Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York University Langone Medical Center, USA.
Clin Lung Cancer. 2010 Jan;11(1):25-9. doi: 10.3816/CLC.2010.n.004.
Mediastinoscopy is considered the gold standard for evaluating mediastinal lymph nodes. However, endobronchial ultrasound-guided transbronchial needle aspiration has lately offered a less invasive alternative, with the ability to obtain nodal samples under direct visualization. Recent literature found an early learning curve for this technique. We present the initial experience of 4 thoracic surgeons with the procedure.
A retrospective chart review was performed on the first 51 patients on whom an endobronchial ultrasound-guided transbronchial needle aspiration was performed from January 5, 2007, to July 24, 2008. This group included 43 patients with a history or known diagnosis of malignancy as well as 8 patients with a presumed sarcoidosis diagnosis. All negative results were confirmed with mediastinoscopy. The technique's sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were assessed.
A total of 73 lymph nodes underwent biopsy in 51 patients. These individuals included 34 men and 17 women, with an average age of 62 years (range, 21-89 years). No surgical or postoperative complications were noted. Overall, a correct diagnosis was established in 88% of the patients (45 of 51). After the first 25 cases (a mean of 6 cases per surgeon), a technique modification was adapted to increase diagnostic yield. The first 25 cases had a 72.22% sensitivity and 80% accuracy, whereas the last 26 cases had a 95.45% sensitivity and 96.15% accuracy (P = .07).
Endobronchial ultrasound-guided transbronchial needle aspiration is a quickly mastered technique that offers a safe, minimally invasive, and accurate means to evaluate mediastinal lymph nodes.
纵隔镜检查被认为是评估纵隔淋巴结的金标准。然而，近年来支气管内超声引导下经支气管针吸活检术提供了一种侵入性较小的替代方法，能够在直接可视化下获取淋巴结样本。最近的文献发现该技术存在早期学习曲线。我们介绍 4 位胸外科医生在该程序中的初步经验。
对 2007 年 1 月 5 日至 2008 年 7 月 24 日期间进行的前 51 例支气管内超声引导下经支气管针吸活检术的患者进行回顾性图表审查。该组包括 43 例有恶性肿瘤病史或已知诊断的患者以及 8 例疑似结节病诊断的患者。所有阴性结果均经纵隔镜检查证实。评估了该技术的敏感性、特异性、阳性预测值、阴性预测值和准确性。
51 例患者共进行了 73 个淋巴结活检。这些患者包括 34 名男性和 17 名女性，平均年龄为 62 岁（范围，21-89 岁）。未发生手术或术后并发症。总体而言，88%（45/51）的患者建立了正确的诊断。在前 25 例（平均每位外科医生 6 例）之后，采用了一种技术修改方法来提高诊断率。前 25 例的敏感性为 72.22%，准确性为 80%，而最后 26 例的敏感性为 95.45%，准确性为 96.15%（P=0.07）。
支气管内超声引导下经支气管针吸活检术是一种快速掌握的技术，为评估纵隔淋巴结提供了一种安全、微创、准确的方法。
