Dziedzic Dariusz, Peryt Adam, Szolkowska Malgorzata, Langfort Renata, Orlowski Tadeusz
Department of Thoracic Surgery, National Research Institute of Chest Diseases, Warsaw, Poland.
Department of Patomorphology, National Research Institute of Chest Diseases, Warsaw, Poland.
SAGE Open Med. 2015 Oct 9;3:2050312115610128. doi: 10.1177/2050312115610128. eCollection 2015.
Mediastinoscopy as diagnostic procedure for evaluation of mediastinum in patients with non-small-cell lung cancer has long been considered the reference standard. However, less invasive method has occurred. Endobronchial ultrasound-guided transbronchial needle aspiration came into widespread use and has resulted in controversy as to whether it is a good replacement for mediastinoscopy. We chose to demonstrate the usefulness of endobronchial ultrasound-guided transbronchial needle aspiration in evaluating the mediastinum in patients with non-small-cell lung cancer.
Over a 48-month period, 1841 patients underwent endobronchial ultrasound-guided transbronchial needle aspiration at our healthcare centre. In all patients, 2964 biopsies from the lymph node group N2 and 783 from group N1 were taken. The mean short axis of the lymph nodes biopsied was 2.0 (range: 0.6-2.6). The mean number of lymph node stations biopsied per patient was 2.6. Patients with a negative result of endobronchial ultrasound-guided transbronchial needle aspiration underwent mediastinoscopy. All patients with a negative result in endobronchial ultrasound-guided transbronchial needle aspiration and mediastinoscopy underwent surgical resection with lymph node sampling.
The metastases to lymph nodes N2/N3 and N1 were found in 1111 (60.3%) and 199 (9.3%), respectively. Mediastinoscopy was performed in 730 patients with a positive result in 83 (11.4%) patients. In the group of operated patients, metastatic N1 disease was found in 264 (14.1%). In the group of the operated patients, mediastinal involvement of disease (N2) was found in 30 patients (4.5%). The sensitivity, negative predictive value and diagnostic accuracy for hilar lymph node staging for endobronchial ultrasound-guided transbronchial needle aspiration were 57%, 96% and 96%, respectively. The sensitivity, negative predictive value and diagnostic accuracy per patient for mediastinal lymph node staging for endobronchial ultrasound-guided transbronchial needle aspiration and mediastinoscopy were 91%, 85%, 93% and 73%, 95.5%, 97%, respectively. The specificity and positive predictive value of both tests were 100%.
The clinical usefulness of endobronchial ultrasound-guided transbronchial needle aspiration is undeniable according to diagnostic performance data. Endobronchial ultrasound-guided transbronchial needle aspiration should be considered complementary to mediastinoscopy in the evaluation of patients with radiographically abnormal mediastinum.
长期以来，纵隔镜检查一直被视为评估非小细胞肺癌患者纵隔情况的诊断标准方法。然而，出现了侵入性较小的方法。支气管内超声引导下经支气管针吸活检术已广泛应用，并引发了它是否能很好替代纵隔镜检查的争议。我们选择证明支气管内超声引导下经支气管针吸活检术在评估非小细胞肺癌患者纵隔方面的有效性。
在48个月期间，1841例患者在我们的医疗中心接受了支气管内超声引导下经支气管针吸活检术。所有患者中，对N2组淋巴结进行了2964次活检，对N1组淋巴结进行了783次活检。活检淋巴结的平均短轴为2.0（范围：0.6 - 2.6）。每位患者活检的淋巴结站平均数量为2.6个。支气管内超声引导下经支气管针吸活检术结果为阴性的患者接受了纵隔镜检查。所有支气管内超声引导下经支气管针吸活检术和纵隔镜检查结果为阴性的患者均接受了淋巴结采样的手术切除。
N2/N3和N1淋巴结转移分别在1111例（60.3%）和199例（9.3%）患者中发现。730例患者进行了纵隔镜检查，其中83例（11.4%）结果为阳性。在手术患者组中，发现264例（14.1%）有N1期转移疾病。在手术患者组中，发现30例（4.5%）有纵隔疾病累及（N2）。支气管内超声引导下经支气管针吸活检术对肺门淋巴结分期的敏感性、阴性预测值和诊断准确性分别为57%、96%和96%。支气管内超声引导下经支气管针吸活检术和纵隔镜检查对每位患者纵隔淋巴结分期的敏感性、阴性预测值和诊断准确性分别为91%、85%、93%和73%、95.5%、97%。两种检查的特异性和阳性预测值均为100%。
根据诊断性能数据，支气管内超声引导下经支气管针吸活检术的临床有效性是不可否认的。在评估影像学上纵隔异常的患者时，支气管内超声引导下经支气管针吸活检术应被视为纵隔镜检查的补充方法。
