Endobronchial Ultrasound versus Mediastinoscopy for Mediastinal Nodal Staging of Non-Small-Cell Lung Cancer
Endobronchial Ultrasound versus Mediastinoscopy for Mediastinal Nodal Staging of Non-Small-Cell Lung Cancer
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DOI：
10.1097/jto.0000000000000388
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发表时间：
2015-02-01
影响因子：
20.4
通讯作者：
Kim, Hojoong
中科院分区：
文献类型：
--
作者：
Um, Sang-Won;Kim, Hong Kwan;Kim, Hojoong
简介：正确的纵隔分期对于确定非小细胞肺癌（NSCLC）患者最合适的治疗策略至关重要。本研究的目的是比较支气管内超声引导下经支气管针吸活检（EBUS-TBNA）与纵隔镜检查在NSCLC患者的诊断性能。方法：在韩国的三级转诊中心进行了前瞻性试验。入组了经组织学证实的NSCLC和疑似N1、N2或N3转移的患者。每例患者均接受了EBUS-TBNA，随后进行了纵隔镜检查。手术切除和完整的淋巴结清扫的患者进行了没有证据的纵隔转移是明显的后纵隔oscopy.Results：在总数，138例患者进行EBUS-TBNA和127完成EBUS-TBNA和纵隔镜检查。59.1%的患者确诊为N2/N3疾病。EBUS-TBNA的诊断敏感性、特异性、准确性、阳性预测值和阴性预测值（NPV）分别为88.0%、100%、92.9%、100%和85.2%。纵隔镜检查的诊断敏感性、特异性、准确性、阳性预测值和NPV分别为81.3%、100%、89.0%、100%和78.8%。结论：EBUS-TBNA对cN 1 -3 NSCLC纵隔分期的诊断能力优于纵隔镜检查（上级）。由于EBUS-TBNA创伤小，诊断灵敏度上级，因此应作为NSCLC患者的一线手术。
Introduction: Correct mediastinal staging is critical for determination of the most appropriate management strategy in patients with non-small-cell lung cancer (NSCLC). The purpose of this study was to compare the diagnostic performance of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) with that of mediastinoscopy in patients with NSCLC.Methods: A prospective trial was conducted in a tertiary referral center in Korea. Patients with histologically proven NSCLC and suspicion for N1, N2, or N3 metastasis were enrolled. Each patient underwent EBUS-TBNA followed by mediastinoscopy. Surgical resection and complete lymph node dissection were conducted in patients for whom no evidence of mediastinal metastasis was apparent after mediastinoscopy.Results: In total, 138 patients underwent EBUS-TBNA and 127 completed both EBUS-TBNA and mediastinoscopy. N2/N3 disease was confirmed in 59.1% of the patients. The diagnostic sensitivity, specificity, accuracy, positive predictive value, and negative predictive value (NPV) of EBUS-TBNA on a per-person analysis were 88.0%, 100%, 92.9%, 100%, and 85.2%, respectively. The diagnostic sensitivity, specificity, accuracy, positive predictive value, and NPV of mediastinoscopy on a per-person analysis were 81.3%, 100%, 89.0%, 100%, and 78.8%, respectively. Significant differences in the sensitivity, accuracy, and NPV were evident between EBUS-TBNA and mediastinoscopy (p < 0.005).Conclusions: EBUS-TBNA was superior to mediastinoscopy in terms of its diagnostic performance for mediastinal staging of cN1-3 NSCLC. Because EBUS-TBNA is both less invasive and affords superior diagnostic sensitivity, it should be the first-line procedure performed in patients with NSCLC.