Endobronchial Ultrasound-guided Transvascular Needle Aspiration A Single-Center Experience
Endobronchial Ultrasound-guided Transvascular Needle Aspiration A Single-Center Experience
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DOI：
10.1097/lbr.0000000000000227
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发表时间：
2015-10-01
影响因子：
3.3
通讯作者：
Cicenia, Joseph C.
中科院分区：
文献类型：
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作者：
Panchabhai, Tanmay S.;Machuzak, Michael S.;Cicenia, Joseph C.
背景资料：支气管内超声引导下经支气管针吸活检（EBUS-TBNA）是肺癌和纵隔淋巴结病分期和诊断的有效方法。中央纵隔血管结构可能妨碍EBUS-TBNA进入纵隔窗淋巴结和某些位于中央的实质病变。因此，有必要采用经血管方法。很少有这样的报告存在于literature.Methods：我们回顾性分析了结果的支气管内超声引导下经血管针吸活检（EBUS-TVNA）进行超过1年的样本纵隔淋巴结（站：5）和肺部病变无法通过标准支气管镜检查或EBUS-TBNA。收集了关于适应症、位置、大小和与邻近血管的关系、经血管通过次数、EBUS-TVNA诊断、最终诊断、手术图像和并发症的数据。患者的图表进行了审查，为6个月后的后期并发症的证据，包括纵隔炎或纵隔hemorrhaging.Results：865 EBUS-TBNA程序，10个进行了穿越肺动脉或其分支。9例为左侧病变，3例为肺门实质结节，6例为肺门或纵隔淋巴结，其余为右侧肿块。9例患者的快速现场评价为淋巴细胞诊断或阳性，9例患者的最终细胞病理学诊断为：5例非小细胞肺癌，1例小细胞癌，1例转移性结肠癌和2例正常淋巴组织。1例患者出现坏死，需要视频辅助胸腔镜手术诊断组织胞浆菌病。出血是微不足道的，没有短期/长期consequence.Conclusions：从我们的单中心的经验，我们得出结论，在经验丰富的手，EBUS-TVNA是可行的，具有较高的收益率，但没有并发症。需要进行更大规模的前瞻性试验来探索其诊断潜力。
Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is well established for the staging and diagnosis of lung cancer and mediastinal lymphadenopathy. Central mediastinal vascular structures may preclude EBUS-TBNA access to lymph nodes in the aortopulmonary window and certain centrally located parenchymal lesions. Thus, a transvascular approach is necessitated. Few such reports exist in the literature.Methods: We retrospectively analyzed the results of endobronchial ultrasound-guided transvascular needle aspiration (EBUS-TVNA) performed over 1 year to sample mediastinal lymph nodes (stations: 5) and lung lesions inaccessible by standard bronchoscopy or EBUS-TBNA. Data regarding the indication, location, size, and relationship to adjacent blood vessels, the number of transvascular passes, EBUS-TVNA diagnosis, the final diagnosis, procedural images, and complications were collected. Patients' charts were reviewed for 6 months after the procedure for evidence of late complications, including mediastinitis or mediastinal hemorrhage.Results: Of 865 EBUS-TBNA procedures, 10 were performed by traversing the pulmonary artery or its branches. Nine were for left-sided lesions, 3 for hilar parenchymal nodules, 6 for hilar or mediastinal LN, and the remainder for a right-sided mass. Rapid-onsite evaluation was either diagnostic or positive for lymphoid cells in 9 patients and the final cytopathology was diagnostic in 9 patients: 5 non-small cell lung cancer, 1 small cell cancer, 1 metastatic colon cancer, and 2 normal lymphoid tissue. One patient had necrosis and required video assisted thoracoscopic surgery to diagnose histoplasmosis. Bleeding was insignificant, with no short-term/long-term complications.Conclusions: From our single-center experience, we conclude that in experienced hands, EBUS-TVNA is feasible, with a high yield, but without complications. Larger prospective trials are warranted to explore its diagnostic potential.