Pneumonologia i alergologia polska · 2008
[Ultrasound guided transbronchial needle aspiration as a diagnostic tool for lung cancer and sarcoidosis].
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Szlubowski Artur, Kuzdzał Jarosław, Pankowski Juliusz, Obrochta Anna, Soja Jerzy, Hauer Jolanta, Kołodziej Marcin, Zieliński Marcin
Аннотация
INTRODUCTION: The aim of the study was to assess the diagnostic yield of ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in mediastinal or hilar adenopathy in: 1) staging of non-small cell lung cancer (NSCLC) (97); 2) other malignant neoplasms including: small cell lung cancer (SCLC), metastatic neoplasms and Hodgkin's disease (16); 3) NSCLC recurrence (7); 4) sarcoidosis and other non-malignant diseases (29).
MATERIAL AND METHODS: Real time EBUS-TBNA was performed under local anaesthesia and sedation in 149 consecutive patients - 237 biopsies in groups of lymph nodes: subcarinal (7) - 107, all paratracheal (2R, 2L, 4R, 4L) - 86, hilar (10R, 10L) - 41 and interlobar (11R, 11L) - 3. A mean axis of punctured node was 15 mm (range: 7-42 mm). All negative results were verified by transcervical extended bilateral mediastinal lymphadenectomy (TEMLA), mediastinoscopy or thoracotomy.
RESULTS: Lymph node biopsy was technically successful in 92% and was diagnostic in 55% of lung cancer patients and in 85.7% of sarcoidosis patients. In NSCLC staging sensitivity of EBUS-TBNA was 88.7%, specificity 100%, accuracy 92.8% and NPV 83.3% (89.7%, 100%, 94.9% and 90.9% per biopsy), and in the whole group it was 91.5%, 98.7%, 94.6% and 87.3% respectively. In 7.2% of NSCLC staging patients with false negative results of EBUS-TBNA (mainly subcarinal) there was observed partial involvement of metastatic lymph nodes, mean 34.3% (range 10-50%), confirmed by TEMLA.
CONCLUSION: The diagnostic value of EBUS-TBNA is very high in lung cancer, NSCLC staging and sarcoidosis.
MATERIAL AND METHODS: Real time EBUS-TBNA was performed under local anaesthesia and sedation in 149 consecutive patients - 237 biopsies in groups of lymph nodes: subcarinal (7) - 107, all paratracheal (2R, 2L, 4R, 4L) - 86, hilar (10R, 10L) - 41 and interlobar (11R, 11L) - 3. A mean axis of punctured node was 15 mm (range: 7-42 mm). All negative results were verified by transcervical extended bilateral mediastinal lymphadenectomy (TEMLA), mediastinoscopy or thoracotomy.
RESULTS: Lymph node biopsy was technically successful in 92% and was diagnostic in 55% of lung cancer patients and in 85.7% of sarcoidosis patients. In NSCLC staging sensitivity of EBUS-TBNA was 88.7%, specificity 100%, accuracy 92.8% and NPV 83.3% (89.7%, 100%, 94.9% and 90.9% per biopsy), and in the whole group it was 91.5%, 98.7%, 94.6% and 87.3% respectively. In 7.2% of NSCLC staging patients with false negative results of EBUS-TBNA (mainly subcarinal) there was observed partial involvement of metastatic lymph nodes, mean 34.3% (range 10-50%), confirmed by TEMLA.
CONCLUSION: The diagnostic value of EBUS-TBNA is very high in lung cancer, NSCLC staging and sarcoidosis.
Предметные рубрики MeSH
AdultAgedBiopsy, Fine-NeedleCarcinoma, Non-Small-Cell LungFemaleHodgkin DiseaseHumansLung NeoplasmsLymphatic DiseasesLymphatic MetastasisMaleMiddle AgedNeoplasm StagingPolandPredictive Value of TestsRetrospective StudiesSarcoidosis, PulmonarySensitivity and SpecificitySmall Cell Lung CarcinomaUltrasonography