Mehmood Shafqat, Loya Asif, Yusuf Muhammed Aasim
Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan.
Acta Cytol. 2013;57(5):436-42. doi: 10.1159/000351474. Epub 2013 Sep 7.
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has proven to be helpful in obtaining tissue samples from enlarged mediastinal and intra-abdominal lymph nodes. This is especially beneficial in the diagnosis and staging of malignancy. We retrospectively reviewed the clinical utility of this method at a tertiary care cancer hospital in Pakistan.
The medical records of 183 consecutive patients referred to the gastroenterology service from August 2008 to March 2012 were reviewed in this retrospective study. The mean age of the patients at presentation was 46.7 years (range 6-87; 62% males); 119 patients had mediastinal and 64 had intra-abdominal lymphadenopathy. Major indications for referral were diagnosis of lymphadenopathy of unknown origin detected on CT scan or PET-CT, to exclude lymph node metastasis in patients with a known primary tumor and to rule out relapse of lymphoma following treatment or during follow-up. Rapid on-site evaluation (ROSE) was performed in all patients to confirm the adequacy of sampling, followed by definitive cytopathological evaluation.
EUS-FNA with ROSE obtained adequate tissue for cytology in 97.3% of the patients in this cohort. These results were further confirmed on final cytopathological analysis in 96.2% of patients. Two patients (1.1%) had inadequate specimens for final interpretation (97.3 vs. 96.2; p = 0.001). Clinical utility was 95% for mediastinal lymphadenopathy and 98.4% for intra-abdominal lymphadenopathy. Only 1 patient had a serious complication requiring hospitalization and this was successfully managed conservatively.
EUS-FNA is safe and has a high clinical utility in diagnosing unexplained mediastinal and intra-abdominal lymphadenopathy.
内镜超声引导下细针穿刺活检（EUS-FNA）已被证明有助于从肿大的纵隔和腹腔淋巴结获取组织样本。这在恶性肿瘤的诊断和分期中特别有益。我们回顾性地评估了该方法在巴基斯坦一家三级癌症专科医院的临床应用价值。
本回顾性研究对2008年8月至2012年3月间连续转诊至胃肠病科的183例患者的病历进行了审查。患者就诊时的平均年龄为46.7岁（范围6-87岁；62%为男性）；119例患者有纵隔淋巴结病变，64例有腹腔淋巴结病变。转诊的主要指征是CT扫描或PET-CT检查发现不明原因的淋巴结病变，排除已知原发性肿瘤患者的淋巴结转移，以及排除治疗后或随访期间淋巴瘤的复发。对所有患者进行了快速现场评估（ROSE）以确认采样是否充分，随后进行最终的细胞病理学评估。
在该队列中，采用ROSE的EUS-FNA为97.3%的患者获取了足够用于细胞学检查的组织。在96.2%的患者中，最终的细胞病理学分析进一步证实了这些结果。两名患者（1.1%）的标本不足以进行最终解读（97.3%对96.2%；p = 0.001）。纵隔淋巴结病变的临床应用价值为95%，腹腔淋巴结病变为98.4%。只有1例患者出现严重并发症需要住院治疗，该患者经保守治疗成功治愈。
EUS-FNA在诊断不明原因的纵隔和腹腔淋巴结病变方面安全且具有很高的临床应用价值。
