支气管内超声引导针吸活检术在纵隔淋巴结CT阳性肺癌分期中的价值

目的 评价支气管内超声引导下针吸活检术(EBUS-TBNA)在纵隔淋巴结CT阳性肺癌病例分期中的应用价值.方法 2009年9月至12月共对28例胸部CT纵隔淋巴结阳性(短径≥1 cm)的肺癌病人行EBUS-TBNA检查.总结穿刺结果,评价该方法的诊断价值和安全性.结果 28例共穿刺淋巴结40组,淋巴结穿刺取材满意率96.3%(27/28例),无任何相关并发症.EBUS-TBNA阳性(取得恶性细胞病理学证据)20例,阴性(未取得恶性细胞病理学证据)8例;阴性者接受进一步外科手术,术后证实纵隔淋巴结转移2例(EBUS-TBNA假阴性).EBUS-TBNA检查准确率92.9%(26/28例),灵敏度90.9%(20/22例),特异度100%(6/6例),阳性预测值100%(20/20例),阴性预测值75%(6/8例).结论 EBUS-TBNA是评价纵隔淋巴结CT阳性肺癌分期的安全有效方法.     

支气管内超声引导针吸活检术在胸部疾病中的临床应用价值

目的介绍支气管内超声引导针吸活检术(Endobronchial ultrasound-guided transbronchial needleaspiration,EBUS-TBNA)用于肺癌分期及胸部疾病诊断的新方法,探讨EBUS-TBNA在胸部疾病中的临床应用价值。方法回顾性分析2009年9月至2010年5月106例患者经EBUS-TBNA检查的临床资料,其中男75例,女31例;平均年龄62.3岁。根据适应证的不同,将106例患者分为3种情况行EBUS-TBNA,以进一步明确诊断:(1)已明确诊断或怀疑肺癌(76例),胸部CT示:纵隔淋巴结肿大(≥1.0 cm);(2)不明原因的纵隔和(或)肺门淋巴结肿大以及纵隔肿物(22例);(3)大气道旁肺实质内占位(8例)。结果 (1)已明确诊断或怀疑肺癌76例,经EBUS-TBNA检查证实纵隔淋巴结转移58例,未见纵隔淋巴结转移18例。EBUS-TBNA检查阴性者中16例接受胸腔镜或开胸手术,行肺叶切除或肺楔形切除加纵隔淋巴结清扫,术后病理证实12例肺癌纵隔淋巴结未见转移,2例肺癌纵隔淋巴结可见癌转移(EBUS-TBNA检查假阴性),其余2例为肺内良性病变;EBUS-TBNA在肺癌纵隔淋巴结分期中的敏感性、特异性和准确性分别为96.66%(58/60),100.00%(12/12)和97.22%(70/72)。(2)不明原因的纵隔和(或)肺门淋巴结肿大以及纵隔肿物22例,经EBUS-TBNA检查后明确恶性病变7例,良性病变13例;EBUS-TBNA在纵隔病变良恶性诊断和鉴别诊断方面的敏感性为87.50%(7/8)。(3)大气道旁肺实质内占位8例,经EBUS-TBNA检查后7例明确诊断,其中6例肺癌;EBUS-TBNA在大气道旁肺实质内占位中诊断的敏感性和准确率分别为85.71%(6/7)和87.50%(7/8)。所有患者检查耐受良好,无任何相关并发症发生。结论 EBUS-TBNA是一种安全有效的诊断技术,应成为胸部疾病诊断和分期的常用方法。     

支气管内超声引导针吸活检术在肺癌分期中的应用

目的 探讨支气管内超声引导针吸活检术(EBUS-TBNA)在肺癌分期中的应用价值.方法 回顾性总结2009年9月至2010年2月,52例胸部CT均发现纵隔淋巴结肿大≥1.0 cm肺癌病人经EBUS-TBNA检查的临床资料.结果 经EBUS-TBNA检查证实纵隔淋巴结转移(阳性)者41例,未见纵隔淋巴结转移(阴性)者11例.阳性者放弃手术,予以化疗.阴性者接受胸腔镜或开胸手术,行肺叶切除或肺楔形切除加纵隔淋巴结清扫.术后病理证实,9例纵隔淋巴结确实末见转移,2例纵隔淋巴结可见癌转移,即EBUS-TBNA检查假阴性.EBUS-TBNA的敏感性、特异性、准确性、阳性预测价值及阴性预测价值分别为95.3%、100%、96.2%、100%及81.8%.该检查耐受良好,无任何相关并发症发生.结论 EBUS-TBNA是一种安全、有效的肺癌分期方法.

Abstract：

Objective To determine the value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for staging of lung cancer. Methods The study was retrospective, a total of 52 patients underwent EBUSTBNA for known or suspected lung cancer. All patients were detected enlarged mediastinal lymph nodes on CT scan ( ≥ 1.0cm). Results Of the 52 patients, 41 patients were found with N2 or N3 disease on EBUS-TBNA. 11 patients with negative EBUS-TBNA underwent thoracoscopy or thoracotomy for pulmonary resection and mediastinal lymph node dissection, 9 patients were confirmed N0 by pathology, whereas 2 patients had metastatic lymph node. The diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value of EBUS-TBNA for the mediastinal staging of lung cancer were 95.3%, 100%, 96.2%, 100%, and 81.8%, respectively. The procedure was uneventful, and there were no postoperative complications. Conclusion EBUS-TBNA is an effective and safe technique for mediastinal staging in lung cancer patients.     

超声引导下经支气管针吸活检术在肺癌诊断中的应用

目的评价超声引导下经支气管针吸活检术(endobronchial ultrasound-guided transbronchial needle aspiration,EBUS-TBNA)在肺癌诊断中的应用价值。方法回顾性分析2017-11—2018-10间75例拟诊肺癌并接受EBUS-TBNA的患者的临床资料。EBUS-TBNA未能明确诊断者,根据患者情况行外科手术或随诊6个月。结果影像学怀疑肺癌伴纵隔淋巴结和(或)肺门淋巴结肿大(短径≥1cm)59例,经EBUS-TBNA确诊肺癌51例。8例未能明确诊断,经胸腔镜或开胸手术确诊肺癌2例、肺部炎性病变4例、结核及结节病各1例。大气道旁肺实质内占位16例。经EBUS-TBNA确诊肺癌13例,肺部炎症1例及结核1例,经内科保守治疗并随诊6个月,病变部位明显吸收;左肺下叶气管旁肺占位1例,经胸腔镜手术证实为鳞癌。EBUS-TBNA在本组肺癌诊断中敏感度为95.5%(64/67),特异度为100%(8/8),阳性预测值为100%(64/64),阴性预测值为72.7%(8/11),准确度为96%(72/75)。所有患者检查耐受良好,无任何相关并发症发生。结论对于肺癌的诊断,EBUS-TBNA是一种安全有效的检查技术。     

支气管内超声引导针吸活检术诊断胸部疾病

目的 探讨EBUS-TBNA在诊断胸部疾病中的应用价值.方法 回顾性分析2009年9月至2011年8月343例经EBUS-TBNA术检查患者资料,男219例,女124例;年龄(59.4±13.6)岁.其中影像学可疑或已明确肺癌,并伴有纵隔或肺门淋巴结肿大208例;不伴有肺内占位的纵隔和(或)肺门淋巴结肿大或纵隔占位94例;邻近大气道的肺实质内占位41例.结果 患者胸部病变短径(1.94±1.01) cm,穿刺胸部病变(1.77±0.86)个/例,穿刺(4.71±2.69)次,每处病变平均穿刺2.66次.本组EBUS-TBNA诊断纵隔和(或)肺门良、恶性病变总的敏感性95.6％(238/249例)、特异性100％( 94/94例)、阳性预测值100％(238/238例)、阴性预测值89.5％(94/105例)、准确性96.8％(332/343例).208例明确或可疑肺癌患者中151例经EBUS-TBNA诊断纵隔淋巴结转移,4例为结核,2例为Ⅱ期结节病;51例EBUS-TBNA阴性患者中37例接受进一步手术,32例证实为真阴性.EBUS-TBNA对本组188例肺癌患者纵隔淋巴结分期的敏感性96.8％(151/156例)、特异性100.0％(32/32例)、准确性97.3％(183/188例),阳性预测值100.0％(151/151例)、阴性预测值86.5％(32/37例).94例纵隔和(或)肺门淋巴结肿大或纵隔占位患者中22例恶性病变,73例良性病变中有23例诊断为淋巴结反应性增生,其中有13例接受进一步手术,6例为假阴性.EBUS-TBNA诊断本组纵隔病变良、恶性的敏感性88.0％(22/25例)、特异性100％(73/73例)、阴性预测值95.9％(70/73例)准确性97.9％(92/94例).EBUSTBNA对本组纵隔恶性和良性病变诊断的准确率分别为88.0％(22/25例)和95.9％(70/73例).41例邻近大气道的肺实质内占位中恶性33例;8例EBUS-TBNA阴性,其中4例经进一步手术证实为假阴性.EBUS-TBNA诊断大气道旁肺实质内占位中的敏感性89.2％(33/37例)、准确性90.2％(37/41例).全组病例无穿刺相关并发症发生.结论 EBUS-TBNA术对于肺癌的病理分期可靠,诊断邻近大气道的肺门或纵隔占位等胸部疾病安全、有效.     

支气管内超声引导针吸活检术（EBUS-TBNA）临床应用的初步体会

目的探讨支气管内超声引导针吸活检术（endobronchial ultrasound-guided transbronchial needle aspiration,EBUS-TBNA）在明确纵隔和肺门肿大淋巴结定性诊断中的应用价值。方法2009年9~11月,对25例胸部CT检查提示纵隔和（或）肺门淋巴结肿大（短径〉1 cm）进行EBUS-TBNA检查,阴性者进一步接受纵隔镜检查或胸腔镜、开胸手术加以确证。结果本组25例共穿刺32组淋巴结。EBUS-TBNA明确淋巴结恶性转移者15例;EBUS-TBNA阴性者10例,其中1例开胸术后证实隆突下淋巴结转移。EBUS-TBNA在纵隔和肺门肿大淋巴结良恶性鉴别诊断中的敏感性、特异性和准确性分别为94%（15/16）,100%（9/9）和96%（24/25）。所有患者检查耐受良好,无任何相关并发症发生。结论EBUS-TBNA是评价纵隔及肺门淋巴结安全有效的方法。     

超声引导下经支气管针吸活检术对单纯纵隔病变的诊断价值

目的探讨超声引导下经支气管针吸活检术(EBUS-TBNA)在单纯纵隔病变诊断中的临床价值。方法回顾性分析2012-06—2015-06间113例接受EBUS-TBNA检查的单纯纵隔疾病患者的临床资料。最终诊断结果需经手术活检、纵隔镜检查或长期随访确诊。EBUS-TBNA检查或组织病理检查明确者,定义为阳性;无明确病理结果或取材不满意者定义为阴性。所有统计结果使用SPSS17.0统计软件分析。结果 113例入选患者经EBUS-TBNA检查,其中98例明确诊断、15例未能明确诊断,确诊率为86.7%(98/113)。明确诊断病例中,恶性病变41例,良性病变57例。15例未能明确诊病例中,取材不满意6例,诊断非特异性炎症9例。接受进一步外科活检(纵隔镜手术、胸腔镜手术或开胸手术)或至少6个月的临床随访验证,确诊为结节病4例、纵隔结核病3例、淋巴瘤3例、小细胞肺癌1例、炎性反应4例。EBUS-TBNA诊断敏感性、特异性、阳性预测值、阴性预测值分别为90.9%(40/44)、98.6%(68/69)、97.6%(40/41)和94.4%(68/72)。结论对于单纯纵隔病变,EBUS-TBNA是一种很有价值的微创检测手段,有很好的应用前景。     

上腔静脉综合征诊断中支气管内超声引导针吸活检术的应用

目的 探讨支气管内超声引导针吸活检术(EBUS-TBNA)在诊断上腔静脉阻塞综合征(SVCS)中的应用价值.方法 回顾性分析520例中20例SVCS EBUS-TBNA术患者的临床资料,男14例,女6例;年龄35 ～ 77岁,平均(59.1 ±14.6)岁.上腔静脉周围病变短径1.69～9.50cm,平均(3.32±1.79) cm,其中6例隆凸下淋巴结肿大,短径1.73 ～3.01 cm,平均(2.14±0.49) cm.结果 每例穿刺3～5次,平均(4.35±0.75)次.术后病理证实小细胞癌10例,腺癌4例,鳞癌1例,霍奇金淋巴瘤1例.4例穿刺病理未发现恶性证据,其中1例穿刺获取组织量少,2例术前CT显示纵隔占位内有明显钙化考虑良性可能性较大,此3例获取标本抗酸染色及结核分枝杆菌荧光扩增试验阴性,考虑为纵隔炎性病变;另1例因纵隔肿物巨大高度怀疑恶性肿瘤,故而进一步行胸腔镜胸腔活检术,术后病理证实为B细胞源性非霍奇金淋巴瘤.本组EBUS-TBNA对于SVCS病因的诊断率为90.0％ (18/20).结论 EBUS-TBNA是诊断SVCS病因的一种安全有效的方法.     

超声引导下经支气管针吸活检术诊断肺癌术后局部复发的临床价值

目的研究超声引导下经支气管针吸活检术(EBUS-TBNA)在肺癌术后患者中诊断肺癌局部复发的临床价值。方法回顾性分析2007-01—2019-03间接受手术治疗的83例肺癌患者的临床资料。结果 83例患者EBUS-TBNA诊断肺癌术后局部复发的灵敏度、特异度、阳性预测值、阴性预测值和总体准确性分别为100%(50/50)、84.85%(28/33)、90.91%(50/55)、100%(28/28)、93.98%(78/83)。结论 EBUS-TBNA诊断肺癌术后局部复发,具有高准确性。     

超声支气管镜引导针吸活检在纵隔及肺门淋巴结肿大中的临床应用

目的探讨超声支气管镜引导针吸活检术(endobronchial ultrasoundguided transbronchial needle aspiration,EBUSTBNA)在纵隔及肺门淋巴结肿大诊断中的应用价值。方法回顾性分析我院2013年10月~2016年10月EBUS-TBNA检查105例资料,其中纵隔淋巴结肿大102例,肺门淋巴结肿大3例。结果 EBUS-TBNA病理确诊恶性91例,良性14例。良性中的6例非特异性淋巴结炎经手术复检5例为恶性,1例确诊良性。恶性肿瘤诊断准确率95.2%(100/105),敏感度94.8%(91/96),特异性100%(9/9),阳性预测值100%(91/91),阴性预测值64.3%(9/14)。结论 EBUS-TBNA安全、有效,敏感度和特异度高。     

The value of mediastinal staging with endobronchial ultrasound-guided transbronchial needle aspiration in patients with lung cancer

Objective: To evaluate the diagnostic yield, the learning curve and the safety of endobronchial ultrasound-guided transbronchial needle biopsy (EBUS-TBNA) in mediastinal staging of patients with lung cancer. Methods: Mediastinal staging was performed with EBUS-TBNA according to the Danish national guidelines in patients fulfilling one or more of the following criteria: (1) central tumour; (2) enlarged (>10 mm) mediastinal lymph nodes on computed tomography; or (3) positron emission tomography (PET)-positive mediastinal lymph nodes. The study period began in January 2006 when EBUS-TBNA was introduced in the department and ended in December 2007. All records were reviewed retrospectively. None of the four examiners had any previous experience with EBUS-TBNA or ultrasound when the study began. All examinations were performed under general anaesthesia. Patients without useful cytological material from the EBUS-TBNA were subjected to a supplementary standard cervical mediastinoscopy if the mediastinal lymph nodes were found to be enlarged (>10 mm), PET positive or if the examiner was insecure of the result of the EBUS-TBNA. Patients with mediastinal lymph node involvement, detected by EBUS-TBNA or standard cervical mediastinoscopy, were referred to oncological treatment, while those without mediastinal lymph node involvement underwent – if they were otherwise eligible for surgery – resection and systematic lymph node sampling either by thoracotomy or by video-assisted thoracoscopy. Final mediastinal staging was defined as positive if mediastinal lymph node involvement was detected by EBUS-TBNA, standard cervical mediastinoscopy or surgery, or defined as negative otherwise. Results: A total of 157 patients were included in the study. N2/N3 disease was found in 67 patients (42.6%). EBUS-TBNA missed the mediastinal spread in 10 patients. Five of the ten patients had lymph node metastases in station 5, 6 or 8 – out of reach of EBUS-TBNA or standard cervical mediastinoscopy. EBUS-TBNA had a sensitivity of 0.85 (0.74–0.93) and a negative predictive value of 0.90 (0.82–0.95). No complications occurred from EBUS-TBNA. The number of supplementary standard cervical mediastinoscopies decreased significantly in the study period. Conclusion: The results of this study suggest that staging of the mediastinum with EBUS-TBNA is safe and easy to learn – even without previous experience with ultrasound. The diagnostic yield of EBUS-TBNA is in accordance with the yield of standard cervical mediastinoscopy reported in the literature. We do not find any indications in the present study of the recommended necessity for mediastinoscopy in all EBUS-TBNA-negative patients.     

Role of endobronchial ultrasound-guided transbronchial needle aspiration in the management of lung cancer

Endobronchial ultrasound (EBUS) is a promising new modality first introduced during the early 1990s. The radial probe EBUS was initially developed seeking for high-resolution imaging of processes in the airway wall and outside the airways. The structure of special importance was lymph nodes, walls of the central airways, and the mediastinum. After the development of miniaturized radial probes with flexible catheters having a balloon at the tip, it has been applied to aid bronchoscopists during biopsy of patients with respiratory diseases. In particular, the role of EBUS in transbronchial needle aspiration (TBNA) has been established. Radial probe EBUS-guided TBNA has increased the yield of TBNA of mediastinal lymph nodes, although it was still not a real-time procedure with target visualization. New convex probe EBUS (CP-EBUS) with the ability to perform real-time EBUS-guided TBNA (EBUS-TBNA) has emerged to overcome these problems. Indications for EBUS-TBNA are (1) lymph node staging in lung cancer patients; (2) diagnosis of intrapulmonary tumors; (3) diagnosis of unknown hilar and/or mediastinal lymphadenopathy; and (4) diagnosis of mediastinal tumors. Case series using EBUS-TBNA for mediastinal lymph node staging in lung cancer have reported a high yield, ranging from 89% to 98% (average 94.5%). To date, there are no reports of major complications related to EBUS-TBNA. EBUS-TBNA is a novel approach with a high diagnostic yield that is safe. The aim of this article was to review the current role of EBUS-TBNA for the management of lung cancer patients.     

Is sampling really effective in staging non-small cell lung cancer? A prospective study

Is sampling really effective in staging non-small cell lung cancer? The aim of the study was to assess if systematic nodal dissection is necessary in order to stage non-small cell lung cancer correctly or whether mediastinal lymph node sampling can be used and whether in selected cases it could replace systematic nodal dissection for the treatment of lung cancer. A prospective study was conducted in 94 patients affected by clinically resectable non-small cell lung cancer (stages I-IIIB) who were surgically treated by the same team of surgeons. During surgery mediastinal lymph node sampling was done first and then another surgeon completed the systematic nodal dissection and performed the lung resection. One hundred and ninety-three mediastinal nodal stations were investigated using the American Thoracic Society lymph node map to identify them. On analysing the 193 mediastinal nodal stations investigated, it emerged that in 181 cases (94%) mediastinal lymph node sampling and systematic nodal dissection yielded the same histopathological findings, whereas in 12 cases (6%) there was no agreement between the two techniques. The negative predictive value of mediastinal lymph node sampling was 92.8% (103/111). The results of the study show no statistical difference between mediastinal lymph node sampling and systematic nodal dissection in staging non-small cell lung cancer. However, it is possible that in a limited percentage of cases a nodal station could be understaged and thus the surgical resection could prove incomplete if mediastinal lymph node sampling alone is performed. Moreover, in those cases where mediastinal lymph node sampling detects N2 disease and systematic nodal dissection has not been completed, the intervention cannot be considered radical.     

Surgical assessment and intraoperative management of mediastinal lymph nodes in non-small cell lung cancer

Mediastinal lymph node status has important prognostic and therapeutic implications for nonsmall cell lung cancer patients. Consequently, an accurate pathologic assessment of mediastinal lymph nodes for metastasis is essential. Despite the significance of nodal assessment, practice patterns among surgeons vary widely. Therefore we reviewed the literature to provide evidence-based recommendations regarding the ideal means and extent of preoperative and intraoperative pathologic mediastinal lymph node staging in non-small cell lung cancer patients. We found that the most sensitive and accurate intraoperative method is a complete mediastinal lymph node dissection. Pathologic evaluation of at least 10 mediastinal lymph node from at least three stations should be performed at the time of surgery.     

支气管内超声引导针吸活检术在肺癌分期的应用

目的 接受EBUS-TBNA检查,其评价支气管内超声引导针吸活检术(endobronchial ultrasound-guided transbronchial needle aspiration,EBUS-TBNA)在肺癌分期的应用价值.方法 2008年7月至2010年3月,128例肺癌患者中男102例,女26例,年龄37 -85岁,平均60.1岁.胸部CT或PET/CT影像学检查均提示肺癌并肺门或纵隔淋巴结肿大,未除外转移.回顾分析其临床影像学与内镜超声的表现及穿刺活检的结果.结果 128例内镜超声均可见肺门或纵隔多组肿大的淋巴结,短径6～16 mm,平均12.3 mm.成功穿刺189组淋巴结,过程顺利,无并发症发生.EBUS-TBNA准确率98.53％,灵敏度98.50％,特异度100％.结论EBUS-TBNA作为肺门及纵隔淋巴结活检的一种新手段,创伤小,并发症少,准确性高,在肺癌分期的应用安全、可行.     

Invasive staging of superior mediastinum in non-small cell lung cancer patients with specific indications

This prospective study was done between February 2001 and December 2002 on 84 non-small cell lung cancer patients who were apparently operable. We selectively performed mediastinoscopy to 46 patients (54.76%, group 1) with the following indications: clinical T4 tumor, high operative risk, radiologically enlarged mediastinal lymph nodes, clinical T3 tumors with central location, radiologically identified mediastinal lymph nodes of any size with adeno or large cell carcinoma histology. Other 38 patients (45.23%, group 2) underwent thoracotomy without mediastinoscopy. Sensitivity, specificity, negative predictive value and positive predictive value of the indications were calculated. Cost analysis was done in the 84 patients and the results were compared with alternative mediastinal staging strategies (vs. routine, and vs. selectively to patients with radiologically positive mediastinal lymph nodes) if they had been applied to our population. Group 1 had higher selectivity to differentiate N2 patients (p=0.02). Sensitivity, specificity, negative predictive value and positive predictive value of indications were calculated as: 0.85, 0.54, 0.92 and 0.36, respectively. Our approach was most economical in terms of total cost per patient and money spent unnecessarily per patient. Mediastinal evaluation in operable lung cancer patients should decrease the number of surgical procedures, N2 disease found at thoracotomy and cost.     

New Endoscopic Ultrasound (EUS) Applications in Lung Cancer: Evaluation of Patients With Negative Mediastinal CT and Re-Staging After Neoadjuvant Treatment

The main purpose of staging in non-small cell lung cancer (NSCLC) is to assess mediastinal lymph node involvement, with thoracic CT being the main non-invasive test for this. However, given that up to 15% of patients who show no mediastinal lymph node involvement in the CT has lymph node metastasis during surgery, other examinations are required. Endoscopic ultrasonography guided fine-needle aspiration (EUS-FNA) was shown to be able to detect advanced disease (metastatic mediastinal lymph nodes, adrenal metastasis, mediastinal invasion by the tumor) in approximately 25% of patients with a CT that suggested a non-advanced disease.Another situation in which CT has a very limited value is in the evaluation of the response to induction therapy, with its most limiting factor being its intrinsic inability to distinguish between a tumor and necrosis. In this context, EUS-FNA was shown to have a good performance, with a sensitivity, negative predictive value and precision of 75%, 67%, and 83%, respectively.In conclusion, EUS-FNA may be considered a good alternative in the pre-operative staging of patients with NSCLC, with and without diseased mediastinal lymph nodes in CT, and could play an important role in the mediastinal re-staging of these patients by identifying a patient sub-group who might benefit from additional surgical treatment.