Rusu-Cordunean F, Cernomaz A T, Berlea Mădălina Lavinia, Ferariu D, Grigoriu B D
Rev Med Chir Soc Med Nat Iasi. 2015 Jan-Mar;119(1):31-7.
Lung cancer has a very dismal prognosis and careful diagnosis and staging is of outmost importance. EBUS has become a cornerstone investigation for diagnosis and staging and current guidelines stress that there is a steep learning curve when introducing this tech- nique in practice (only 30 procedures are considered necessary). Over a period of 10 months a total of 21 patients have been addressed to our unit for an EBUS TBNA procedure. Only three were referred for staging purposes (for lung, digestive and cervix cancers) the others being primary diagnostic approaches where simpler procedures had previously failed. Procedures were initially performed under local anesthesia (3 cases) then under general anesthesia and jet ventilation using a laryngeal mask approach. Mediastinal lymph node group 7 was the most frequent target (9 cases) followed by group 4R (8 cases) and peribronchial tumoral processes (7 cases); one case did not required any needle-aspiration. On average each examination resulted in the sampling of 1.4 targets. There were no significant procedure related severe adverse events. Although 21 G cytology needles were used, adequate histological samples were obtained for 11 cases and cytology was the examination of choice for 9 cases. The pathology/cytology results were retrospectively assessed as satisfactory for 15 cases (confirmed neoplastic or other disease) and inconclusive for 5 cases. Non neoplastic disorders were represented by sarcoidosis, tuberculosis and bronchogenic cyst (3 cases). The procedure can be considered fast and safe; trained pathology personnel play an extremely important role: presently referrals are rare for staging purposes.
肺癌的预后非常糟糕，因此仔细的诊断和分期至关重要。超声支气管镜引导针吸活检术（EBUS）已成为诊断和分期的一项基础检查，当前指南强调，在实际操作中引入这项技术时存在陡峭的学习曲线（仅需进行30例操作）。在10个月的时间里，共有21例患者被送至我们科室进行EBUS经支气管针吸活检术（TBNA）。只有3例是为了分期（针对肺癌、消化道癌和宫颈癌），其他则是初次诊断方法，此前采用的更简单的方法均告失败。操作最初在局部麻醉下进行（3例），随后在全身麻醉和使用喉罩通气的情况下进行。纵隔淋巴结7组是最常见的目标（9例），其次是4R组（8例）和支气管周围肿瘤病变（7例）；1例无需任何针吸操作。平均每次检查采集1.4个目标样本。未发生与操作相关的严重不良事件。尽管使用了21G细胞学针，但11例获得了足够的组织学样本，9例选择了细胞学检查。病理/细胞学结果经回顾性评估，15例结果令人满意（确诊为肿瘤或其他疾病），5例结果不明确。非肿瘤性疾病包括结节病、结核病和支气管源性囊肿（3例）。该操作可被认为是快速且安全的；训练有素的病理专业人员发挥着极其重要的作用：目前用于分期目的的转诊很少见。
