Application of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in the Management of Mediastinal and Hilar Lymphadenopathy Without Intrapulmonary Mass: Experience from the Largest Cancer Center of Southern China
Tóm tắt
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is useful for lung cancer diagnosis and lymph node staging. The purpose of this study was to investigate EBUS-TBNA for managing mediastinal and hilar lymphadenopathies without intrapulmonary masses. We retrospectively reviewed our EBUS-TBNA database that was obtained between August 2010 and October 2012. Mediastinal and hilar lymphadenopathies of unknown origin and in the absence of known pulmonary malignancies were included. Final diagnoses were determined by EBUS-TBNA, surgery, and/or clinical follow-up for at least 6 months. Sensitivity, specificity, accuracy, and positive and negative predictive values were determined using standard statistical methods. We identified 128 patients with mediastinal and hilar lymphadenopathies and without intrapulmonary masses. EBUS-TBNA was successfully performed to obtain samples from 161 lymph nodes and mediastinal masses. EBUS-TBNA was diagnostic for 119 of 128 patients (93.0 %) for all disease categories. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of EBUS-TBNA were 89.8, 100, 100, 81.6, and 93.0 %, respectively. The procedures were uneventful and there were no severe complications. EBUS-TBNA is a safe, minimally invasive approach for diagnosing mediastinal and hilar lymphadenopathies without intrapulmonary masses. It obviates the need for more invasive procedures for tissue sampling of the mediastinum and hilum.
Tài liệu tham khảo
Detterbeck, F. C., Jantz, M. A., Wallace, M., Vansteenkiste, J., & Silvestri, G. A. (2007). Invasive mediastinal staging of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest, 132, 202S–220S.
Yasufuku, K., Chiyo, M., Sekine, Y., Chhajed, P. N., Shibuya, K., Iizasa, T., et al. (2004). Real time endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal and hilar lymph nodes. Chest, 126, 122–128.
Yasufuku, K., Chiyo, M., Koh, E., Moriya, Y., Iyoda, A., Sekine, Y., et al. (2005). Endobronchial ultrasound guided transbronchial needle aspiration for staging of lung cancer. Lung Cancer, 50, 347–354.
Herth, F. J., Eberhardt, R., Vilmann, P., Krasnik, M., & Ernst, A. (2006). Real-time endobronchial ultrasound guided transbronchial needle aspiration for sampling mediastinal lymph nodes. Thorax, 61, 795–798.
Yasufuku, K., Nakajima, T., Motoori, K., Sekine, Y., Shibuya, K., Hiroshima, K., et al. (2006). Comparison of endobronchial ultrasound, positron emission tomography, and CT for lymph node staging of lung cancer. Chest, 130, 710–718.
Ernst, A., Anantham, D., Eberhardt, R., Krasnik, M., & Herth, F. J. (2008). Diagnosis of mediastinal adenopathy—real-time endobronchial ultrasound guided needle aspiration versus mediastinoscopy. Journal of Thoracic Oncology, 3, 577–582.
Ernst, A., Eberhardt, R., Krasnik, M., & Herth, F. J. (2009). Efficacy of endobronchial ultrasound-guided transbronchial needle aspiration of hilar lymph nodes for diagnosing and staging cancer. Journal of Thoracic Oncology, 4, 947–950.
Anderson, J. M., Murchison, J., & Patel, D. (2003). CT-guided lung biopsy: factors influencing diagnostic yield and complication rate. Clinical Radiology, 58, 791–797.
Porte, H., Roumilhac, D., Eraldi, L., Cordonnier, C., Puech, P., & Wurtz, A. (1998). The role of mediastinoscopy in the diagnosis of mediastinal lymphadenopathy. European Journal of Cardio-Thoracic Surgery, 13, 196–199.
Hammoud, Z. T., Anderson, R. C., Meyers, B. F., Guthrie, T. J., Roper, C. L., Cooper, J. D., et al. (1999). The current role of mediastinoscopy in the evaluation of thoracic disease. Journal of Thoracic and Cardiovascular Surgery, 118, 894–899.
Yasufuku, K., Nakajima, T., Fujiwara, T., Yoshino, I., & Keshavjee, S. (2011). Utility of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of mediastinal masses of unknown etiology. Annals of Thoracic Surgery, 91, 831–836.
Ye, T., Hu, H., Luo, X., & Chen, H. (2011). The role of endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) for qualitative diagnosis of mediastinal and hilar lymphadenopathy :a prospective analysis. BMC Cancer, 11, 100.
Navani, N., Lawrence, D. R., Kolvekar, S., Hayward, M., McAsey, D., Kocjan, G., et al. (2012). EBUS-TBNA prevents mediastinocopies in the diagnosis of isolated mediastinal lymphadenopathy: A prospective trial. American Journal of Respiratory and Critical Care Medicine, 186, 255–260.
Yasufuku, K., Pierre, A., Darling, G., de Perrot, M., Waddell, T., Johnston, M., et al. (2011). A prospective controlled trial of endobronchial ultrasound-guided transbronchial needle aspiration compared with mediastinoscopy for mediastinal lymph node staging of lung cancer. Journal of Thoracic and Cardiovascular Surgery, 142, 1393–1400.
Lennon, A. M., Rintoul, R. C., & Penman, I. D. (2006). Competition for EUS (a) EBUS-TBNA (b) video assisted thoracoscopy. Endoscopy, 38, S80–S83.
Lee, H. S., Lee, G. K., Lee, H. S., Kim, M. S., Lee, J. M., Kim, H. Y., et al. (2008). Real-time endobronchial ultrasound-guided transbronchial needle aspiration in mediastinal staging of non-small cell lung cancer: How many aspirations per target lymph node station? Chest, 134, 368–374.
Gu, P., Zhao, Y. Z., Jiang, L. Y., Zhang, W., Xin, Y., & Han, B. H. (2009). Endobronchial ultrasoundguided transbronchial needle aspiration for staging of lung cancer: A systematic review and meta-analysis. European Journal of Cancer, 45, 1389–1396.
Varela-Lema, L., Fernandez-Villar, A., & Ruano-Ravina, A. (2009). Effectiveness and safety of endobronchial ultrasound-transbronchial needle aspiration: A systematic review. European Respiratory Journal, 33, 1156–1164.