Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
Ann Thorac Surg. 2010 Dec;90(6):1753-7. doi: 10.1016/j.athoracsur.2010.06.052.
Endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) has been proposed as a safe, less-invasive alternative to mediastinoscopy to stage mediastinal lymph nodes in patients with lung cancer. We evaluated the negative predictive value of EBUS-TBNA in lung cancer patients suspected of having N2 nodal metastases.
This study is a single-institution retrospective review of cases with suspected or confirmed lung cancer undergoing mediastinoscopy after a negative EBUS-TBNA between June 2006 and February 2008.
A total of 494 patients underwent EBUS-TBNA during the study period. Twenty-nine patients with suspected or confirmed lung cancer had a negative EBUS-TBNA and underwent subsequent mediastinoscopy. Mediastinoscopy was performed for findings suspicious of N2 disease based on noninvasive imaging. Mediastinoscopy found metastatic nodes in eight of 29 patients (28%) for a patient-specific negative predictive value of EBUS-TBNA of 72% (95% CI, 56% to 89%). Mediastinal lymph node dissection found four further patients with positive N2 nodes (19%). The EBUS-TBNA and mediastinoscopy sampled the same lymph node station on 36 occasions in the 29 patients. The average lymph node size was 10 mm. Mediastinoscopy was positive in 5 of 36 stations, for a nodal-specific negative predictive value of EBUS-TBNA of 86% (95% CI, 75% to 97%).
Endobronchial ultrasound with transbronchial needle aspiration can effectively sample mediastinal lymph node stations in patients with lung cancer. However, in this early experience, 28% of patients with high clinical suspicion of nodal disease had N2 mediastinal nodal metastases confirmed by mediastinoscopy despite negative EBUS-TBNA.
经支气管超声引导针吸活检术（EBUS-TBNA）已被提议作为一种安全、微创的替代纵隔镜检查的方法，用于对肺癌患者纵隔淋巴结进行分期。我们评估了 EBUS-TBNA 在疑似 N2 淋巴结转移的肺癌患者中的阴性预测值。
这是一项回顾性单机构研究，纳入了 2006 年 6 月至 2008 年 2 月期间，经 EBUS-TBNA 检查为阴性后，疑似或确诊为肺癌并随后接受纵隔镜检查的患者。
在研究期间，共有 494 例患者接受了 EBUS-TBNA 检查。29 例疑似或确诊为肺癌且 EBUS-TBNA 为阴性的患者随后接受了纵隔镜检查。纵隔镜检查是基于非侵入性影像学检查发现可疑 N2 疾病的结果进行的。在 29 例患者中，纵隔镜检查发现 8 例（28%）患者有转移淋巴结，EBUS-TBNA 的患者特异性阴性预测值为 72%（95%CI，56%至 89%）。纵隔淋巴结清扫术进一步发现 4 例 N2 阳性淋巴结患者（19%）。在 29 例患者中，EBUS-TBNA 和纵隔镜检查共在 36 个淋巴结站取样。平均淋巴结大小为 10mm。纵隔镜检查阳性的 36 个淋巴结站中有 5 个，EBUS-TBNA 的淋巴结特异性阴性预测值为 86%（95%CI，75%至 97%）。
经支气管超声引导针吸活检术可以有效地对肺癌患者的纵隔淋巴结站进行取样。然而，在这一早期经验中，尽管 EBUS-TBNA 为阴性，但仍有 28%的高度怀疑有淋巴结疾病的患者在纵隔镜检查中被证实存在 N2 纵隔淋巴结转移。
