F J F, Ernst A, Eberhardt R, Vilmann P, Dienemann H, Krasnik M
Dept of Pneumology and Critical Care Medicine, Thoraxklinik at the University of Heidelberg, Heidelberg, Germany.
Eur Respir J. 2006 Nov;28(5):910-4. doi: 10.1183/09031936.06.00124905. Epub 2006 Jun 28.
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) can sample enlarged mediastinal lymph nodes in patients with nonsmall cell lung cancer (NSCLC). To date, EBUS-TBNA has only been used to sample nodes visible on computed tomography (CT). The aim of the present study was to determine the accuracy of EBUS-TBNA in sampling nodes <or=1 cm in diameter. NSCLC patients with CT scans showing no enlarged lymph nodes (no node >1 cm) in the mediastinum underwent EBUS-TBNA. Identifiable lymph nodes at locations 2r, 2l, 4r, 4l, 7, 10r, 10l, 11r and 11l were aspirated. All patients underwent subsequent surgical staging. Diagnoses based on aspiration results were compared with those based on surgical results. In 100 patients (mean age 58.9 yrs; 68 males), 119 lymph nodes ranging 5-10 mm in size were detected and sampled. Malignancy was detected in 19 patients but missed in two; all diagnoses were confirmed by surgical findings. The mean diameter of the punctured lymph nodes was 8.1 mm. The sensitivity of EBUS-TBNA for detecting malignancy was 92.3%, specificity was 100%, and the negative predictive value was 96.3%. No complications occurred. In conclusion, endobronchial ultrasound-guided transbronchial needle aspiration can accurately sample even small mediastinal nodes, therefore avoiding unnecessary surgical exploration in one out of six patients who have no computed tomography evidence of mediastinal disease. Potentially operable patients with no signs of mediastinal involvement on computed tomography may benefit from pre-surgical endobronchial ultrasound-guided transbronchial needle aspiration and staging.
支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）可对非小细胞肺癌（NSCLC）患者肿大的纵隔淋巴结进行取样。迄今为止，EBUS-TBNA仅用于对计算机断层扫描（CT）上可见的淋巴结进行取样。本研究的目的是确定EBUS-TBNA对直径≤1 cm的淋巴结取样的准确性。对纵隔CT扫描显示无肿大淋巴结（无直径>1 cm的淋巴结）的NSCLC患者进行EBUS-TBNA。对2r、2l、4r、4l、7、10r、10l、11r和11l部位可识别的淋巴结进行针吸。所有患者随后均接受手术分期。将基于针吸结果的诊断与基于手术结果的诊断进行比较。在100例患者（平均年龄58.9岁；男性68例）中，检测并取样了119个大小为5-10 mm的淋巴结。19例患者检测到恶性肿瘤，但2例漏诊；所有诊断均经手术结果证实。穿刺淋巴结的平均直径为8.1 mm。EBUS-TBNA检测恶性肿瘤的敏感性为92.3%，特异性为100%，阴性预测值为96.3%。未发生并发症。总之，支气管内超声引导下经支气管针吸活检术即使对小的纵隔淋巴结也能准确取样，从而避免了六分之一纵隔无疾病CT证据患者的不必要手术探查。计算机断层扫描无纵隔受累迹象的潜在可手术患者可能受益于术前支气管内超声引导下经支气管针吸活检术及分期。
