一种用于肺癌T分期的有前景的工具：凸阵探头支气管内超声在检测纵隔和肺门血管侵犯方面是否优于计算机断层扫描？

A promising tool for T-staging of lung cancer: Is convex probe endobronchial ultrasound superior to computed tomography in detecting invasion of mediastinal and hilar vessels?

作者信息

Alıcı İbrahim Onur, Susam Seher, Yüksel Yavuz Melike, Bayramiç Eda, Güldaval Filiz, Anar Ceyda, Üçvet Ahmet, Büyükşirin Melih

机构信息

Department of Chest Disease, SBÜ İzmir Dr. Suat Seren Chest Diseases and Thoracic Surgery Health Application and Research Center, Izmir, Turkey.

Department of Radiology, SBÜ İzmir Dr. Suat Seren Chest Diseases and Thoracic Surgery Health Application and Research Center, Izmir, Turkey.

出版信息

Turk Gogus Kalp Damar Cerrahisi Derg. 2019 Jun 17;27(3):355-359. doi: 10.5606/tgkdc.dergisi.2019.16987. eCollection 2019 Jul.

DOI:10.5606/tgkdc.dergisi.2019.16987

PMID:32082884

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7021418/

Abstract

BACKGROUND

In the present study, we aimed to compare performance of convex probe endobronchial ultrasound and computed tomography in detecting vascular invasion of mediastinal and hilar lesions.

METHODS

Medical data of a total of 55 patients (47 males, 8 females; mean age 59.6±7.7 years; range, 29 to 76 years) who underwent convex probe endobronchial ultrasound for diagnosis and staging of lung cancer in a tertiary care hospital between May 2016 and December 2017 were retrospectively analyzed. The presence of vascular invasion was determined according to two main criteria: visualization of the tumor tissue within the vessel lumen and loss of vessel-tumor hyperechoic interface. All available contrast enhanced computed tomography images were retrospectively re-evaluated by a blinded radiologist. The intra-rater agreement between convex probe endobronchial ultrasound and computed tomography was analyzed. The sensitivity, specificity, positive and negative predictive values, and accuracy of both modalities were calculated.

RESULTS

A total of 65 vessel-tumor interface areas of 55 patients were analyzed. Almost all mediastinal and hilar vascular structures including pulmonary arteries and veins, aorta, superior vena cava and its branches, and left atrium with pulmonary veno-atrial junctions could be easily assessed by convex probe endobronchial ultrasound. The intra-agreement of both modalities in detecting vascular invasion was k=0.268 (p=0.028). In nine patients with a surgical confirmation, the sensitivity, specificity, positive and negative predictive values, and accuracy values were 100%, 33.3%, 75.0%, 100%, and 77.7%, respectively for convex probe endobronchial ultrasound and 66.6%, 33.3%, 66.6%, 33.3%, and 55.5%, respectively for computed tomography.

CONCLUSION

Convex probe endobronchial ultrasound can be used to detect vascular invasion alone or in conjunction with contrast-enhanced computed tomography. Hence, a T lesion would be better differentiated from T in clinical staging of lung cancer.

摘要

背景

在本研究中，我们旨在比较凸阵探头支气管内超声与计算机断层扫描在检测纵隔及肺门病变血管侵犯方面的性能。

方法

回顾性分析了2016年5月至2017年12月期间在一家三级医疗中心接受凸阵探头支气管内超声检查以诊断和分期肺癌的55例患者（47例男性，8例女性；平均年龄59.6±7.7岁；范围29至76岁）的医学数据。根据两个主要标准确定血管侵犯的存在：血管腔内肿瘤组织的可视化以及血管 - 肿瘤高回声界面的消失。所有可用的对比增强计算机断层扫描图像由一位不知情的放射科医生进行回顾性重新评估。分析凸阵探头支气管内超声与计算机断层扫描之间的观察者内一致性。计算两种检查方法的敏感性、特异性、阳性和阴性预测值以及准确性。

结果

共分析了55例患者的65个血管 - 肿瘤界面区域。几乎所有纵隔和肺门血管结构，包括肺动脉和静脉、主动脉、上腔静脉及其分支以及带有肺静脉 - 心房交界处的左心房均可通过凸阵探头支气管内超声轻松评估。两种检查方法在检测血管侵犯方面的一致性系数k = 0.268（p = 0.028）。在9例经手术证实的患者中，凸阵探头支气管内超声的敏感性、特异性、阳性和阴性预测值以及准确性分别为100%、33.3%、75.0%、100%和77.7%，计算机断层扫描的相应值分别为66.6%、33.3%、66.6%、33.3%和55.5%。