Val-Bernal José-Fernando, Martino María, Yllera Elena, Romay Félix, Sánchez-Ares María, Nallib Ihab Abdulkader
Pathology Unit, Medical and Surgical Sciences Department, University of Cantabria and IDIVAL Research Institute, SANTANDER, SPAIN.
Turk Patoloji Derg. 2019;35(2):92-101. doi: 10.5146/tjpath.2018.01437.
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive technique for investigating hilar and mediastinal lymphadenopathy. This study reports eleven cases in which EBUS-TBNA was used to assess mediastinal and hilar lymph nodes for the presence of metastatic melanoma.
A retrospective study was performed of all patients who had a history of melanoma and underwent EBUS-TBNA to assess hilar or mediastinal lymphadenopathy for the presence of metastatic melanoma. In seven cases, molecular analysis to detect mutations in the BRAF gene was also used.
Eight patients had been diagnosed with malignant melanoma in the past (mean 54.4 months, range 18 to 115 months) while in the other three this tumor was primarily diagnosed in the staging phase. The male-female ratio was 6:5, and the mean age was 60.3 years (range 42 to 88 years). The mean hilar or mediastinal lymph node size detected with computed tomography was 3.0 cm (range 1.1 to 8.1 cm). Eight (72.7%) cases had metastases to the lung associated with metastases in the mediastinal lymph nodes. In four (50%) of these cases, the lung metastasis was solitary. Three (27.3%) cases had metastases in the mediastinal lymph nodes in absence of lung metastases. Metastatic melanoma was diagnosed by cytology and confirmed by cell block study with immunohistochemistry in all cases. BRAF mutations were detected in two (28.6%) of seven cases studied.
Cytology and tissue samples obtained from EBUS-TBNA are adequate to detect metastatic melanoma and permit in some cases the determination of biomarkers and identify the presence or absence of mutations in the BRAF gene. The procedure is safe, fast, and precise for the staging of melanoma.
支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）是一种用于检查肺门和纵隔淋巴结病的微创技术。本研究报告了11例使用EBUS-TBNA评估纵隔和肺门淋巴结是否存在转移性黑色素瘤的病例。
对所有有黑色素瘤病史并接受EBUS-TBNA以评估肺门或纵隔淋巴结病是否存在转移性黑色素瘤的患者进行回顾性研究。7例患者还进行了检测BRAF基因突变的分子分析。
8例患者过去曾被诊断为恶性黑色素瘤（平均54.4个月，范围18至115个月），另外3例在分期阶段首次诊断出该肿瘤。男女比例为6:5，平均年龄为60.3岁（范围42至88岁）。计算机断层扫描检测到的平均肺门或纵隔淋巴结大小为3.0 cm（范围1.1至8.1 cm）。8例（72.7%）患者伴有纵隔淋巴结转移的同时发生了肺转移。其中4例（50%）患者的肺转移为单发。3例（27.3%）患者有纵隔淋巴结转移但无肺转移。所有病例均通过细胞学诊断为转移性黑色素瘤，并经细胞块研究及免疫组化证实。7例研究病例中有2例（28.6%）检测到BRAF基因突变。
从EBUS-TBNA获得的细胞学和组织样本足以检测转移性黑色素瘤，在某些情况下还能确定生物标志物并识别BRAF基因是否存在突变。该方法对黑色素瘤分期安全、快速且精确。
