Liu Yongjian, Chen Minjiang, Sun Xuefeng, Shao Chi, Xu Yan, Chen Yong, Zhao Yuanyuan, Zhao Jing, Wang Mengzhao
Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China.
Zhongguo Fei Ai Za Zhi. 2019 Apr 20;22(4):223-227. doi: 10.3779/j.issn.1009-3419.2019.04.04.
Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is well known as an important technique for diagnosis and staging of lung cancer. But a standard protocol to deal with patients who have a negative pathology result still needs to be defined. Herein, we describe the subsequent procedures of these patients in a single center.
A total of 1,412 patients with clinical suspected lung cancer and mediastinal metastasis who underwent EBUS-TBNA were collected between September 2010 and December 2016. Among them, 51 patients with nonspecific pathology result were included and retrospectively analyzed.
The 51 patients were stratified into five groups by clinical characterize and follow-up procedures: (1) Diagnosed by other bronchoscopy procedures group (9 cases). Abnormalities of tracheobronchial tree were found during visual examination in the majority of patients (8 cases). Biopsy, endobronchial brushing, bronchoalveolar lavage, and transbronchial lung biopsy (TBLB) were used to get a specific diagnosis. (2) EBUS-TBNA re-biopsy group (11 cases). Patients in this group had normal mucosal appearance and airway lumen. Re-biopsy were performed on patients in this group. (3) Surgery group (6 cases). Patients underwent surgery after negative result of EBUS-TBNA. Five of them were confirmed with non-nodal metastasis after surgery. (4) Underwent other pathology diagnosis group (15 cases). patients in this group had other metastasis sites besides midiastinal lymph node. Computed tomography (CT)-guided fine-needle aspiration and lymph node biopsy were performed. (5) Follow-up group (10 cases). None invasive procedure was used in this group. The median follow up time was 38 months. One patient was diagnosed lymphoma during the follow up.
Diagnostic procedures should be chosen based on the clinical character in EBUS-TBNA negative patients with suspected lung cancer. Long time follow-up is very important in patients whose diagnosis is apparently unknown.
支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）是肺癌诊断和分期的一项重要技术。但对于病理结果为阴性的患者，仍需制定标准的处理方案。在此，我们描述了单中心这些患者的后续处理流程。
收集2010年9月至2016年12月期间共1412例临床怀疑肺癌且有纵隔转移并接受EBUS-TBNA的患者。其中，纳入51例病理结果不明确的患者并进行回顾性分析。
根据临床特征和随访流程，将51例患者分为五组：（1）经其他支气管镜检查确诊组（9例）。大多数患者（8例）在直视检查时发现气管支气管树异常。采用活检、支气管内刷检、支气管肺泡灌洗和经支气管肺活检（TBLB）以明确诊断。（2）EBUS-TBNA再次活检组（11例）。该组患者黏膜外观和气道腔正常。对该组患者进行了再次活检。（3）手术组（6例）。EBUS-TBNA结果为阴性后患者接受了手术。其中5例术后确诊有非淋巴结转移。（4）接受其他病理诊断组（15例）。该组患者除纵隔淋巴结外还有其他转移部位。进行了计算机断层扫描（CT）引导下细针穿刺抽吸和淋巴结活检。（5）随访组（10例）。该组未采用任何侵入性检查。中位随访时间为38个月。1例患者在随访期间被诊断为淋巴瘤。
对于疑似肺癌且EBUS-TBNA结果为阴性的患者，应根据临床特征选择诊断方法。对于诊断明显不明确的患者，长时间随访非常重要。
