Marshall Tanya, Kalanjeri Satish, Almeida Francisco Aecio
Department of Internal Medicine, Cleveland Clinic Akron General, Akron, Ohio.
Pulmonary and Critical Care Medicine, Harry S. Truman Memorial Veterans Hospital.
Curr Opin Pulm Med. 2022 Jan 1;28(1):17-30. doi: 10.1097/MCP.0000000000000843.
Lung cancer is the leading cause of cancer-related deaths worldwide. In the absence of distant metastases, accurate mediastinal nodal staging determines treatment approaches to achieve most favourable outcomes for patients. Mediastinal staging differentiates N0/N1 disease from N2/N3 in surgical candidates. Likewise, presence of nodal involvement in nonsurgical candidates who are being considered for stereotactic body radiation therapy is also critical. This review article seeks to discuss the current options available for mediastinal staging in nonsmall cell lung cancer (NSCLC), particularly the role of bronchoscopy.
Although several techniques are available to stage the mediastinum, bronchoscopy with EBUS-TBNA with or without EUS-FNA appears to be superior in most clinical situations based on its ability to concomitantly diagnose and stage at once, safety, accessibility to the widest array of lymph node stations, cost and low risk of complications. However, training and experience are required to achieve consistent diagnostic accuracy with EBUS-TBNA.
EBUS-TBNA with or without EUS-FNA is considered the modality of choice in the diagnosis and staging of NSCLC in both surgical and nonsurgical candidates.
肺癌是全球癌症相关死亡的主要原因。在没有远处转移的情况下，准确的纵隔淋巴结分期决定了治疗方法，以实现患者最有利的预后。纵隔分期可区分手术候选者的N0/N1疾病与N2/N3疾病。同样，对于正在考虑接受立体定向体部放射治疗的非手术候选者，淋巴结受累情况也至关重要。本文旨在探讨目前非小细胞肺癌（NSCLC）纵隔分期的可用方法，特别是支气管镜检查的作用。
虽然有几种技术可用于纵隔分期，但基于其能够同时进行诊断和分期、安全性、可触及最广泛的淋巴结站、成本以及并发症风险低等能力，带或不带EUS-FNA的EBUS-TBNA支气管镜检查在大多数临床情况下似乎更具优势。然而，要通过EBUS-TBNA获得一致的诊断准确性需要培训和经验。
带或不带EUS-FNA的EBUS-TBNA被认为是手术和非手术候选者NSCLC诊断和分期的首选方式。
