Caglayan Benan, Salepci Banu, Dogusoy Ilgaz, Fidan Ali, Sener Comert Sevda, Kiral Nesrin, Yavuzer Dilek, Sarac Gulsen
Department of Pulmonary Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey.
Iran J Radiol. 2012 Nov;9(4):183-9. doi: 10.5812/iranjradiol.3882. Epub 2012 Nov 20.
In the diagnosis of malignant lymph nodes (LNs) and staging of lung cancer, sampling of mediastinal and hilar LNs is essential. Mediastinoscopy is known as the gold standard. Convex probe (CP) endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) is a noninvasive and highly sensitive diagnostic method in mediastinal and hilar LN sampling.
Evaluating the role of CP-EBUS-guided TBNA in the diagnosis of mediastinal and hilar LNs suspicious of malignancy.
One hundred twenty patients with a known lung malignancy or hilar/mediastinal LNs detected by thoracic computed tomography (CT) and/or positron emission tomography (PET)-CT suspicious for malignancy were included in this prospective study. The procedure was performed by Olympus 7.5 MHz CP endoscope and EU C2000 processor by the oral route under topical anesthesia and conscious sedation. After visualization of LNs, their dimensions were recorded. Aspiration was considered as "insufficient" if there were inadequate lymphocytes on the smears. Diagnosis of "malignancy" on cytologic examination was considered as the "final diagnosis". If diagnosis was negative for malignancy, more invasive procedures were performed to confirm the diagnosis.
Twenty four females and 96 male patients (mean age, 57.8 ± 9.1) were included. A total of 177 LN stations were aspirated in 120 patients. In 82 patients, the diagnosis was malignant by EBUS-guided TBNA and in the remaining 38; the diagnosis was established by further invasive procedures. Of the 38 EBUS-guided TBNA negative patients, 28 were diagnosed as non-malignant and 10 were malignant. The sensitivity, diagnostic accuracy and negative predictive value of CP EBUS-guided TBNA were 89.1%, 91.6% and 73.6%, respectively. No major complications were seen.
As an alternative method to mediastinoscopy, EBUS-guided TBNA is a safe and noninvasive procedure with high sensitivity in the diagnosis of malignant mediastinal LNs.
在恶性淋巴结（LN）的诊断及肺癌分期中，纵隔和肺门淋巴结的采样至关重要。纵隔镜检查被视为金标准。凸阵探头（CP）支气管内超声（EBUS）引导下经支气管针吸活检（TBNA）是纵隔和肺门淋巴结采样中一种无创且高度敏感的诊断方法。
评估CP-EBUS引导下TBNA在诊断可疑恶性纵隔和肺门淋巴结中的作用。
本前瞻性研究纳入了120例已知患有肺部恶性肿瘤或经胸部计算机断层扫描（CT）和/或正电子发射断层扫描（PET）-CT检测出肺门/纵隔淋巴结可疑为恶性的患者。该操作通过Olympus 7.5 MHz CP内镜和EU C2000处理器经口腔途径在局部麻醉和清醒镇静下进行。观察到淋巴结后，记录其大小。如果涂片上淋巴细胞数量不足，则认为抽吸“不足”。细胞学检查诊断为“恶性”被视为“最终诊断”。如果恶性诊断为阴性，则进行更具侵入性的操作以确诊。
纳入24例女性和96例男性患者（平均年龄57.8±9.1岁）。120例患者共抽吸了177个淋巴结站。82例患者经EBUS引导下TBNA诊断为恶性，其余38例通过进一步的侵入性操作确诊。在38例EBUS引导下TBNA阴性的患者中，28例被诊断为非恶性，10例为恶性。CP EBUS引导下TBNA的敏感性、诊断准确性和阴性预测值分别为89.1%、91.6%和73.6%。未观察到重大并发症。
作为纵隔镜检查的替代方法，EBUS引导下TBNA是一种安全、无创的操作，在诊断恶性纵隔淋巴结方面具有高敏感性。
