Chiba W, Sawai S, Ishida H, Hanawa T, Matsubara Y, Ikeda S, Kinoshita M, Ikei N
Respiratory Division, Kyoto Katsura Hospital, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1993 Apr;41(4):603-9.
Of 140 cases of mediastinal neoplasms in our hospital, histological diagnosis was confirmed in 129 cases. We examined the methods of preoperative biopsy with those 129 cases. Biopsy had been performed in 25 cases. Mediastinoscopy was performed in seven cases, needle biopsy in eight cases, lymph node biopsy in eight cases, esophageal biopsy using a gastrofiberscope in one case, transbronchial biopsy using a bronchoscope in one case. The true positive rates of those methods were 100% for both mediastinoscopy and lymph node biopsy, and 75% for needle biopsy. Preoperative misdiagnosis occurred in two cases of needle biopsy. The postoperative histological diagnosis was malignant lymphoma in both cases. We performed gene analysis of the immunoglobulin heavy chain gene, light chain kappa and lambda genes, and the T-cell receptor beta gene by use of biopsied specimens, and we found rearrangement bands of these genes in the cases of malignant lymphoma. Therefore, we summarize that gene analysis is a reliable method if malignant lymphoma is suspected. If a needle biopsy is performed under CT guidance, the needle is sure to puncture the tumor. We concluded, therefore, that if a tumor is located in the anterior mediastinum, CT-guided needle biopsy should be performed first of all. Mediastinoscopy is a useful method if the tumor is located in the mid-mediastinum.
在我院的140例纵隔肿瘤病例中，129例确诊为组织学诊断。我们用这129例病例研究了术前活检方法。25例进行了活检。其中7例行纵隔镜检查，8例行针吸活检，8例行淋巴结活检，1例行纤维胃镜下食管活检，1例行支气管镜下经支气管活检。纵隔镜检查和淋巴结活检的真阳性率均为100%，针吸活检为75%。针吸活检有2例术前误诊。术后组织学诊断均为恶性淋巴瘤。我们利用活检标本对免疫球蛋白重链基因、轻链κ和λ基因以及T细胞受体β基因进行了基因分析，发现在恶性淋巴瘤病例中这些基因有重排带。因此，我们总结认为，如果怀疑为恶性淋巴瘤，基因分析是一种可靠的方法。如果在CT引导下进行针吸活检，针肯定能穿刺到肿瘤。因此，我们得出结论，如果肿瘤位于前纵隔，应首先进行CT引导下针吸活检。如果肿瘤位于中纵隔，纵隔镜检查是一种有用的方法。
