Araya Tomoyuki, Demura Yoshiki, Kasahara Kazuo, Matsuoka Hiroki, Yamamura Kenta, Nishitsuji Masaru, Nishi Koichi
Department of Respiratory Medicine, Ishikawa Prefectural Central Hospital, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
J Bronchology Interv Pulmonol. 2013 Apr;20(2):121-6. doi: 10.1097/LBR.0b013e31829182a0.
The discovery of driver oncogenes has increased the need to obtain a sufficient amount of tissue specimens for lung cancer diagnosis. Although endoscopic ultrasound (with bronchoscope)-guided fine-needle aspiration (EUS-B-FNA) is reportedly a feasible and well-tolerated modality, additional advantages of EUS-B-FNA are yet to be thoroughly investigated. The purpose of this study was to evaluate the ability of EUS-B-FNA to obtain sufficient tissue specimens for pathologic and molecular diagnoses of lung cancer.
Among lung cancer patients who were diagnosed between December 2010 and December 2012 in our institute, patients who underwent EUS-B-FNA to diagnose lung cancer were enrolled (n=26). EUS-B-FNA was performed when bronchoscopic diagnosis was impossible or difficult to obtain sufficient samples. Epidermal growth factor receptor (EGFR) mutations and echinoderm microtubule-associated protein-like 4 and the anaplastic lymphoma kinase (EML4-ALK) fusion gene were evaluated using EUS-B-FNA samples of non-small cell lung cancer.
EUS-B-FNA was performed on 28 lesions in 26 patients. Among the target lesions, 23 were mediastinal lymph nodes including nodal stations 2L, 4L, 7, 8, and 10L. The remaining 5 were intrapulmonary lesions. EUS-B-FNAs were completed without complications in all the patients. The diagnostic yield of EUS-B-FNA in diagnosing lung cancer was 100% (26/26). Additional diagnostic gain of EUS-B-FNA was 69.2% (18/26) as compared to bronchoscopy alone. EGFR mutations and EML4-ALK fusion gene could be evaluated in all patients with non-small cell lung cancer (n=20) using EUS-B-FNA samples. One case with EGFR mutation and 1 case with ALK fusion gene were diagnosed. Six non-small cell carcinomas were also diagnosed by bronchoscopy, but all bronchoscopic samples were insufficient to evaluate mutation analyses.
EUS-B-FNA is a practical and feasible method to obtain abundant tumorous tissue samples for pathologic diagnosis and molecular analysis, particularly when the target lesions are inaccessible by other modalities because of their locations or because of the patient's poor physical condition.
驱动癌基因的发现增加了获取足够数量的组织标本用于肺癌诊断的需求。尽管据报道，超声内镜（联合支气管镜）引导下细针穿刺活检（EUS-B-FNA）是一种可行且耐受性良好的方法，但其更多优势仍有待深入研究。本研究旨在评估EUS-B-FNA获取足够组织标本用于肺癌病理和分子诊断的能力。
在2010年12月至2012年12月间于我院确诊的肺癌患者中，纳入接受EUS-B-FNA以诊断肺癌的患者（n = 26）。当支气管镜诊断无法进行或难以获取足够样本时，进行EUS-B-FNA。使用非小细胞肺癌的EUS-B-FNA样本评估表皮生长因子受体（EGFR）突变以及棘皮动物微管相关蛋白样4与间变性淋巴瘤激酶（EML4-ALK）融合基因。
对26例患者的28个病灶进行了EUS-B-FNA。在目标病灶中，23个为纵隔淋巴结，包括2L、4L、7、8和10L组淋巴结。其余5个为肺内病灶。所有患者的EUS-B-FNA均顺利完成，无并发症发生。EUS-B-FNA诊断肺癌的阳性率为100%（26/26）。与单纯支气管镜检查相比，EUS-B-FNA的额外诊断获益为69.2%（18/26）。使用EUS-B-FNA样本可对所有非小细胞肺癌患者（n = 20）进行EGFR突变和EML4-ALK融合基因评估。诊断出1例EGFR突变病例和1例ALK融合基因病例。通过支气管镜检查也诊断出6例非小细胞癌，但所有支气管镜样本均不足以进行突变分析评估。
EUS-B-FNA是一种实用且可行的方法，可获取丰富的肿瘤组织样本用于病理诊断和分子分析，特别是当目标病灶因位置原因或患者身体状况不佳而无法通过其他方式获取时。
