Endobronchial ultrasound-guided transbronchial needle aspiration and cervical mediastinoscopy for mediastinal staging of non-small cell lung cancer: a retrospective comparison study
Endobronchial ultrasound-guided transbronchial needle aspiration and cervical mediastinoscopy for mediastinal staging of non-small cell lung cancer: a retrospective comparison study
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支气管内超声引导下经支气管针吸活检和颈纵隔镜检查用于非小细胞肺癌纵隔分期：一项回顾性比较研究
DOI：
10.21037/jtd.2018.01.51
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发表时间：
2018-03-01
影响因子：
2.5
通讯作者：
Zhang, Li
中科院分区：
文献类型：
--
作者：
Zhang, Rong;Ma, Yuxiang;Zhang, Li
背景：浸润性纵隔淋巴结分期对可切除的非小细胞肺癌（NSCLC）患者至关重要。本回顾性研究旨在比较支气管内超声引导下经支气管针吸活检（EBUS-TBNA）与颈部纵隔镜检查（CMS）在放射学肿大纵隔淋巴结中的诊断率。方法：收集2009年1月至2016年3月的回顾性数据。入组接受EBUS-TBNA或CMS进行侵袭性纵隔分期的纵隔淋巴结肿大（短轴>= 10 mm）的疑似肺癌患者。采用实质性根治性切除术和系统性纵隔淋巴结清扫术（SML）作为金标准。结果：EBUS-TBNA组55例，CMS组190例，均纳入分析集。在每例分析中，EBUS-TBNA和CMS之间的N分期准确性无显著差异（83.6% vs. 78.9%，P=0.444）。EBUS-TBNA诊断恶性淋巴结的敏感性明显高于CMS（82.4%vs.47.6%，P=0.039）。淋巴结诊断比较EBUS-TBNA和CMS均显示出较高的诊断敏感性、特异性和准确性（82.4%对94.7%，P=0.130; 97.4%对100%，P=0.173; 98.8%对92.9%，P=0.025; CMS的诊断准确率略高于EBUS-TBNA。恶性淋巴结短轴较良性淋巴结长（平均14.2vs.6.5mm，P= 15 mm），恶性率为48.8%。结论：对于临床怀疑肺癌伴纵隔淋巴结肿大的患者，EBUS-TBNA和CMS均是有利的侵袭性纵隔分期选择。EBUS-TBNA具有较高的恶性诊断敏感性和较少的并发症。
Background: Invasive mediastinal lymph node staging is essential to resectable non-small cell lung cancer (NSCLC) patients. This retrospective study aimed to compare the diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) against cervical mediastinoscopy (CMS) in radiologically enlarged mediastinal lymph nodes.Methods: Retrospective data were collected from January 2009 to March 2016. Suspected lung cancer patients with enlarged mediastinal lymph nodes (short axis >= 10 mm), underwent EBUS-TBNA or CMS for invasive mediastinal staging were enrolled. Substantial radical resection with systematic mediastinal lymphadenectomy (SML) was used as the gold standard. Mediastinal lymph nodes diagnostic comparison and N staging analysis were conducted in this study.Results: Fifty-five patients received EBUS-TBNA and one hundred and ninety patients received CMS were included into the analysis set. In per case analysis, no significant differences were seen between EBUS-TBNA and CMS in N staging accuracy (83.6% vs. 78.9%, P=0.444). EBUS-TBNA had significantly higher sensitivity than CMS (82.4% vs. 47.6%, P=0.039) in malignant lymph nodes diagnosis. In lymph nodes diagnosis comparison (station #2, #4 and #7), both EBUS-TBNA and CMS showed high diagnostic sensitivity, specificity and accuracy (82.4% vs. 94.7%, P=0.130; 97.4% vs. 100%, P=0.173; 98.8% vs. 92.9%, P=0.025; respectively), CMS had slightly better diagnostic accuracy rate than EBUS-TBNA. Malignant lymph nodes had longer short axis than benign nodes (mean 14.2 vs. 6.5 mm, P= 15 mm, the malignant rate was 48.8%. More complications and injuries were found in patients receiving CMS.Conclusions: For clinically suspected lung cancers with enlarged mediastinal lymph nodes, both EBUS-TBNA and CMS are favorable invasive mediastinal staging options. EBUS-TBNA may be preferred for its higher malignant diagnostic sensitivity and fewer complications.