Czarnecka-Kujawa Katarzyna, Yasufuku Kazuhiro
Division of Respirology, University Health Network, Canada University of Toronto, Toronto, Canada.
Division of Thoracic Surgery, University Health Network, Canada University of Toronto, Toronto, Canada.
J Thorac Dis. 2017 Mar;9(Suppl 2):S83-S97. doi: 10.21037/jtd.2017.03.102.
This review provides an update on the current role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and mediastinoscopy (Med) in assessment of patients with non-small cell lung cancer (NSCLC). Invasive mediastinal lymph node (LN) staging is the major application for both of these techniques. Up until recently, Med was the gold standard for invasive mediastinal LN staging in NSCLC. However, EBUS-TBNA has shown to be equivalent, and in some studies better than Med for invasive staging of lung cancer. EBUS-TBNA offers access to N1 LNs and development of the thin convex probe EBUS (TCP-EBUS) will expand EBUS-TBNA access from the paratracheal region and central airways to more distal parabronchial regions allowing for more extensive N1 LN assessment and sampling more distal lung tumors. EBUS-TBNA is more cost-effective than Med and it is currently recommended as the test of first choice for invasive mediastinal LN staging in lung cancer. Confirmatory Med should be performed selectively in patients with high pretest probability of metastatic disease. Addition of esophageal ultrasound fine needle aspiration (EUS-FNA) may increase diagnostic yield of EBUS-TBNA mediastinal staging. Both Med and EBUS-TBNA can be used in primary lung cancer diagnosis, restaging of the mediastinum following neoadjuvant therapy and in diagnosis of lung cancer recurrence. In the future, a combination of EBUS-TBNA with or without EUS-FNA and Med is most likely going to provide the most optimal invasive assessment of the mediastinum in patients with lung cancer. The decision on test choice and sequence should be made on a case-by-case basis and factoring in local resources and expertise.
本综述介绍了支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）和纵隔镜检查（Med）在非小细胞肺癌（NSCLC）患者评估中的当前作用。侵入性纵隔淋巴结（LN）分期是这两种技术的主要应用。直到最近，Med一直是NSCLC侵入性纵隔LN分期的金标准。然而，EBUS-TBNA已被证明具有同等效果，并且在一些研究中，对于肺癌的侵入性分期优于Med。EBUS-TBNA可用于获取N1淋巴结，而薄凸探头EBUS（TCP-EBUS）的开发将把EBUS-TBNA从气管旁区域和中央气道的取材范围扩展到更远端的支气管旁区域，从而能够更广泛地评估N1淋巴结并对更远端的肺部肿瘤进行取材。EBUS-TBNA比Med更具成本效益，目前被推荐作为肺癌侵入性纵隔LN分期的首选检查。对于转移疾病预测试验概率高的患者，应选择性地进行验证性Med检查。增加食管超声细针穿刺活检（EUS-FNA）可能会提高EBUS-TBNA纵隔分期的诊断率。Med和EBUS-TBNA均可用于原发性肺癌诊断、新辅助治疗后纵隔再分期以及肺癌复发的诊断。未来，EBUS-TBNA联合或不联合EUS-FNA以及Med最有可能为肺癌患者提供最优化的纵隔侵入性评估。检查选择和顺序的决定应根据具体情况并考虑当地资源和专业知识来做出。
