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经食管内镜超声联合支气管镜检查:澳大利亚某地方卫生区在肺癌筛查前的见解

Transoesophageal endoscopic ultrasound with bronchoscope: insights from an Australian Local Health District ahead of lung cancer screening.

作者信息

Lindfield Matthew, Lloyd Angus, George Vineeth, Grainge Christopher, Twaddell Scott, Arnold David

机构信息

Department of Respiratory and Sleep Medicine, The Canberra Hospital, Canberra, Australian Capital Territory, Australia.

The Australian National University, Canberra, Australian Capital Territory, Australia.

出版信息

Intern Med J. 2025 Aug;55(8):1333-1338. doi: 10.1111/imj.70113. Epub 2025 Jun 26.


DOI:10.1111/imj.70113
PMID:40574480
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12347304/
Abstract

BACKGROUND: The combined use of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and transoesophageal endoscopic ultrasound with bronchoscope-guided fine-needle aspiration (EUS-B-FNA) is preferred in the diagnosis and staging of non-small cell lung cancer (NSCLC); however, there is limited utilisation of EUS-B-FNA in Australia. With a National Lung Cancer Screening program (NLCSP) commencing in 2025, additional diagnostics may be required by bronchoscopists. AIMS: We describe the endoscopic model of care offered and outcomes achieved by Respiratory Physicians experienced in EUS-B-FNA practicing in a regional Australian tertiary referral hospital. METHODS: Adult patients within the Hunter New England Local Health District (HNELDH) who underwent a diagnostic/staging EBUS-TBNA or EUS-B-FNA procedures, as recorded in a prospectively collected procedural database from 2016 to 2022, were included. RESULTS: 1564 patients (688 female), median age 68 years had a diagnostic or staging EBUS-TBNA and/or EUS-B-FNA (1268 EBUS-TBNA, 262 EUS-B-FNA and 34 combined). The diagnostic yield for procedures performed with an indication of suspected lung malignancy was as follows: EBUS-TBNA: 75.5%, EUS-B-FNA: 85.7%, and combined procedure: 61.1%. Three major infectious complications were observed in EUS-B-FNA (1.15%) and two in EBUS-TBNA (0.16%). These complications precede the institution's policy of pre-procedural antibiotic prophylaxis started in 2021. CONCLUSION: EUS-B-FNA can be performed safely by competent EBUS-TBNA respiratory physicians provided that prospective data and complication monitoring are in place.

摘要

背景:在非小细胞肺癌(NSCLC)的诊断和分期中,支气管内超声引导下经支气管针吸活检(EBUS-TBNA)与经食管内镜超声引导下支气管镜引导细针穿刺活检(EUS-B-FNA)联合使用是首选方法;然而,EUS-B-FNA在澳大利亚的应用有限。随着2025年国家肺癌筛查计划(NLCSP)的启动,支气管镜检查医生可能需要更多的诊断方法。 目的:我们描述了在澳大利亚一家地区三级转诊医院中,有EUS-B-FNA经验的呼吸内科医生提供的内镜护理模式及取得的结果。 方法:纳入2016年至2022年在Hunter New England地方卫生区(HNELDH)接受诊断/分期EBUS-TBNA或EUS-B-FNA手术的成年患者,这些数据记录在一个前瞻性收集的手术数据库中。 结果:1564例患者(688例女性),中位年龄68岁,接受了诊断或分期EBUS-TBNA和/或EUS-B-FNA(1268例EBUS-TBNA,262例EUS-B-FNA,34例联合手术)。以疑似肺恶性肿瘤为指征进行的手术诊断率如下:EBUS-TBNA为75.5%,EUS-B-FNA为85.7%,联合手术为61.1%。EUS-B-FNA观察到3例主要感染并发症(1.15%),EBUS-TBNA观察到2例(0.16%)。这些并发症发生在该机构2021年开始的术前抗生素预防政策之前。 结论:只要有前瞻性数据和并发症监测,有能力的EBUS-TBNA呼吸内科医生可以安全地进行EUS-B-FNA。

相似文献

[1]
Transoesophageal endoscopic ultrasound with bronchoscope: insights from an Australian Local Health District ahead of lung cancer screening.

Intern Med J. 2025-8

[2]
Utility and Safety of Endoscopic Ultrasound With Bronchoscope-Guided Fine-Needle Aspiration in Mediastinal Lymph Node Sampling: Systematic Review and Meta-Analysis.

Respir Care. 2015-7

[3]
Added value of combined endobronchial and oesophageal endosonography for mediastinal nodal staging in lung cancer: a systematic review and meta-analysis.

Lancet Respir Med. 2016-10-20

[4]
Combined endobronchial and esophageal endosonography for the diagnosis and staging of lung cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline, in cooperation with the European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS).

Endoscopy. 2015-6

[5]
EUS-B-FNA Enhances the Diagnostic Yield of EBUS Bronchoscope for Intrathoracic Lesions.

Lung. 2022-10

[6]
Combined endobronchial and endoscopic ultrasound-guided fine needle aspiration for mediastinal lymph node staging of lung cancer: a meta-analysis.

Eur J Cancer. 2013-3-5

[7]
Transbronchial and transesophageal fine-needle aspiration using an ultrasound bronchoscope in mediastinal staging of potentially operable lung cancer.

Chest. 2010-3-26

[8]
Pulmonologist-performed transoesophageal sampling for lung cancer staging using an endobronchial ultrasound video-bronchoscope: an Australian experience.

Intern Med J. 2017-2

[9]
Endobronchial ultrasound-guided transbronchial needle aspiration in real-life settings.

Respir Med. 2025-9

[10]
Endoscopic ultrasound-guided fine needle aspiration and endobronchial ultrasound-guided transbronchial needle aspiration: Are two better than one in mediastinal staging of non-small cell lung cancer?

J Thorac Cardiovasc Surg. 2014-10

本文引用的文献

[1]
Systematic endoscopic staging of mediastinum to guide radiotherapy planning in patients with locally advanced non-small-cell lung cancer (SEISMIC): an international, multicentre, single-arm, clinical trial.

Lancet Respir Med. 2024-6

[2]
Assessment of Advanced Diagnostic Bronchoscopy Outcomes for Peripheral Lung Lesions: A Delphi Consensus Definition of Diagnostic Yield and Recommendations for Patient-centered Study Designs. An Official American Thoracic Society/American College of Chest Physicians Research Statement.

Am J Respir Crit Care Med. 2024-3-15

[3]
Diagnostic Yield vs Diagnostic Accuracy for Peripheral Lung Biopsy Evaluation: Evidence Supporting a Future Pragmatic End Point.

Chest. 2024-6

[4]
EUS-B-FNA Enhances the Diagnostic Yield of EBUS Bronchoscope for Intrathoracic Lesions.

Lung. 2022-10

[5]
Infectious complications of EBUS-TBNA: A nested case-control study using 10-year registry data.

Lung Cancer. 2021-11

[6]
Transitioning to Combined EBUS EUS-B FNA for Experienced EBUS Bronchoscopist.

Diagnostics (Basel). 2021-6-2

[7]
Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries.

CA Cancer J Clin. 2021-5

[8]
EBUS-TBNA versus EUS-B-FNA for the evaluation of undiagnosed mediastinal lymphadenopathy: The TEAM randomized controlled trial.

Clin Respir J. 2020-11

[9]
An Evaluation of Diagnostic Yield From Bronchoscopy: The Impact of Clinical/Radiographic Factors, Procedure Type, and Degree of Suspicion for Cancer.

Chest. 2020-6

[10]
Endoscopic Ultrasound with Bronchoscope-Guided Fine Needle Aspiration for the Diagnosis of Paraesophageally Located Lung Lesions.

Respiration. 2018-9-25

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