Carmo Joana, Bispo Miguel, Marques Susana, Chagas Cristina
Gastroenterology Department, Hospital de Egas Moniz - Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal.
Endosc Int Open. 2018 Apr;6(4):E432-E436. doi: 10.1055/s-0044-101602. Epub 2018 Mar 29.
Significant the prevalence of mediastinal lymph nodes (MLN) has been documented in autopsy and computed tomography (CT) studies. Awareness of the local prevalence and characteristics of lymph nodes will be relevant when performing endoscopic ultrasonography (EUS) for staging of malignant neoplasias. The aims of this study were to document the prevalence and echo features of MLN in patients undergoing EUS for non-malignant extrathoracic disease and to identify predictive factors for the presence of MLN.
A prospective single-center study was performed over 6 months. Mediastinal stations 9, 8, 7, 6, 5, 4 L and 2 were systematically evaluated using a linear echoendoscope in all patients undergoing EUS due to benign extrathoracic pathology and without history of oncologic disease. Demographic, clinical and EUS features of the lymph nodes were analysed.
Seventy-five patients were included: male/female 32/43; mean age, 63 years. The majority of patients (72 %) had lymph nodes in at least one mediastinal station and 88 % of these were found in stations 7 or 4 L. Overall, 133 MLN were identified: 19 % were hypoechogenic, 6 % had a short-axis diameter > 10 mm, and 6 % were round. The prevalence of lymph nodes was higher in smokers (83 % vs 64 %, = 0.024), with a higher average number of lymph nodes per patient in this group (2.1 vs 1.6; = 0.017). By logistic regression analysis, none of the variables analyzed were independently associated with the presence of MLN.
This prospective Portuguese study documented a higher prevalence of MLN than previously reported in Northern Europe, in patients with no evidence of oncologic disease. This higher prevalence may negatively influence the specificity and positive predictive value for malignancy of MLN (N) staging by EUS.
尸检和计算机断层扫描（CT）研究已证实纵隔淋巴结（MLN）的显著患病率。在对恶性肿瘤进行内镜超声检查（EUS）分期时，了解淋巴结的局部患病率和特征具有重要意义。本研究的目的是记录接受EUS检查的非恶性胸外疾病患者中MLN的患病率和回声特征，并确定MLN存在的预测因素。
进行了一项为期6个月的前瞻性单中心研究。对所有因良性胸外病变接受EUS检查且无肿瘤疾病史的患者，使用线性超声内镜对纵隔9、8、7、6、5、4L和2区进行系统评估。分析了淋巴结的人口统计学、临床和EUS特征。
纳入75例患者，男32例，女43例；平均年龄63岁。大多数患者（72%）至少有一个纵隔区出现淋巴结，其中88%位于7区或4L区。共识别出133个MLN：19%为低回声，6%短轴直径>10mm，6%为圆形。吸烟者的淋巴结患病率更高（83%对64%，P=0.024），该组患者平均每人的淋巴结数量更多（2.1对1.6；P=0.017）。通过逻辑回归分析，所分析的变量均与MLN的存在无独立相关性。
这项葡萄牙前瞻性研究记录了无肿瘤疾病证据的患者中MLN的患病率高于北欧此前报道的水平。这种较高的患病率可能会对EUS进行MLN（N）分期诊断恶性肿瘤的特异性和阳性预测值产生负面影响。
