Janssen J, Johanns W, Luis W, Greiner L
Medizinische Klinik A, Klinikum Wuppertal, Universität Witten-Herdecke.
Dtsch Med Wochenschr. 1998 Nov 20;123(47):1402-9. doi: 10.1055/s-2007-1024195.
As the mediastinum has been a region difficult to access for biopsy, mediastinoscopy has been required in most cases. In a prospective study the value of transoesophageal endoscopic ultrasound (TEUS) guided aspiration biopsy was assessed as an alternative.
TEUS-guided fine-needle aspirations were performed between May 1995 and March 1998 in 35 patients with mediastinal space-occupying lesions. In all cases the conventional endoscopic method or percutaneous puncture-sonography had been impossible or had failed. In one patient it had been performed after a negative mediastinoscopy.
In 34 patients (97%) the aspirated tissue cylinder could be evaluated histologically. There were no complications. Malignancy was demonstrated in 24 patients, and there were one case each of sarcoidosis, silicoanthracosis and two cases of retrosternal goitre. In four of seven patients the negative preoperative diagnosis was confirmed at operation or by follow-up. There were two false-negative results and in one patient there has been no definitive diagnosis. The accuracy of the method was thus 91.4%, the positive predictive value for malignancy 88.9% and the negative predictive value for malignancy 72.7%. Ultrasound alone was a poor predictor of malignancy in lymph node enlargement.
TEUS-guided fine-needle aspiration of space-occupying mediastinal lesions is an effective and low-risk method that can in selected cases shorten the diagnostic process and avoid methods that are expensive or lead to complications such as transpulmonary biopsy guided by computed tomography or mediastinoscopy.
由于纵隔一直是难以进行活检的区域，多数情况下需要进行纵隔镜检查。在一项前瞻性研究中，评估了经食管内镜超声（TEUS）引导下穿刺活检作为一种替代方法的价值。
1995年5月至1998年3月期间，对35例纵隔占位性病变患者进行了TEUS引导下细针穿刺抽吸。所有病例中，传统内镜检查方法或经皮穿刺超声检查均无法进行或已失败。1例患者在纵隔镜检查阴性后进行了此项检查。
34例患者（97%）的抽吸组织条可进行组织学评估。无并发症发生。24例患者诊断为恶性肿瘤，结节病、硅沉着病各1例，胸骨后甲状腺肿2例。7例患者中有4例术前阴性诊断在手术或随访中得到证实。有2例假阴性结果，1例患者未明确诊断。因此，该方法的准确率为91.4%，恶性肿瘤的阳性预测值为88.9%，恶性肿瘤的阴性预测值为72.7%。单纯超声对淋巴结肿大的恶性肿瘤预测能力较差。
TEUS引导下对纵隔占位性病变进行细针抽吸是一种有效且低风险的方法，在某些情况下可缩短诊断过程，避免采用如计算机断层扫描引导下经肺活检或纵隔镜检查等昂贵或会导致并发症的方法。
