Bohle W, Meier C, Zoller W G
Klinik für Allgemeine Innere Medizin, Gastroenterologie, Hepatologie und Infektiologie, Katharinenhospital, Klinikum Stuttgart.
Dtsch Med Wochenschr. 2013 Mar;138(9):412-7. doi: 10.1055/s-0032-1332961. Epub 2013 Feb 19.
According to recent clinical trials, EUS-FNA has a high diagnostic yield in case of mediastinal and abdominal lymphadenopathy. However, it is questionable, if the results of centers of excellence can be maintained in daily clinical practice.
We retrospectively analyzed the results of 141 EUS-FNP in 121 patients (female 25, male 86; mean age 61,5 years, range 22-87) of 119 mediastinal and 22 abdominal lymph nodes, performed under routine conditions in daily clinical practice in a community hospital. Histopathological examination of operative specimens or clinical follow-up served as gold standard.
In 124/141 (80 %) of cases, adequate specimens could be obtained, irrespective of lymph node size. During follow-up, the rate of adequate specimens obtained increased from 77 % (2002-2006) to 98 % (2007-2010). Sensitivity and specifity for the diagnosis of malignancy was 77 and 100 % (diagnostic accuracy 92 %). During follow-up, a relevant learning curve could be observed with a significant increase in sensitivity (72 to 80 %).
In comparison to the results of centers of excellence, our diagnostic accuracy is slightly inferior. However, even in daily routine praxis, EUS-FNP is a safe and accurate method of sampling mediastinal and abdominal lymph nodes.
根据最近的临床试验，对于纵隔和腹部淋巴结病，超声内镜引导下细针穿刺抽吸活检术（EUS-FNA）具有较高的诊断率。然而，在日常临床实践中能否保持卓越中心的结果仍存在疑问。
我们回顾性分析了在一家社区医院日常临床实践的常规条件下，对121例患者（女性25例，男性86例；平均年龄61.5岁，范围22 - 87岁）的119个纵隔淋巴结和22个腹部淋巴结进行的141次EUS-FNP的结果。手术标本的组织病理学检查或临床随访作为金标准。
在124/141（80%）的病例中，无论淋巴结大小，均可获得足够的标本。在随访期间，获得足够标本的比例从77%（2002 - 2006年）增加到98%（2007 - 2010年）。诊断恶性肿瘤的敏感性和特异性分别为77%和100%（诊断准确性为92%）。在随访期间，可以观察到一条相关的学习曲线，敏感性显著提高（从72%提高到80%）。
与卓越中心的结果相比，我们的诊断准确性略低。然而，即使在日常实践中，EUS-FNP也是一种安全、准确的纵隔和腹部淋巴结采样方法。
