Tu Justin Siew Yoong, Witt Ashleigh, Giudice Christina, Steinfort Daniel, Heinze Stefan, Rangamuwa Kanishka
Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Australia.
Department of Medicine, University of Melbourne, Melbourne, Australia.
Medicine (Baltimore). 2025 Jun 13;104(24):e42969. doi: 10.1097/MD.0000000000042969.
Superior vena cava obstruction (SVCO) is a radiographic finding in patients with mediastinal masses, which may be accompanied by features of superior vena cava syndrome (SVCS). SVCS is associated with physiologic impairments that increase procedural risk. Data regarding the risk of complications following endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in patients with SVCO is limited. To assess whether rates of procedural complications from EBUS-TBNA are increased in patients with SVCO. A retrospective observational study was performed on all patients undergoing EBUS-TBNA by the respiratory department at major Australian tertiary center from January 1 to December 31, 2021. Imaging review identified radiographic SVCO, which was classified by anatomical location and degree of obstruction following a grading system previously described in the literature. Clinical features of SVCS were noted, alongside and procedural outcomes and complications. The primary outcome for this study was the rate of complications. Data was assessed with simple statistics and chi-square analysis. 245 linear EBUS procedures were performed. Radiographic SVCO of moderate severity or greater (>50% obstruction) was present in 11 (4%) patients, mild severity (<50% obstruction) in 13 (5%), indeterminate but likely in 4 (2%), indeterminate but unlikely in 20 (8%), and absent in 197 patients (80%). Rates of major complications were low across the cohort (7% in patients with SVCO, 8% in patients with SVCO), and were independent of SVCO (P = .34). Amongst the 24 patients with SVCO, the original radiology reports mentioned obstruction in only 4 patients, and overall clinical features of SVCS was rarely documented or assessed. SVCO is underreported and under-assessed in our cohort of patients both clinically and radiologically, however SVCO does not appear to be associated with a greater risk of complications following EBUS-TBNA. This study demonstrates that EBUS-TBNA can safety be performed in patients with radiological SVCO.
上腔静脉阻塞（SVCO）是纵隔肿块患者的影像学表现，可能伴有上腔静脉综合征（SVCS）的特征。SVCS与增加手术风险的生理损害相关。关于SVCO患者经支气管超声引导下经支气管针吸活检（EBUS-TBNA）后并发症风险的数据有限。为了评估SVCO患者EBUS-TBNA的手术并发症发生率是否增加。对2021年1月1日至12月31日在澳大利亚主要三级中心呼吸科接受EBUS-TBNA的所有患者进行了一项回顾性观察研究。影像学检查确定了影像学上的SVCO，根据先前文献中描述的分级系统按解剖位置和阻塞程度进行分类。记录了SVCS的临床特征以及手术结果和并发症。本研究的主要结果是并发症发生率。数据采用简单统计和卡方分析进行评估。共进行了245例线性EBUS手术。11例（4%）患者存在中度或更严重的影像学SVCO（阻塞>50%），13例（5%）为轻度严重程度（阻塞<50%），4例（2%）不确定但可能存在，20例（8%）不确定但不太可能存在，197例患者（80%）不存在。整个队列的主要并发症发生率较低（SVCO患者为7%，非SVCO患者为8%），且与SVCO无关（P = 0.34）。在24例SVCO患者中，原始放射学报告仅提及4例患者有阻塞，SVCS的总体临床特征很少被记录或评估。在我们的患者队列中，SVCO在临床和放射学上均报告不足且评估不足，然而，SVCO似乎与EBUS-TBNA术后更高的并发症风险无关。这项研究表明，影像学上有SVCO的患者可以安全地进行EBUS-TBNA。
