Crombag Laurence M M J, Szlubowski Artur, Stigt Jos A, Schuurbiers Olga, Korevaar Daniël A, Bonta Peter I, Annema Jouke T
Dept. of Pulmonology, F5-144, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Endoscopy Unit, Pulmonary Hospital in Zakopane, Poland.
Lung Cancer. 2017 Jun;108:38-44. doi: 10.1016/j.lungcan.2017.02.011. Epub 2017 Feb 20.
In patients with lung cancer, left adrenal glands (LAG) suspected for distant metastases (M1b) based on imaging require further evaluation for a definitive diagnosis. Tissue acquisition is regularly performed using conventional EUS-FNA. The aim of this study was to investigate the success rate of endoscopic ultrasound guided fine-needle aspiration using the EBUS scope (EUS-B-FNA) for LAG analysis.
This is a prospective multicenter study in consecutive patients with (suspected) lung cancer and suspected mediastinal and LAG metastases. Following complete mediastinal staging using the EBUS scope (EBUS+EUS-B), the LAG was evaluated and sampled by both EUS-B (experimental procedure) and conventional EUS (current standard of care).
The success rate for LAG analysis (visualized, sampled and adequate tissue obtained) was 89% (39/44; 95% CI 76-95%) for EUS-B-FNA, and 93% (41/44; 95%CI 82-98%) for EUS-FNA. In the absence of metastases at EUS-B and/or EUS, surgical verification of the LAG or 6 months clinical and radiological follow-up was obtained, but missing for 5 patients. The prevalence of LAG metastases was 54% (21/39). In patients in whom LAG was seen and sampled, sensitivity for LAG metastases was at least 87% (95%CI 65-97%) for EUS-B, and at least 83% (95%CI 62-95%) for conventional EUS.
LAG analysis by EUS-B shows a similar high success rate in comparison to conventional EUS.
Both a mediastinal nodal and LAG evaluation can be adequately performed with just an EBUS scope and single endoscopist. This staging strategy is likely to reduce patient-burden and costs.
在肺癌患者中，基于影像学怀疑左肾上腺（LAG）有远处转移（M1b）的情况需要进一步评估以明确诊断。通常使用传统的超声内镜引导下细针穿刺抽吸术（EUS-FNA）获取组织。本研究的目的是调查使用超声支气管镜（EBUS）进行超声内镜引导下细针穿刺抽吸术（EUS-B-FNA）分析LAG的成功率。
这是一项针对连续的（疑似）肺癌且怀疑有纵隔和LAG转移患者的前瞻性多中心研究。在使用EBUS（EBUS+EUS-B）完成纵隔分期后，通过EUS-B（实验操作）和传统EUS（当前护理标准）对LAG进行评估和取样。
EUS-B-FNA对LAG分析的成功率（可视化、取样并获得足够组织）为89%（39/44；95%CI 76-95%），EUS-FNA为93%（41/44；95%CI 82-98%）。在EUS-B和/或EUS检查未发现转移的情况下，对LAG进行了手术验证或6个月的临床及影像学随访，但有5例患者未进行。LAG转移的发生率为54%（21/39）。在LAG可见并取样的患者中，EUS-B对LAG转移的敏感性至少为87%（95%CI 65-97%），传统EUS至少为83%（95%CI 62-95%）。
与传统EUS相比，EUS-B对LAG分析显示出相似的高成功率。
仅使用EBUS和单一内镜医师就可以充分进行纵隔淋巴结和LAG评估。这种分期策略可能会减轻患者负担并降低成本。
