胸外癌纵隔淋巴结病变的诊断：EBUS-TBNA 在实际操作中的地位？

Diagnostic of mediastinal lymphadenopathy in extrathoracic cancer: A place for EBUS-TBNA in real life practice?

机构信息

Pôle cardiovasculaire et pulmonaire, clinique de pneumologie, hôpital Calmette, CHU de Lille, 59000 Lille, France.

Service de pneumologie, hôpital Larrey, CHU de Toulouse, 31000 Toulouse, France.

出版信息

Respir Med Res. 2019 May;75:1-4. doi: 10.1016/j.resmer.2019.03.001. Epub 2019 Apr 10.

DOI:10.1016/j.resmer.2019.03.001

PMID:31235451

Abstract

INTRODUCTION

Mediastinal lymphadenopathy in patients with extrathoracic malignancy is common. To obtain tissue proof of metastatic spread, EBUS-TBNA is an alternative to mediastinoscopy or thoracoscopy, but there are limited data about its diagnostic performance. The aim of this study was to determine the diagnostic accuracy of EBUS-TBNA for the evaluation of mediastinal lymphadenopathy in patients with extrathoracic cancers.

METHODS

We performed a multicenter retrospective study based on an online questionnaire to collect data from January 2011 to December 2012 in all patients with proven extrathoracic malignancy (current or past) and suspected mediastinal lymph node metastases who underwent EBUS-TBNA for diagnosis.

RESULTS

Hundred and eighty-five patients were included. Extrathoracic malignancies observed were urological (43), breast (35), gastrointestinal (33), head and neck (30), melanoma (11), lymphoma (6), and others (27). EBUS-TBNA confirmed malignancy in 93 patients (50.3%): concordant metastases in 67 (36.2%); new lung cancer in 25 (13.5%); and 1 unidentified cancer. The diagnostic accuracy, sensitivity, specificity, negative predictive value, and positive predictive value were respectively 54.6%, 68.4%, 100%, 53.3%, and 100%.

CONCLUSION

Mediastinoscopy remain the reference, but EBUS-TBNA may be considered as first line investigation in patients with suspected mediastinal lymph node metastases and extrathoracic malignancy. It prevented a surgical procedure in 50.3% of patients.

摘要

介绍

胸外恶性肿瘤患者的纵隔淋巴结病很常见。为了获得转移性播散的组织证据，EBUS-TBNA 是纵隔镜或胸腔镜检查的替代方法，但关于其诊断性能的数据有限。本研究的目的是确定 EBUS-TBNA 对评估胸外恶性肿瘤患者纵隔淋巴结病的诊断准确性。

方法

我们进行了一项多中心回顾性研究，基于在线问卷收集 2011 年 1 月至 2012 年 12 月期间所有经证实患有胸外恶性肿瘤（现症或既往）且疑似纵隔淋巴结转移的患者接受 EBUS-TBNA 诊断的数据。

结果

共纳入 185 例患者。观察到的胸外恶性肿瘤为泌尿系统（43 例）、乳腺（35 例）、胃肠道（33 例）、头颈部（30 例）、黑色素瘤（11 例）、淋巴瘤（6 例）和其他（27 例）。EBUS-TBNA 证实 93 例（50.3%）恶性肿瘤：67 例（36.2%）为一致转移；25 例（13.5%）为新的肺癌；1 例未明确癌症。诊断准确性、敏感性、特异性、阴性预测值和阳性预测值分别为 54.6%、68.4%、100%、53.3%和 100%。