支气管内超声引导下经支气管针吸活检术在小细胞肺癌诊断中的应用

Endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of small cell lung cancer.

作者信息

Murakami Yasushi, Oki Masahide, Saka Hideo, Kitagawa Chiyoe, Kogure Yoshihito, Ryuge Misaki, Tsuboi Rie, Oka Saori, Nakahata Masashi, Funahashi Yoriko, Hori Kazumi, Ise Yuko, Ichihara Shu, Moritani Suzuko

机构信息

Department of Respiratory Medicine, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya 460-0001, Japan.

Department of Pathology, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya 460-0001, Japan.

出版信息

Respir Investig. 2014 May;52(3):173-8. doi: 10.1016/j.resinv.2013.11.004. Epub 2013 Dec 22.

DOI:10.1016/j.resinv.2013.11.004

PMID:24853017

Abstract

BACKGROUND

Massive lymphadenopathy and direct mediastinal invasion are well-recognized phenomena in patients with small cell lung cancer (SCLC). The aim of this study was to assess the utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of SCLC.

METHODS

We retrospectively reviewed the records of 780 patients who underwent EBUS-TBNA at our institution from March 2004 to June 2012. Of these, 101 had a final diagnosis of SCLC. Excluding 3 patients with known SCLC who underwent EBUS-TBNA for staging purposes and including 2 patients who underwent EBUS-TBNA twice for the diagnosis of recurrence after achieving complete response by chemoradiation therapy during the study period, a total of 100 EBUS-TBNA procedures in 98 patients were analyzed.

RESULTS

Other diagnostic tests prior to the initial EBUS-TBNA had failed to yield a diagnosis in 41 patients. The overall diagnostic yield of EBUS-TBNA for SCLC was 97% (97 of 100). Rapid on-site cytologic evaluation (ROSE) was performed at the operator's discretion in 77 procedures. ROSE did not have any impact on diagnostic yield (99% with ROSE vs. 90% without ROSE, p=0.1), but the use of ROSE was associated with fewer lesions (mean 1.1 with ROSE vs. 1.6 without ROSE, p<0.01) or aspirates (mean 2.3 with ROSE vs. 4.0 without ROSE, p<0.01).

CONCLUSIONS

EBUS-TBNA provided a high diagnostic yield in SCLC with or without ROSE. EBUS-TBNA can be recommended for patients suspected to have SCLC, even if other diagnostic tests have failed.

摘要

背景

小细胞肺癌（SCLC）患者出现大量淋巴结肿大和纵隔直接侵犯是公认的现象。本研究的目的是评估支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）在SCLC诊断中的效用。

方法

我们回顾性分析了2004年3月至2012年6月在本机构接受EBUS-TBNA的780例患者的记录。其中，101例最终诊断为SCLC。排除3例已知SCLC且因分期目的接受EBUS-TBNA的患者，并纳入2例在研究期间经放化疗达到完全缓解后因诊断复发而接受两次EBUS-TBNA的患者，共分析了98例患者的100次EBUS-TBNA操作。

结果

在最初的EBUS-TBNA之前，其他诊断测试未能在41例患者中得出诊断结果。EBUS-TBNA对SCLC的总体诊断率为97%（100例中的97例）。77例操作中，根据操作者的判断进行了快速现场细胞学评估（ROSE）。ROSE对诊断率没有任何影响（有ROSE时为99%，无ROSE时为90%，p = 0.1），但使用ROSE时病变（有ROSE时平均为1.1个，无ROSE时为1.6个，p < 0.01）或抽吸物（有ROSE时平均为2.3次，无ROSE时为4.0次，p < 0.01）较少。