经支气管超声（EBUS）作为一种诊断和分期工具在评估纵隔淋巴结疾病中的应用及准确性。

Utility and accuracy of endobronchial ultrasound as a diagnostic and staging tool for the evaluation of mediastinal adenopathy.

机构信息

Department of Surgery, Greenville Hospital System, Greenville, SC, USA.

出版信息

Surg Endosc. 2013 Apr;27(4):1119-23. doi: 10.1007/s00464-012-2613-9. Epub 2012 Dec 13.

DOI:10.1007/s00464-012-2613-9

PMID:23239294

Abstract

BACKGROUND

Endobronchial ultrasound (EBUS) is an emerging technology for mediastinal evaluation which is less invasive than cervical mediastinoscopy, the traditional gold standard. The purpose of our study is to evaluate the utility and accuracy of EBUS as a diagnostic and staging tool at our regional teaching institution.

METHODS

We retrospectively reviewed the institutional thoracic surgery database for all patients undergoing EBUS between August, 2008 and March, 2011.

RESULTS

190 patients underwent EBUS. 87 (46 %) patients underwent EBUS for diagnosis only; 73 (38 %) for staging only; and 30 (16 %) for both diagnosis and staging. Diagnoses obtained by diagnostic EBUS included non-small cell lung cancer--n = 36 (31 %); other cancer--n = 22 (19 %); sarcoid/granulomatous--n = 8 (7 %); benign lymphoid tissue--n = 50 (43 %); and was nondiagnostic in one case (1 %). For staging EBUS 53 (51 %) patients had benign lymph node tissue. 103 patients had a benign result at the time of EBUS. Fifty-six (54 %) of these patients underwent subsequent mediastinal lymph node dissection or mediastinoscopy for tissue confirmation with the remainder undergoing follow up surveillance chest CT scans. Two patients had a false negative EBUS. Both false negative studies sampled levels 4L, 4R, and 7. The overall false negative rate was 2 % for all benign results, and 4 % for those benign results confirmed with lymph node dissection or mediastinoscopy. The sensitivity and specificity of diagnostic EBUS was 97 and 100 %. The sensitivity and specificity for staging EBUS was 98 and 100 %. In those patients (n = 103) undergoing a staging EBUS, a mean of 2.6 nodal stations were sampled, with 59 % (n = 61) of these patients having three lymph node stations sampled and 33 % (n = 30) had two lymph node stations sampled.

CONCLUSION

We found that EBUS is a highly accurate and minimally invasive manner in which to both diagnose mediastinal masses and stage the mediastinum.

摘要

背景

支气管内超声（EBUS）是一种新兴的纵隔评估技术，与传统的金标准——颈纵隔镜相比，它的侵入性更小。我们研究的目的是评估 EBUS 在我们地区教学机构作为诊断和分期工具的效用和准确性。

方法

我们回顾性地审查了 2008 年 8 月至 2011 年 3 月期间所有接受 EBUS 检查的机构胸外科数据库。

结果

190 例患者接受了 EBUS。87 例（46%）患者仅接受 EBUS 诊断；73 例（38%）患者仅接受 EBUS 分期；30 例（16%）患者同时接受诊断和分期。诊断性 EBUS 获得的诊断包括非小细胞肺癌-n = 36（31%）；其他癌症-n = 22（19%）；结节病/肉芽肿-n = 8（7%）；良性淋巴组织-n = 50（43%）；一例（1%）无法诊断。对于分期性 EBUS，53 例（51%）患者的淋巴结组织为良性。103 例患者在 EBUS 时的结果为良性。56 例（54%）患者随后进行纵隔淋巴结切除或纵隔镜检查以进行组织确认，其余患者接受随访胸部 CT 扫描。2 例患者出现 EBUS 假阴性。这两项假阴性研究均采样了 4L、4R 和 7 水平。所有良性结果的总体假阴性率为 2%，经淋巴结切除或纵隔镜检查确认的良性结果的假阴性率为 4%。诊断性 EBUS 的敏感性和特异性分别为 97%和 100%。分期性 EBUS 的敏感性和特异性分别为 98%和 100%。在接受分期性 EBUS 的 103 例患者中，平均采样 2.6 个淋巴结站，其中 59%（n = 61）的患者采样 3 个淋巴结站，33%（n = 30）的患者采样 2 个淋巴结站。