超声内镜引导下经支气管针吸活检术纵隔分期肺癌：系统评价和汇总数据分析。
Endosonography with lymph node sampling for restaging the mediastinum in lung cancer: A systematic review and pooled data analysis.
机构信息
Department of Thoracic Surgery/Oncology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou, China.
Department of Thoracic Surgery, the First Affiliated Hospital, Medical College of Shantou University, Shantou, Guangdong, China.
出版信息
J Thorac Cardiovasc Surg. 2020 Mar;159(3):1099-1108.e5. doi: 10.1016/j.jtcvs.2019.07.095. Epub 2019 Aug 28.
BACKGROUND
Mediastinal restaging after induction treatment is still a difficult and controversial issue. We aimed to investigate the diagnostic accuracy of endobronchial ultrasound-guided transbronchial needle aspiration and endoscopic ultrasound-guided fine-needle aspiration for restaging the mediastinum after induction treatment in patients with lung cancer.
METHODS
Embase and PubMed databases were searched from conception to March 2019. Data from relevant studies were analyzed to assess sensitivity and specificity of endobronchial ultrasound-guided transbronchial needle aspiration and endoscopic ultrasound-guided fine-needle aspiration, and to fit the hierarchical summary receiver operating characteristic curves.
RESULTS
A total of 10 studies consisting of 558 patients fulfilled the inclusion criteria. All patients were restaged by endobronchial ultrasound-guided transbronchial needle aspiration, endoscopic ultrasound-guided fine-needle aspiration, or both. Negative results were confirmed by subsequent surgical approaches. There were no complications reported during any endosonography approaches reviewed. The pooled sensitivities of endobronchial ultrasound-guided transbronchial needle aspiration and endoscopic ultrasound-guided fine-needle aspiration were 65% (95% confidence interval [CI], 52-76) and 73% (95% CI, 52-87), respectively, and specificities were 99% (95% CI, 78-100) and 99% (95% CI, 90-100), respectively. The area under the hierarchical summary receiver operating characteristic curves were 0.85 (95% CI, 0.81-0.88) for endobronchial ultrasound-guided transbronchial needle aspiration and 0.99 (95% CI, 0.98-1) for endoscopic ultrasound-guided fine-needle aspiration. Moreover, for patients who received chemotherapy alone, the pooled sensitivity of endosonography with lymph node sampling for restaging was 66% (95% CI, 56-75), and specificity was 100% (95% CI, 34-100); for patients who received chemoradiotherapy, the results seemed similar with a sensitivity of 77% (95% CI, 47-92) and specificity of 99% (95% CI, 48-100).
CONCLUSIONS
Endosonography with lymph node sampling is an accurate and safe technique for mediastinal restaging of lung cancer.
背景
诱导治疗后纵隔重新分期仍然是一个困难且有争议的问题。我们旨在研究支气管内超声引导经支气管针吸活检和内镜超声引导下细针抽吸术在肺癌患者诱导治疗后重新分期纵隔中的诊断准确性。
方法
从概念到 2019 年 3 月，在 Embase 和 PubMed 数据库中进行了搜索。对相关研究的数据进行了分析，以评估支气管内超声引导经支气管针吸活检和内镜超声引导下细针抽吸术的敏感性和特异性，并拟合分层汇总受试者工作特征曲线。
结果
共有 10 项研究（共 558 例患者）符合纳入标准。所有患者均通过支气管内超声引导经支气管针吸活检、内镜超声引导下细针抽吸术或两者联合进行重新分期。阴性结果通过随后的手术方法得到证实。在审查的任何内镜超声方法中均未报告并发症。支气管内超声引导经支气管针吸活检和内镜超声引导下细针抽吸术的汇总敏感性分别为 65%（95%置信区间，52-76）和 73%（95%置信区间，52-87），特异性分别为 99%（95%置信区间，78-100）和 99%（95%置信区间，90-100）。分层汇总受试者工作特征曲线下面积分别为支气管内超声引导经支气管针吸活检 0.85（95%置信区间，0.81-0.88）和内镜超声引导下细针抽吸术 0.99（95%置信区间，0.98-1）。此外，对于仅接受化疗的患者，纵隔重新分期的超声内镜淋巴结采样的汇总敏感性为 66%（95%置信区间，56-75），特异性为 100%（95%置信区间，34-100%）；对于接受放化疗的患者，结果似乎相似，敏感性为 77%（95%置信区间，47-92），特异性为 99%（95%置信区间，48-100%）。
结论
超声内镜淋巴结采样是一种准确、安全的肺癌纵隔重新分期技术。
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