Division of Cardiothoracic Surgery, Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Ann Thorac Surg. 2013 Aug;96(2):403-10. doi: 10.1016/j.athoracsur.2013.04.003. Epub 2013 May 31.
Endobronchial ultrasonography with transbronchial needle aspiration (EBUS-TBNA) has been shown to be equivalent to mediastinoscopy in lung cancer staging for mediastinal node involvement. Rapid on-site evaluation (ROSE) to determine the adequacy of nodal sampling has been claimed to be beneficial.
A retrospective evaluation was performed in 170 patients who underwent EBUS-TBNA from July 2008 to May 2011. The patients were classified as having either high or low pretest probability for mediastinal disease based on history and radiographic imaging. ROSE was compared with the final pathology reports based on slides and cell blocks.
One hundred thirty-one (77%) patients were classified as being in the high pretest cohort based on clinical staging. Of these, 101 (77%) patients had adequate tissue sampling based on ROSE, with 70 (69%) patients having positive mediastinal disease. In the 30 (23%) patients who had inadequate tissue by ROSE, the final analysis of all the prepared slides and cell blocks allowed for a diagnosis in all but 8 patients. The sensitivity and specificity of ROSE in the high pretest probability cohort were 89.5% and 96.4%, respectively, whereas the overall sensitivity and specificity of EBUS-TBNA was 92.1% and 100%, respectively. Despite having inadequate tissue on ROSE in 30 of 131 patients, sufficient tissue was available on final analysis for diagnosis in 22 of 30 patients.
ROSE does not impact clinical decision making if a thorough mediastinal staging using EBUS is performed. Despite inadequate tissue sampling assessment by ROSE, a final diagnosis was made in most patients, potentially avoiding an additional surgical procedure to prove mediastinal disease.
经支气管超声引导针吸活检术(EBUS-TBNA)已被证明在肺癌分期中对于纵隔淋巴结受累与纵隔镜检查具有同等价值。快速现场评估(ROSE)可确定淋巴结取样的充分性,据称这是有益的。
对 2008 年 7 月至 2011 年 5 月期间进行 EBUS-TBNA 的 170 例患者进行了回顾性评估。根据病史和影像学检查,患者被分为纵隔疾病的高或低术前概率。ROSE 与基于切片和细胞块的最终病理报告进行比较。
根据临床分期,131 例(77%)患者被归类为高术前队列。在这些患者中,101 例(77%)患者的 ROSE 显示组织取样充分,其中 70 例(69%)患者存在阳性纵隔疾病。在 30 例(23%)ROSE 显示组织不足的患者中,对所有制备的切片和细胞块进行最终分析,除 8 例患者外,所有患者均可诊断。在高术前概率队列中,ROSE 的敏感性和特异性分别为 89.5%和 96.4%,而 EBUS-TBNA 的总体敏感性和特异性分别为 92.1%和 100%。尽管在 131 例患者中有 30 例 ROSE 显示组织不足,但在 30 例患者中有 22 例最终分析中仍有足够的组织用于诊断。
如果使用 EBUS 进行彻底的纵隔分期,ROSE 不会影响临床决策。尽管 ROSE 评估的组织取样不足,但大多数患者仍可做出最终诊断,从而可能避免进行额外的手术以证实纵隔疾病。