Oki Masahide, Saka Hideo, Seki Yukio, Kogure Yoshihito, Niwa Hideyuki, Yamada Arisa, Torii Atsushi, Kitagawa Chiyoe, Ando Masahiko
Department of Respiratory Medicine, NHO Nagoya Medical Center, Nagoya, Japan.
Department of Respiratory Medicine, Matsunami General Hospital, Gifu, Japan.
ERJ Open Res. 2024 Dec 2;10(6). doi: 10.1183/23120541.00326-2024. eCollection 2024 Nov.
Both combined endobronchial ultrasonography (EBUS) and transoesophageal bronchoscopic ultrasonography (EUS-B) and EBUS alone have been recommended for preoperative mediastinal staging of nonsmall cell lung cancer (NSCLC). However, no randomised study comparing these two methods has been published. The purpose of the present study was to compare the sensitivity of EBUS and that of combined EBUS and EUS-B (EBUS/EUS-B) in terms of detecting N2/N3 disease during staging of NSCLC.
Patients with known or suspected, potentially operable NSCLC were recruited and randomised to undergo EBUS or EBUS/EUS-B under conscious sedation. The primary end-point was a comparison of the sensitivity of EBUS alone and EBUS/EUS-B.
A total of 240 patients were enrolled and randomised, among whom 219 (105 EBUS group; 114 EBUS/EUS-B group) were included in the analysis. The sensitivities of EBUS and EBUS/EUS-B in terms of detecting N2/N3 disease were 75.0% and 79.3% respectively (p=0.698). In the EBUS/EUS-B group, only EUS-B yielded diagnostic results in two patients; the sensitivity thus increased from 72.4% to 79.3% on addition of EUS-B to EBUS.
The difference in the sensitivities of EBUS alone and EBUS/EUS-B in terms of diagnosing N2/N3 disease was not statistically significant. Although the increase in sensitivity with the addition of EUS-B is modest, it is maximised when EUS-B is used to sample lymph nodes not accessible by EBUS alone.
对于非小细胞肺癌（NSCLC）的术前纵隔分期，推荐使用联合支气管内超声检查（EBUS）和经食管支气管镜超声检查（EUS-B）以及单独使用EBUS。然而，尚未发表比较这两种方法的随机研究。本研究的目的是比较EBUS与联合EBUS和EUS-B（EBUS/EUS-B）在NSCLC分期过程中检测N2/N3疾病方面的敏感性。
招募已知或疑似、可能可手术的NSCLC患者，并在清醒镇静下随机分为接受EBUS或EBUS/EUS-B检查。主要终点是比较单独使用EBUS和EBUS/EUS-B的敏感性。
共纳入240例患者并进行随机分组，其中219例（105例在EBUS组；114例在EBUS/EUS-B组）纳入分析。EBUS和EBUS/EUS-B在检测N2/N3疾病方面的敏感性分别为75.0%和79.3%（p = 0.698）。在EBUS/EUS-B组中，仅EUS-B在两名患者中得出诊断结果；因此，在EBUS基础上加用EUS-B后，敏感性从72.4%提高到79.3%。
单独使用EBUS和EBUS/EUS-B在诊断N2/N3疾病方面的敏感性差异无统计学意义。虽然加用EUS-B后敏感性提高幅度不大，但当使用EUS-B对单独EBUS无法到达的淋巴结进行采样时，敏感性提高幅度最大。
