Ko J C, Yang P C, Yuan A, Chang D B, Yu C J, Wu H D, Lee L N, Kuo S H, Luh K T
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Republic of China.
Am J Respir Crit Care Med. 1994 Mar;149(3 Pt 1):783-7. doi: 10.1164/ajrccm.149.3.8118650.
We prospectively analyzed the diagnostic yield and safety of ultrasound (US)-guided transthoracic needle aspiration biopsy in the histologic diagnosis of 40 patients with superior vena cava (SVC) syndrome. During a 4-yr period, 40 patients with SVC obstruction were admitted to National Taiwan University Hospital. Of these patients 10 had histologic confirmation by sputum cytology (3 patients), fiberoptic bronchoscopy with biopsy (2 patients), or lymph node biopsy (5 patients) at admission. A total of 30 undiagnosed patients underwent real-time ultrasonographic (US) evaluation as well as color Doppler imaging. Patients with tumor detectable by US underwent US-guided transthoracic needle aspiration biopsy. Of the 30 patients who received US chest examination, 29 had widening of the upper mediastinal shadows in the chest radiographs. In 27 patients tumors were detected by chest US. After assessment of collateral vessels by color Doppler US, these 27 patients underwent US-guided transthoracic needle aspiration biopsies; histologic diagnoses were confirmed in 25. The diagnostic yield was 83.3%. The mean duration from admission to histologic diagnosis was 2.1 days. None of the patients developed complications. We conclude that chest US and color Doppler images are useful tools for evaluation of patients with SVC syndrome. US-guided transthoracic needle aspiration biopsy appears to be a safe, effective, and rapid approach for obtaining an accurate histologic diagnosis. Specific treatment can thus be initiated without delay.
我们前瞻性地分析了超声（US）引导下经胸针吸活检在40例上腔静脉（SVC）综合征患者组织学诊断中的诊断率及安全性。在4年期间，40例SVC梗阻患者入住台湾大学附属医院。其中10例患者在入院时通过痰细胞学检查（3例）、纤维支气管镜活检（2例）或淋巴结活检（5例）获得了组织学确诊。共有30例未确诊患者接受了实时超声（US）评估及彩色多普勒成像检查。超声可检测到肿瘤的患者接受了US引导下经胸针吸活检。在接受胸部US检查的30例患者中，29例胸部X线片显示上纵隔阴影增宽。胸部US检查发现27例患者存在肿瘤。在通过彩色多普勒US评估侧支血管后，这27例患者接受了US引导下经胸针吸活检；25例获得了组织学确诊。诊断率为83.3%。从入院到组织学诊断的平均时间为2.1天。所有患者均未发生并发症。我们得出结论，胸部US及彩色多普勒成像对于评估SVC综合征患者是有用的工具。US引导下经胸针吸活检似乎是一种安全、有效且快速的方法，可用于获得准确的组织学诊断。从而能够立即开始进行针对性治疗。
