Endoscopy Unit, Pulmonary Hospital, Zakopane, Poland.
Eur J Cardiothorac Surg. 2010 May;37(5):1180-4. doi: 10.1016/j.ejcts.2009.11.014. Epub 2009 Dec 22.
The aim of the study was to assess the diagnostic yield of the endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in restaging of the non-small-cell lung cancer (NSCLC) patients after neo-adjuvant therapy.
In a consecutive group of NSCLC patients with pathologically confirmed N2 disease, who underwent neo-adjuvant chemotherapy, EBUS-TBNA was performed. All patients with negative EBUS-TBNA underwent subsequently the transcervical extended bilateral mediastinal lymphadenectomy (TEMLA) as a confirmatory test.
A total of 61 patients underwent restaging EBUS-TBNA between 1 June 2007 and 31 December 2008. There were 85 mediastinal lymph nodes biopsied (stations: 2R - 2, 4R - 24, 2L - 1, 4L - 18 and 7 - 40). EBUS-TBNA revealed metastatic lymph node involvement in 18 of 61 patients (30%) and in 22 of 85 biopsies (26%). In 43 patients with negative or uncertain EBUS-TBNA, who underwent subsequent TEMLA, metastatic nodes were diagnosed in nine patients (15%) - in seven (12%) in stations accessible for EBUS-TBNA (stations: 2R - 1, 4R - 5, 7 - 4) and in two (3%) in station not accessible for EBUS-TBNA (station: 5 - 2). The false-negative results of biopsies were found only in small nodes (5.8+/-2.8 mm x 7.5+/-2 mm). Moreover, all positive N2 nodes diagnosed by TEMLA contained only small metastatic deposits. There were three of 61 (5%) patients with false-positive results of biopsies in stations: 4R - 1, 4L - 1, and 7 - 2. A diagnostic sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of the restaging EBUS-TBNA was 67% (95% confidence interval (CI) - 65-90), 86% (95% CI - 82-95), 80%, 91% (95% CI - 80-100) and 78% (95% CI - 73-93), respectively. No complications of EBUS-TBNA were observed.
EBUS-TBNA is an effective and safe technique for mediastinal restaging in NSCLC patients, and after the data presented in our study, in patients with negative results of EBUS-TBNA, a surgical restaging of the mediastinum might not be mandatory.
本研究旨在评估支气管内超声引导经支气管针吸活检术（EBUS-TBNA）在新辅助治疗后非小细胞肺癌（NSCLC）患者分期中的诊断效能。
连续入组了一组经病理证实存在 N2 疾病的 NSCLC 患者，这些患者接受了新辅助化疗，对其进行了 EBUS-TBNA。所有 EBUS-TBNA 结果为阴性的患者随后进行经颈纵隔扩大双侧淋巴结清扫术（TEMLA）作为确认性检查。
2007 年 6 月 1 日至 2008 年 12 月 31 日期间，共有 61 例患者接受了分期 EBUS-TBNA。共对 85 个纵隔淋巴结进行了活检（淋巴结站：2R-2、4R-24、2L-1、4L-18 和 7-40）。EBUS-TBNA 在 61 例患者中的 18 例（30%）和 85 次活检中的 22 次（26%）中发现了转移性淋巴结受累。在 43 例 EBUS-TBNA 结果为阴性或不确定的患者中，9 例（15%）接受了随后的 TEMLA，诊断出转移性淋巴结（7 例[12%]位于可进行 EBUS-TBNA 的淋巴结站：2R-1、4R-5 和 7-4），2 例（3%）位于不可进行 EBUS-TBNA 的淋巴结站（5-2）。仅在小淋巴结（5.8+/-2.8 mm x 7.5+/-2 mm）中发现了活检的假阴性结果。此外，TEMLA 诊断为 N2 的所有阳性淋巴结仅包含小的转移灶。在 4R-1、4L-1 和 7-2 淋巴结站中，有 3 例（5%）患者的活检结果出现假阳性。分期 EBUS-TBNA 的诊断敏感性、特异性、准确性、阳性预测值（PPV）和阴性预测值（NPV）分别为 67%（95%置信区间（CI）为 65-90%）、86%（95%CI 为 82-95%）、80%、91%（95%CI 为 80-100%）和 78%（95%CI 为 73-93%）。未观察到 EBUS-TBNA 的并发症。
EBUS-TBNA 是一种有效的、安全的 NSCLC 患者纵隔分期技术，根据我们的研究数据，在 EBUS-TBNA 结果为阴性的患者中，可能不需要对纵隔进行手术分期。
