Sampsonas Fotios, Kakoullis Loukas, Lykouras Dimosthenis, Karkoulias Kiriakos, Spiropoulos Konstantinos
Department of Respiratory Medicine, University Hospital of Patras, Rion Patras, Greece.
Int J Clin Pract. 2018 Feb;72(2). doi: 10.1111/ijcp.13053. Epub 2018 Jan 3.
The use of endobronchial ultrasound trans-bronchial needle aspiration (EBUS-TBNA) as the initial diagnostic and staging procedure in patients with suspected, non-metastatic lung cancer has gained substantial support, and is now recommended by numerous guidelines. Whereas considerable attention has been pointed to the reductions in costs achieved by EBUS-TBNA, that has not been the case for some of its more significant benefits, namely the reduction of the diagnostic work-up time and its ability to accurately assess and restage lymph nodes, which were previously stated incorrectly by CT or PET scan. Both these benefits translate into improved outcomes for patients, as delays are reduced, futile surgeries are prevented and curable operations can be performed on patients previously excluded by CT or PET scan. Indeed, the use of EBUS as the initial diagnostic and staging procedure has been proven to significantly increase survival, compared with conventional diagnostic and staging procedures, in a pragmatic, randomised controlled trial (Navani N. et al, 2015). The instalment of EBUS will have the greatest effect on overwhelmed, suboptimally functioning national healthcare systems, by decreasing the number of required diagnostic and staging procedures, therefore reducing both treatment delays and costs. The improved selection of surgical candidates by EBUS will result in improved patient outcomes. The latest findings regarding the benefits of EBUS are outlined in this review, which, to the best of our knowledge, is the first to emphasise the impact of the procedure, both on timing and costs of lung cancer staging, as well as on survival.
对于疑似非转移性肺癌患者，使用支气管内超声引导经支气管针吸活检术（EBUS-TBNA）作为初始诊断和分期程序已获得广泛支持，目前众多指南都推荐使用。尽管人们相当关注EBUS-TBNA所带来的成本降低，但对于它的一些更显著的益处却并非如此，即缩短诊断检查时间以及准确评估淋巴结并重新分期的能力，而此前CT或PET扫描对这些方面的评估并不准确。这两个益处都能为患者带来更好的治疗结果，因为可以减少延误，避免无效手术，并能对之前被CT或PET扫描排除的患者进行可治愈的手术。事实上，在一项实用的随机对照试验中（Navani N.等人，2015年），与传统诊断和分期程序相比，使用EBUS作为初始诊断和分期程序已被证明能显著提高生存率。EBUS的应用对不堪重负、功能欠佳的国家医疗系统将产生最大影响，通过减少所需的诊断和分期程序数量，从而减少治疗延误和成本。EBUS对手术候选人的更好筛选将带来更好的患者治疗结果。本综述概述了关于EBUS益处的最新研究结果，据我们所知，这是首个强调该程序对肺癌分期的时间、成本以及生存率影响的综述。
