Sakairi Yuichi, Hoshino Hidehisa, Fujiwara Taiki, Nakajima Takahiro, Yasufuku Kazuhiro, Yoshida Shigetoshi, Yoshino Ichiro
Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chiba 260-8670, Japan.
Gen Thorac Cardiovasc Surg. 2013 Sep;61(9):522-7. doi: 10.1007/s11748-013-0263-z. Epub 2013 Jun 9.
Nodal staging of lung cancer is important for selecting surgical candidates. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) was evaluated as a modality for nodal staging of patients with potentially node-positive non-small cell lung cancer (NSCLC).
Endobronchial ultrasound-guided transbronchial needle aspiration was used for nodal staging of NSCLC patients with radiological N2/3 disease (short axis >10 mm on computed tomography and/or standardized positron emission uptake value >2.5 on 2-deoxy-2[F-18] fluoro-D-glucose positron emission tomography), T-stage ≥ T2, or positive serum carcinoembryonic antigen. Data on eligible patients were extracted from the database of our institution and analyzed for differences in nodal stages between radiological staging (RS) and EBUS-TBNA-integrated staging (ES), with validation by pathological staging of patients who had undergone surgery.
Of 480 eligible patients, there were 135 N0/1 and 345 N2/3 patients according to RS. Out of the 345 patients staged as N2/3 by RS, 113 (33 %) were downgraded to N0/1 by ES. Out of the 135 patients staged as N0/1 by RS, 12 (9 %) were upgraded to N2/3 by ES. Patients were restaged as N0/1 in 236 cases and N2/3 in 244 cases by ES, and the distributions of nodal stage between RS and ES were significantly different (p < 0.001). Finally, 215 out of the 236 ES-N0/1 patients underwent lung resection, and 195 (90.7 %) and 20 patients were staged by pathology as N0/1 and N2, respectively.
Endobronchial ultrasound-guided transbronchial needle aspiration is more accurate for lymph node staging compared to radiological staging. EBUS-TBNA can identify patients who are true candidates for surgery.
肺癌的淋巴结分期对于选择手术候选者很重要。评估支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）作为潜在淋巴结阳性非小细胞肺癌（NSCLC）患者淋巴结分期的一种方法。
支气管内超声引导下经支气管针吸活检术用于对具有放射学N2/3疾病（计算机断层扫描短轴>10 mm和/或2-脱氧-2[F-18]氟-D-葡萄糖正电子发射断层扫描标准化正电子发射摄取值>2.5）、T分期≥T2或血清癌胚抗原阳性的NSCLC患者进行淋巴结分期。从我们机构的数据库中提取符合条件患者的数据，并分析放射学分期（RS）和EBUS-TBNA综合分期（ES）之间淋巴结分期的差异，并通过接受手术患者的病理分期进行验证。
在480例符合条件的患者中，根据RS有135例N0/1患者和345例N2/3患者。在RS分期为N2/3的345例患者中，113例（33%）被ES降级为N0/1。在RS分期为N0/1的135例患者中，12例（9%）被ES升级为N2/3。ES将患者重新分期为N0/1共236例，N2/3共244例；RS和ES之间淋巴结分期分布有显著差异（p<0.001）。最后，236例ES-N0/1患者中有215例接受了肺切除术，其中195例（90.7%）和20例经病理分期分别为N0/1和N2。
与放射学分期相比，支气管内超声引导下经支气管针吸活检术在淋巴结分期方面更准确。EBUS-TBNA可以识别真正适合手术的患者。
