Herth F J F, Rabe K F, Gasparini S, Annema J T
Department of Pneumology and Critical Care Medicine, Thoraxklinik at the University of Heidelberg, Amalienstrasse 5, D-69126 Heidelberg, Germany.
Eur Respir J. 2006 Dec;28(6):1264-75. doi: 10.1183/09031936.00013806.
A tissue diagnosis of mediastinal nodes is frequently needed for accurate lung cancer staging as well as the assessment of mediastinal masses. Transbronchial needle aspiration (TBNA) is a safe procedure that is performed during routine bronchoscopy. Provided mediastinal metastases are confirmed, TBNA has a high impact on patient management. Unfortunately, TBNA remains underused in current daily practice, mainly due to the lack of real-time needle visualisation. The introduction of echo-endoscopes has overcome this problem. Endobronchial ultrasound-guided TBNA (EBUS-TBNA) allows real-time controlled tissue sampling of paratracheal, subcarinal and hilar lymph nodes. Mediastinal lymph nodes located adjacent to the oesophagus can be assessed by transoesophageal ultrasound-guided fine needle aspiration (EUS-FNA). Owing to the complementary reach of EBUS-TBNA and EUS-FNA in assessing different regions of the mediastinum, recent studies suggest that complete and accurate mediastinal staging can be achieved by the combination of both procedures. It is expected that implementation of minimally invasive endoscopic methods of endobronchial ultrasound-guided transbronchial needle aspiration and transoesophageal ultrasound-guided fine needle aspiration will reduce the need for surgical staging of lung cancer significantly.
准确进行肺癌分期以及评估纵隔肿块时，常常需要对纵隔淋巴结进行组织诊断。经支气管针吸活检（TBNA）是一种在常规支气管镜检查期间进行的安全操作。若确诊存在纵隔转移，TBNA对患者的治疗管理具有重大影响。遗憾的是，TBNA在当前日常实践中的应用仍然不足，主要原因是缺乏实时针可视化。超声内镜的引入克服了这一问题。支气管内超声引导下经支气管针吸活检（EBUS-TBNA）可对气管旁、隆突下和肺门淋巴结进行实时控制的组织采样。毗邻食管的纵隔淋巴结可通过经食管超声引导下细针穿刺抽吸活检（EUS-FNA）进行评估。由于EBUS-TBNA和EUS-FNA在评估纵隔不同区域方面具有互补性，最近的研究表明，将这两种操作结合起来可实现完整、准确的纵隔分期。预计实施支气管内超声引导下经支气管针吸活检和经食管超声引导下细针穿刺抽吸活检这些微创内镜方法将显著减少肺癌手术分期的需求。
