Guarize Juliana, Casiraghi Monica, Donghi Stefano, Casadio Chiara, Diotti Cristina, Filippi Niccolò, Di Tonno Clementina, Midolo Valeria, Maisonneuve Patrick, Brambilla Daniela, Grana Chiara Maria, Petrella Francesco, Spaggiari Lorenzo
Dept of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
Dept of Pathology, European Institute of Oncology, Milan, Italy.
ERJ Open Res. 2017 Oct 23;3(4). doi: 10.1183/23120541.00009-2017. eCollection 2017 Oct.
Mediastinal lymph node enlargement is common in the follow-up of patients with previously treated malignancies. The aim of this study is to assess the role of endobronchial ultrasound (EBUS) transbronchial needle aspiration (TBNA) for cyto-histological evaluation of positron emission tomography with fluorodeoxyglucose (PET) positive mediastinal and hilar lymph nodes developed in patients with previous malignancies. All EBUS-TBNA cases performed from January 2012 to May 2016 were retrospective reviewed. Results of EBUS-TBNA in patients with mediastinal and/or hilar lymphadenopathies were analysed. Non-malignant cytopathologies were confirmed with surgical procedures or clinical and radiological follow-up. Among 1780 patients, 176 were included in the analysis. 103 of these (58.5%) had a diagnosis of tumour recurrence whereas 73 (41.5%) had a different diagnosis: 63 (35.8%) had a non-neoplastic diagnosis and 8 patients (4.6%) had a different cell type malignancy. Samples were false-negative in 5 (2.8%) out of 176 patients. The overall sensitivity, specificity, negative predicted value and diagnostic accuracy were 95.7% (95% CI 90.2-98.6%), 100% (95% CI 94.0-100%), 92.3% (95% CI 83.2-96.7%) and 97.2% (95% CI 93.5-98.8%), respectively. EBUS-TBNA demonstrated a pathological diagnosis different from the previous tumour in a large percentage of patients, confirming its strategic role in the management of patients with previously treated malignancies.
纵隔淋巴结肿大在既往接受过治疗的恶性肿瘤患者的随访中很常见。本研究的目的是评估经支气管超声（EBUS）引导下经支气管针吸活检（TBNA）在对既往恶性肿瘤患者中出现的氟脱氧葡萄糖正电子发射断层扫描（PET）阳性的纵隔和肺门淋巴结进行细胞组织学评估中的作用。对2012年1月至2016年5月期间所有进行的EBUS-TBNA病例进行回顾性分析。分析了纵隔和/或肺门淋巴结病患者的EBUS-TBNA结果。通过手术或临床及影像学随访证实非恶性细胞病理学结果。在1780例患者中，176例纳入分析。其中103例（58.5%）诊断为肿瘤复发，而73例（41.5%）有不同诊断：63例（35.8%）为非肿瘤性诊断，8例（4.6%）为不同细胞类型的恶性肿瘤。176例患者中有5例（2.8%）样本为假阴性。总体敏感性、特异性、阴性预测值和诊断准确性分别为95.7%（95%可信区间90.2 - 98.6%）、100%（95%可信区间94.0 - 100%）、92.3%（95%可信区间83.2 - 96.7%）和97.2%（95%可信区间93.5 - 98.8%）。EBUS-TBNA在很大比例的患者中显示出与先前肿瘤不同的病理诊断，证实了其在既往接受过治疗的恶性肿瘤患者管理中的重要作用。
