Division of General Thoracic and Foregut Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota 55455, USA.
Ann Thorac Surg. 2010 Jun;89(6):S2079-83. doi: 10.1016/j.athoracsur.2010.03.018.
A thoracic surgeon facile in endobronchial ultrasound-guided fine-needle aspiration (EBUS-FNA) and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) can accurately sample mediastinal lymph nodes (MLNs) for histologic assessment of mediastinal adenopathy and for thoracic malignancy staging. Although mediastinoscopy is the gold standard for histologic MLN assessment, EBUS-FNA and EUS-FNA have emerged as useful, less-invasive sampling techniques that offer access to a wider range of MLN stations than mediastinoscopy and can be used to biopsy suspicious lesions within (ie, peribronchial masses) and outside the mediastinum (ie, left adrenal gland masses, liver lesions, and enlarged celiac lymph nodes). The negative predictive value of EBUS-TBNA and EUS-FNA in patients with malignancy is somewhat lower than the negative predictive value of mediastinoscopy. Therefore, we recommend that nonmalignant EBUS or EUS cytologic findings should be confirmed with a surgical MLN biopsy (ie, mediastinoscopy or thoracoscopy) if the pretest probability of malignancy is high.
胸外科医生擅长支气管内超声引导下细针抽吸术（EBUS-FNA）和内镜超声引导下细针抽吸术（EUS-FNA），可以准确地对纵隔淋巴结（MLN）进行取样，以进行纵隔淋巴结病的组织学评估和胸内恶性肿瘤的分期。虽然纵隔镜检查是纵隔淋巴结组织学评估的金标准，但 EBUS-FNA 和 EUS-FNA 已成为有用的、创伤较小的取样技术，与纵隔镜检查相比，它们可以更广泛地获取 MLN 站的样本，并且可以用于活检纵隔内（如支气管周围肿块）和纵隔外（如左肾上腺肿块、肝脏病变和增大的腹腔淋巴结）的可疑病变。在恶性肿瘤患者中，EBUS-TBNA 和 EUS-FNA 的阴性预测值略低于纵隔镜检查的阴性预测值。因此，如果恶性肿瘤的术前概率较高，我们建议对非恶性的 EBUS 或 EUS 细胞学发现进行手术性 MLN 活检（即纵隔镜检查或胸腔镜检查）以确认。
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