Lee Kyung Jong, Suh Gee Young, Chung Man Pyo, Kim Hojoong, Kwon O Jung, Han Joungho, Um Sang-Won
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
PLoS One. 2014 Mar 14;9(3):e91893. doi: 10.1371/journal.pone.0091893. eCollection 2014.
We evaluated the utility of a combined approach using endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and transesophageal bronchoscopic ultrasound-guided fine-needle aspiration (EUS-FNA-B/E) for mediastinal staging of lung cancer.
An EBUS-TBNA database was analyzed retrospectively. EUS-FNA-B/E was performed after EBUS-TBNA when mediastinal lymph nodes were not accessible using EBUS-TBNA or when tissue sampling using EBUS-TBNA alone was inadequate.
During the study period, 44 patients were enrolled. EBUS-TBNA and EUS-FNA-B/E were performed on 79 and 52 lymph nodes, respectively. The sensitivity, specificity, and accuracy of mediastinal N-staging using EBUS-TBNA alone were 79%, 100%, and 84%, respectively. The sensitivity, specificity, and accuracy of mediastinal N-staging using a combination of EBUS-TBNA and EUS-FNA-B/E were 100%, 100%, and 100%, respectively. Significant differences in sensitivity (P = 0.008) and accuracy (P = 0.004) of mediastinal N-staging were evident when EBUS-TBNA alone and the combined procedure were compared. The nodal stage shifted higher after use of the EUS-FNA-B/E procedure in six cases (13%). No serious complication associated with the procedures was noted.
Use of a combination of EBUS-TBNA and EUS-FNA-B/E can afford better sensitivity and accuracy of mediastinal N-staging compared with use of EBUS-TBNA alone. Such combined procedures should be considered for examination of lesions that are inaccessible or difficult to access by EBUS-TBNA.
我们评估了采用支气管内超声引导下经支气管针吸活检（EBUS-TBNA）及经食管支气管镜超声引导下细针穿刺活检（EUS-FNA-B/E）联合方法对肺癌进行纵隔分期的实用性。
对一个EBUS-TBNA数据库进行回顾性分析。当使用EBUS-TBNA无法获取纵隔淋巴结或仅使用EBUS-TBNA进行组织采样不足时，在EBUS-TBNA之后进行EUS-FNA-B/E。
在研究期间，共纳入44例患者。分别对79个和52个淋巴结进行了EBUS-TBNA和EUS-FNA-B/E。单独使用EBUS-TBNA进行纵隔N分期的敏感性、特异性和准确性分别为79%、100%和84%。联合使用EBUS-TBNA和EUS-FNA-B/E进行纵隔N分期的敏感性、特异性和准确性分别为100%、100%和100%。当比较单独使用EBUS-TBNA与联合操作时，纵隔N分期的敏感性（P = 0.008）和准确性（P = 0.004）存在显著差异。在六例患者（13%）中，使用EUS-FNA-B/E操作后淋巴结分期升高。未发现与操作相关的严重并发症。
与单独使用EBUS-TBNA相比，联合使用EBUS-TBNA和EUS-FNA-B/E可提供更好的纵隔N分期敏感性和准确性。对于EBUS-TBNA无法到达或难以到达的病变检查，应考虑采用这种联合操作。
