Department of Respiratory Medicine, Amsterdam University Medical Centers, location Academic Medical Center (AMC), Amsterdam, the Netherlands.
Interventional Pulmonology Unit, Policlinico S. Orsola-Malpighi, Bologna, Italy.
Lung Cancer. 2019 Aug;134:194-201. doi: 10.1016/j.lungcan.2019.06.006. Epub 2019 Jun 24.
Tissue acquisition of lung tumors is crucial for diagnostic and treatment purposes. In patients with centrally located lung tumors without endobronchial abnormalities the yield of conventional bronchoscopy is poor. Objective of this study was to assess diagnostic yield of EBUS-TBNA in patients with lung tumors, located near or adjacent to the major airways.
International multicenter retrospective analysis (2013-2018) of linear EBUS databases in Bologna, Italy and Amsterdam, The Netherlands. Patients with a centrally-located lung tumor without endobronchial abnormalities who underwent lung tumor search with linear EBUS were included. Diagnostic yield, feasibility of EBUS guided tumor sampling, complication rate, adequacy of the aspirates for mutational analysis, and assessment of mediastinal/vascular invasion (T4) were evaluated.
Real-time EBUS-TBNA diagnostic yield to sample centrally located intrapulmonary tumor was 83% (136/163) and it was independent of tumor location (paratracheal, mainstem, lobar, segmental bronchus). The feasibility to sample the lung tumor was 89% (145/163). In 4 cases the tumor was not found with EBUS. In the other 14 cases, tumor sampling was not performed due to: loss of the echo window after needle insertion [n = 3], interposition of a large vessel [n = 7], switch to radial EBUS [n = 1], switch and sampling through EUS or EUS-B [n = 3]. No major complications occurred. Mutational analysis was successful in 54/63 (86%) of samples. Using surgery as reference standard, EBUS proved more reliable than CT (24/24, 100% versus 22/24, 91.7%, respectively) in the assessment of mediastinal/vascular tumor invasion (T4 status).
Lung tumors presenting without endobronchial abnormalities and located adjacent to the major airways can be safely sampled by EBUS-TBNA resulting in high diagnostic yield irrespective of tumor location. Successful molecular profiling and reliable assessment of mediastinal/vascular invasion (T4) in patients with advanced disease provide additional value to EBUS procedures in the setting of centrally-located lung lesions.
获取肺部肿瘤组织对于诊断和治疗至关重要。对于无支气管内异常的中央型肺部肿瘤患者，传统支气管镜检查的检出率较低。本研究旨在评估经支气管超声内镜引导针吸活检术（EBUS-TBNA）在靠近或毗邻大气道的肺部肿瘤患者中的诊断效能。
回顾性分析 2013 年至 2018 年在意大利博洛尼亚和荷兰阿姆斯特丹进行的线性 EBUS 数据库的国际多中心研究。纳入接受线性 EBUS 进行肺部肿瘤搜索且无支气管内异常的中央型肺部肿瘤患者。评估 EBUS 引导下肿瘤取样的诊断效能、可行性、并发症发生率、用于突变分析的抽吸物的充分性以及纵隔/血管侵犯（T4）的评估。
实时 EBUS-TBNA 对中央型肺内肿瘤的诊断性取样率为 83%（136/163），且与肿瘤位置（气管旁、主支气管、肺叶、段支气管）无关。肿瘤取样的可行性为 89%（145/163）。4 例患者未能通过 EBUS 发现肿瘤。在其余 14 例患者中，由于以下原因未进行肿瘤取样：穿刺后回声窗丢失[3 例]、大血管介入[7 例]、改用径向 EBUS[1 例]、改行 EUS 或 EUS-B[3 例]。未发生重大并发症。54/63（86%）例样本的基因突变分析成功。以手术为参考标准，EBUS 在评估纵隔/血管肿瘤侵犯（T4 状态）方面比 CT 更可靠（分别为 24/24，100%与 22/24，91.7%）。
无支气管内异常且毗邻大气道的肺部肿瘤可通过 EBUS-TBNA 安全取样，且检出率高，与肿瘤位置无关。在中央型肺部病变中，成功的分子谱分析和对有进展性疾病患者的纵隔/血管侵犯（T4）的可靠评估为 EBUS 操作提供了附加价值。
