Dubravcsik Zsolt, Serényi Péter, Madácsy László, Szepes Attila
Bács-Kiskun Megyei Kórház, a Szegedi Tudományegyetem Általános Orvostudományi Kar Oktatókórháza Belgyógyászat-Gasztroenterológia Osztály Kecskemét.
Orv Hetil. 2013 Mar 3;154(9):338-44. doi: 10.1556/OH.2013.29556.
Endoscopic ultrasound and endoscopic ultrasound-guided fine needle aspiration in the posterior mediastinum is technically a relatively simple and safe procedure, and it can provide important information for the further management of patients.
To analyze and compare the results of mediastinal endoscopic ultrasound-guided fine needle aspiration with the data available in the literature.
The authors retrospectively analyzed their prospective database on mediastinal endoscopic ultrasound-guided fine needle aspiration of 49 patients referred to their endoscopy centre between 1 November 2009 and 1 November 2012. For the fine needle aspiration 22 and 25 G needles were used. Two to six needle passes were performed in each patient. All slides were prepared at the endoscopy unit and analyzed at the cytology laboratory.
The authors performed mediastinal endoscopic ultrasound-guided fine needle aspiration for enlarged lymph nodes or suspected mediastinal malignancy in all but 4 patients (2 suspected oesophageal cancers, 1 suspected benign oesophageal stenosis with wall thickening and 1 cardia tumour, all with non-diagnostic endoscopic biopsies). Five patients were excluded from the analysis since fine needle aspiration was not performed in them. Benign lesions were suspected based on the endoscopic ultrasound morphology in 7, and malignant disease in 37 patients. In 3 cases samples obtained by biopsy were not informative for cytological analysis. Cytology confirmed all benign lesions and showed malignancy in 28 cases. Cytology failed to reveal malignancy in 6 patients, although it was suspected based upon endoscopic ultrasound finding. Furthermore, endoscopic ultrasound-guided fine needle aspiration provided the diagnosis in 15 of the 17 patients when bronchoscopy was non-diagnostic. The diagnostic accuracy of the EUS-FNA was the following: sensitivity 82%, specificity 100%, positive predictive value 1.0, negative predictive value 0.54. Only one infectious complication was encountered after fine needle aspiration despite antibiotic prophylaxis.
Endoscopic ultrasound-guided fine needle aspiration of mediastinal pathology is an accurate, safe and technically relatively easy procedure, however it requires practice and skills in mediastinal anatomy. It has an excellent positive predictive value, a very good sensitivity, but slightly poor negative predictive value. The results of this study are concordant with the literature data. The authors suggest that at least 4 needle passes in the absence of on-site pathologist should be performed in order to minimize the number of false-negative results.
后纵隔的内镜超声检查及内镜超声引导下细针穿刺在技术上是相对简单且安全的操作，可为患者的进一步治疗提供重要信息。
分析并比较纵隔内镜超声引导下细针穿刺的结果与文献中的现有数据。
作者回顾性分析了其前瞻性数据库，该数据库涉及2009年11月1日至2012年11月1日期间转诊至其内镜中心的49例接受纵隔内镜超声引导下细针穿刺的患者。细针穿刺使用了22G和25G的针。每位患者进行2至6次进针。所有玻片均在内镜室制备，并在细胞学实验室进行分析。
除4例患者（2例疑似食管癌、1例疑似良性食管狭窄伴管壁增厚、1例贲门肿瘤，所有患者内镜活检均未明确诊断）外，作者对其余所有患者肿大的淋巴结或疑似纵隔恶性肿瘤进行了纵隔内镜超声引导下细针穿刺。5例患者因未进行细针穿刺而被排除在分析之外。根据内镜超声形态，7例患者疑似良性病变，37例患者疑似恶性疾病。3例活检获取的样本无法用于细胞学分析。细胞学检查确诊了所有良性病变，并在28例中显示为恶性。6例患者细胞学检查未能发现恶性病变，尽管根据内镜超声检查结果怀疑为恶性。此外，在17例支气管镜检查未明确诊断的患者中，内镜超声引导下细针穿刺为其中15例提供了诊断。EUS-FNA的诊断准确性如下：敏感性82%，特异性100%，阳性预测值1.0，阴性预测值0.54。尽管进行了抗生素预防，但细针穿刺后仅出现1例感染并发症。
纵隔病变的内镜超声引导下细针穿刺是一种准确、安全且技术上相对容易的操作，然而它需要对纵隔解剖结构有实践经验和技巧。它具有出色的阳性预测值、良好的敏感性，但阴性预测值略差。本研究结果与文献数据一致。作者建议，在没有现场病理学家的情况下，应至少进行4次进针，以尽量减少假阴性结果的数量。
