Serna D L, Aryan H E, Chang K J, Brenner M, Tran L M, Chen J C
Department of Surgery (Cardiothoracic), University of California, Irvine Medical Center, Orange 92668, USA.
Am Surg. 1998 Oct;64(10):1014-8.
Precise mediastinal lymph node staging is essential in non-small cell lung cancer for proper evaluation and treatment. In addition to CT, mediastinoscopy is routinely used for staging and diagnosis of mediastinal malignancy. Recently, endoscopic ultrasound (EUS) combined with fine-needle aspiration (FNA) biopsy has been used to evaluate mediastinal disease. The purpose of this study was to assess and compare mediastinoscopy with EUS/FNA in the evaluation of mediastinal masses. From August 1995 to July 1997, 21 patients with suspected mediastinal malignancy underwent cervical mediastinoscopy with biopsy. During this same period, seven patients with suspected mediastinal malignancy were evaluated using EUS/FNA. All patients were retrospectively studied. Both mediastinoscopy and EUS/FNA were highly sensitive in diagnosing mediastinal malignancy (100% and 86%, respectively). Specificity and positive predictive value were 100 per cent for both procedures. Mediastinoscopy and EUS/FNA are highly accurate methods of staging mediastinal malignancy. Mediastinoscopy provides better access to the upper and anterior mediastinum, whereas EUS/FNA can safely be used to biopsy subcarinal and posterior mediastinal masses. Mediastinoscopy and EUS/FNA target different areas of the mediastinum and may be complimentary in the evaluation of mediastinal malignancy and staging of bronchogenic carcinoma.
精确的纵隔淋巴结分期对于非小细胞肺癌的正确评估和治疗至关重要。除了CT外，纵隔镜检查常用于纵隔恶性肿瘤的分期和诊断。最近，超声内镜（EUS）联合细针穿刺（FNA）活检已被用于评估纵隔疾病。本研究的目的是评估和比较纵隔镜检查与EUS/FNA在评估纵隔肿块中的应用。1995年8月至1997年7月，21例疑似纵隔恶性肿瘤的患者接受了经颈部纵隔镜检查及活检。在同一时期，7例疑似纵隔恶性肿瘤的患者接受了EUS/FNA评估。对所有患者进行回顾性研究。纵隔镜检查和EUS/FNA在诊断纵隔恶性肿瘤方面均具有高度敏感性（分别为100%和86%）。两种检查方法的特异性和阳性预测值均为100%。纵隔镜检查和EUS/FNA是纵隔恶性肿瘤分期的高度准确方法。纵隔镜检查能更好地观察上纵隔和前纵隔，而EUS/FNA可安全地用于隆突下和后纵隔肿块的活检。纵隔镜检查和EUS/FNA针对纵隔的不同区域，在评估纵隔恶性肿瘤和支气管源性癌分期方面可能具有互补性。
