Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Ann Thorac Surg. 2011 Jul;92(1):251-5; discussion 255. doi: 10.1016/j.athoracsur.2011.03.007. Epub 2011 May 18.
This study evaluated the role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the assessment of newly developed mediastinal/hilar abnormalities in patients with previously treated lung cancer.
All EBUS-TBNA cases between July 2008 and October 2010 were retrospectively reviewed. Results of EBUS-TBNA in previously treated lung cancer patients were analyzed. Cancer treatments, numbers of stations biopsied, and pathologic results were recorded. Nonmalignant cytopathology was confirmed with clinical follow-up for benign results.
Of 450 patients who underwent EBUS-TBNA, 44 (9.8%) had previous lung cancer treatment, comprising non-small cell lung cancer in 40, small-cell lung cancer in 3, and typical carcinoid in 1. No EBUS-TBNA was performed for lung cancer restaging. Primary treatments included surgical resection in 22, resection with adjuvant/neoadjuvant therapy in 11, chemoradiation in 5, chemotherapy in 4, and radiotherapy in 2. At the primary treatment, 23 of 44 patients had mediastinoscopy. EBUS-TBNA of mediastinal lymph nodes was performed in 40. An average of 1.7 stations were biopsied (range, 1 to 5). The positive EBUS-TBNA in 28 included mediastinal/hilar recurrence of primary lung cancer (ie, same cell type as primary cancer) in 21, and possible new primary lung cancer (ie, different cell type from primary lung cancer) in 7. The sensitivity, specificity, and diagnostic accuracy were 93.1%, 100%, and 95.1%, respectively.
EBUS-TBNA can differentiate a new primary lung cancer from recurrence of previously treated lung cancer, which will facilitate treatment strategy.
本研究评估了支气管内超声引导经支气管针吸活检（EBUS-TBNA）在评估先前治疗过的肺癌患者中新出现的纵隔/肺门异常中的作用。
回顾性分析 2008 年 7 月至 2010 年 10 月间所有接受 EBUS-TBNA 的病例。分析了先前治疗过的肺癌患者的 EBUS-TBNA 结果。记录了癌症治疗方法、活检的站点数量和病理结果。非恶性细胞学检查通过良性结果的临床随访进行确认。
在接受 EBUS-TBNA 的 450 例患者中，44 例（9.8%）有先前的肺癌治疗史，其中非小细胞肺癌 40 例，小细胞肺癌 3 例，典型类癌 1 例。没有进行 EBUS-TBNA 进行肺癌的重新分期。主要治疗方法包括手术切除 22 例，切除加辅助/新辅助治疗 11 例，放化疗 5 例，化疗 4 例，放疗 2 例。在初次治疗时，44 例患者中有 23 例行纵隔镜检查，40 例行纵隔淋巴结 EBUS-TBNA。平均活检 1.7 个站点（范围 1 至 5）。28 例阳性 EBUS-TBNA 中包括 21 例原发性肺癌的纵隔/肺门复发（即与原发性癌症相同的细胞类型）和 7 例可能的新原发性肺癌（即与原发性肺癌不同的细胞类型）。其敏感性、特异性和诊断准确性分别为 93.1%、100%和 95.1%。
EBUS-TBNA 可以区分新原发性肺癌和先前治疗过的肺癌的复发，这将有助于治疗策略的制定。
