经支气管镜和内镜超声引导下针吸活检在非小细胞肺癌分期中对影像学正常的纵隔的联合应用——一项前瞻性试验。

A combined approach of endobronchial and endoscopic ultrasound-guided needle aspiration in the radiologically normal mediastinum in non-small-cell lung cancer staging--a prospective trial.

机构信息

Endoscopy Unit, Pulmonary Hospital, Zakopane, Poland.

出版信息

Eur J Cardiothorac Surg. 2010 May;37(5):1175-9. doi: 10.1016/j.ejcts.2009.11.015. Epub 2009 Dec 22.

DOI:10.1016/j.ejcts.2009.11.015

PMID:20022761

Abstract

OBJECTIVES

This prospective study aimed to assess the diagnostic yield of the combined approach - endobronchial (EBUS) and endoscopic (EUS) ultrasound-guided needle aspiration (combined ultrasound-needle aspiration (CUS-NA)) in the radiologically normal mediastinum in non-small-cell lung cancer (NSCLC) staging.

METHODS

CUS-NA was performed simultaneously under local anaesthesia and sedation in consecutive NSCLC patients with mediastinal nodes that were not enlarged on CT (stage IA-IIB). All patients with negative CUS-NA subsequently underwent the transcervical extended bilateral mediastinal lymphadenectomy (TEMLA) as a confirmatory test.

RESULTS

A total of 120 NSCLC patients underwent CUS-NA between 1 January 2008 and 31 December 2008. There were 318 mediastinal nodes biopsied (158 EBUS-NA - stations: 2R - 2, 2L - 1, 4R - 34, 4L - 33 and 7 - 88 and 160 EUS-NA - stations: 4L - 57, 7 - 101 and 9 - 2). CUS-NA revealed metastatic lymph node involvement in 19 of 120 patients (16%) and in 31 of 318 biopsies (10%). The prevalence was 22%. In 99 patients with negative CUS-NA, who underwent subsequent TEMLA, metastatic nodes were diagnosed in nine patients (8%) in 11 stations: 2R - 2, 4R - 4, 4L - 1, 5 - 3 and 7 - 1. In all but one patient there were 'minimal N2' only. Diagnostic sensitivity, specificity, total accuracy, positive predictive value (PPV) and negative predictive value (NPV) of CUS-NA for normal mediastinum was 68% (95% confidence interval (CI): 48-84), 98% (95% CI: 92-100), 91% (95% CI: 86-96), 91% (95% CI: 70-99) and 91% (95% CI: 83-96), respectively. The sensitivity of CUS-NA was significantly higher than with EBUS-NA alone (p=0.04) and higher, close to the level of significance than with EUS-NA alone (p=0.07). The NPV of all techniques was high and that of CUS-NA was significantly higher than EBUS-NA alone and EUS-NA alone (p=0.01, p=0.03). No complications of CUS-NA were observed.

CONCLUSIONS

In the radiologically normal mediastinum, CUS-NA is a highly effective and safe technique in NSCLC staging and, if negative, a surgical diagnostic exploration of the mediastinum may be omitted.

摘要

目的

本前瞻性研究旨在评估支气管内超声（EBUS）和内镜超声（EUS）引导下针吸活检（联合超声针吸（CUS-NA））在非小细胞肺癌（NSCLC）分期中对影像学正常纵隔的诊断效果。

方法

对纵隔淋巴结 CT 未肿大（IA-IIB 期）的连续 NSCLC 患者，在局部麻醉和镇静下同时进行 CUS-NA。所有 CUS-NA 阴性的患者随后接受经颈扩大双侧纵隔淋巴结清扫术（TEMLA）作为确证性检查。

结果

2008 年 1 月 1 日至 2008 年 12 月 31 日期间，共有 120 例 NSCLC 患者接受了 CUS-NA 检查。共活检了 318 个纵隔淋巴结（158 个 EBUS-NA 站：2R-2、2L-1、4R-34、4L-33 和 7-88，160 个 EUS-NA 站：4L-57、7-101 和 9-2）。CUS-NA 在 120 例患者中的 19 例（16%）和 318 个活检标本中的 31 例（10%）中发现了转移性淋巴结受累。患病率为 22%。在 99 例 CUS-NA 阴性的患者中，有 9 例（8%）在 11 个站（2R-2、4R-4、4L-1、5-3 和 7-1）诊断出转移性淋巴结。除 1 例患者外，其余均为“微转移 N2”。CUS-NA 对正常纵隔的诊断灵敏度、特异性、总准确率、阳性预测值（PPV）和阴性预测值（NPV）分别为 68%（95%CI：48-84）、98%（95%CI：92-100）、91%（95%CI：86-96）、91%（95%CI：70-99）和 91%（95%CI：83-96）。CUS-NA 的灵敏度明显高于 EBUS-NA 单独检查（p=0.04），且与 EUS-NA 单独检查接近统计学意义（p=0.07）。所有技术的 NPV 均较高，CUS-NA 的 NPV 明显高于 EBUS-NA 单独检查和 EUS-NA 单独检查（p=0.01，p=0.03）。CUS-NA 无并发症发生。