Tertemiz Kemal Can, Alpaydin Aylin Ozgen, Karacam Volkan
Department of Pulmonary Diseases, Dokuz Eylul University Medical Faculty, 35340, Balcova, Izmir, Turkey.
Thoracic Surgery, Dokuz Eylul University Medical Faculty, Balcova, Izmir, Turkey.
Surg Endosc. 2017 Jul;31(7):2829-2836. doi: 10.1007/s00464-016-5293-z. Epub 2016 Oct 21.
Many extrathoracic malignancies can metastasize to lungs and mediastinal lymph nodes. Whether mediastinal lesions are metastasis in these patients changes staging, prognosis, and treatment strategy. In this study, we aimed to find out the contribution of EBUS-TBNA to the diagnosis in cases with extrathoracic malignancy.
Patients who had been previously diagnosed as extrapulmonary solid organ malignancy and in whom mediastinal or hilar lymphadenopathy developed during their follow-up and EBUS-TBNA was applied for diagnostic purposes were retrospectively included in this study.
A total of 91 patients consisting of 35 females (38.5 %) and 56 males (61.5 %) were included in the study. The mean age of the patients was 60.5 (±11.4). Malignancy was not observed in 54 (59.3 %) patients; primary malignancy metastasis was detected in 33 (36.3 %) patients, and primary lung cancer was detected in 4 (4.4 %) patients with EBUS-TBNA. The sensitivity of EBUS-TBNA in extrathoracic malignancies was determined as 90.2 %; its specificity was determined as 100 %, its negative predictive value as 92.5 %, its positive predictive value as 100 %, and its diagnostic accuracy as 95.6 %. The highest rate was determined in the left lower paratracheal lymph node when they were examined in terms of malignancy detection rate in lymph node stations.
EBUS-TBNA is a minimally invasive method with quite a low complication rate that does not require general anesthesia. It should be the first step method to be used in the diagnosis of mediastinal and hilar lymphadenopathies seen in extrathoracic malignancies since it has high diagnostic accuracy, sensitivity, and specificity. EBUS-TBNA significantly reduces the need for surgical intervention. Further surgical interventions can be planned in patients in whom diagnostic competence is not ensured.
许多胸外恶性肿瘤可转移至肺部和纵隔淋巴结。这些患者的纵隔病变是否为转移会改变分期、预后和治疗策略。在本研究中，我们旨在明确超声支气管镜引导针吸活检术（EBUS-TBNA）在胸外恶性肿瘤病例诊断中的作用。
本研究回顾性纳入了先前被诊断为肺外实体器官恶性肿瘤且在随访期间出现纵隔或肺门淋巴结肿大并接受EBUS-TBNA以进行诊断的患者。
本研究共纳入91例患者，其中女性35例（38.5%），男性56例（61.5%）。患者的平均年龄为60.5岁（±11.4）。54例（59.3%）患者未发现恶性肿瘤；33例（36.3%）患者检测到原发性恶性肿瘤转移，4例（4.4%）患者通过EBUS-TBNA检测到原发性肺癌。EBUS-TBNA在胸外恶性肿瘤中的敏感性为90.2%；特异性为100%，阴性预测值为92.5%，阳性预测值为100%，诊断准确性为95.6%。就淋巴结站的恶性肿瘤检出率进行检查时，左下气管旁淋巴结的检出率最高。
EBUS-TBNA是一种微创方法，并发症发生率相当低，且无需全身麻醉。由于其具有较高的诊断准确性、敏感性和特异性，它应成为用于诊断胸外恶性肿瘤中出现的纵隔和肺门淋巴结肿大的首选方法。EBUS-TBNA显著减少了手术干预的需求。对于诊断能力未得到保证的患者，可以规划进一步的手术干预。
