Staging lung cancer: role of endobronchial ultrasound.
Staging lung cancer: role of endobronchial ultrasound.
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DOI：
10.2147/lctt.s46195
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Yoshino I
中科院分区：
文献类型：
--
作者：
Inage T;Nakajima T;Yoshino I
准确的分期是肺癌管理的第一步。淋巴结分期对于医生判断无远处转移患者的初次手术是非常重要的。多年来，纵隔镜检查一直被认为是淋巴结分期的“金标准”。众所周知，纵隔镜检查是一种高度敏感的纵隔分期程序，并已在世界范围内进行，但侵入性。正因为如此，临床医生一直在寻找一种侵入性较小的淋巴结分期方法。支气管内超声引导下经支气管针吸活检（EBUS-TBNA）是一种用于肺癌诊断和分期的微创方法。EBUS-TBNA是一种针吸活检程序，其可达性与凸探头EBUS范围兼容，因此N1淋巴结也可评估。诊断率与纵隔镜检查相似，专用针吸活检获得的核心可用于组织学评估，以确定肺癌的亚型。样品也可用于使用免疫组织化学、DNA/互补DNA的聚合酶链反应和原位杂交来测试各种生物标志物，并且该技术可用于选择特定分子靶向治疗剂的候选物。根据最新出版的美国胸科医师学会指南，EBUS-TBNA现在被认为是对放射学可疑淋巴结患者进行淋巴结分期的“最佳首选试验”。需要适当的培训和全面的临床经验，才能使用该程序进行正确的淋巴结分期。
Accurate staging is the first step in the management of lung cancer. Nodal staging is quite important for physicians to be able to judge the primary operability of patients harboring no distant metastasis. For many years, mediastinoscopy has been considered a “gold standard” modality for nodal staging. Mediastinoscopy is known to be a highly sensitive procedure for mediastinal staging and has been performed worldwide, but is invasive. Because of this, clinicians have sought a less invasive modality for nodal staging. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive modality for diagnosis and staging of lung cancer. EBUS-TBNA is a needle biopsy procedure that has accessibility compatible with the reach of the convex-probe EBUS scope, so N1 nodes are also assessable. The diagnostic yield is similar to that of mediastinoscopy, and the core obtained by the dedicated needle biopsy can be used for histological assessment to determine the subtypes of lung cancer. The samples can also be used to test for various biomarkers using immunohistochemistry, polymerase chain reaction for DNA/complementary DNA, and in situ hybridization, and the technique is useful for selecting candidates for specific molecular-targeted therapeutic agents. According to the newly published American College of Chest Physicians guideline, EBUS-TBNA is now considered “the best first test” for nodal staging in patients with radiologically suspicious nodes. Appropriate training and thorough clinical experience is required to be able to perform correct nodal staging using this procedure.