背景:联合支气管内超声引导下经支气管针吸活检术(EBUS-TBNA)和内镜超声引导下组织采集(EUS-TA)是诊断和分期肺癌纵隔淋巴结(MLN)的准确方法。然而,单独和联合手术在诊断和分期中的各自贡献尚未得到充分研究.这项研究的目的是评估他们各自的表现。
方法:对PET-CT诊断为肺癌的疑似恶性MLN或复发患者行EBUS-TBNA和EUS-TA联合治疗的患者进行回顾性分析。
结果:共有141例患者接受了这两种手术。用EBUS-TBNA获得了82%的正确诊断,91%与EUS-TA,94%与合并程序。整体灵敏度,特异性,EBUS-TBNA的阳性和阴性预测值(PPV和NPV),EUS-TA,诊断恶性肿瘤的联合程序是[75%,100%,100%,58%],[87%,100%,100%,75%],和[93%,100%,100%,80%],分别,联合手术的灵敏度明显更好(p<0.0001)。在74%的患者中,EBUS-TBNA正确评估了分期(82/141例),68%的EUS-TA,85%与合并程序。整体灵敏度,特异性,PPV,EBUS-TBNA的净现值,EUS-TA,肺癌分期的联合程序为[62%,100%,100%,55%],[54%,100%,100%,50%],和[79%,100%,100%,68%],分别,在联合手术的敏感性方面明显更好(p<0.001)。
结论:与单独使用EBUS-TBNA和EUS-TA相比,EBUS-EUS联合方法在肺癌患者的诊断和分期中显示出更好的准确性和敏感性。
BACKGROUND: Combined endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound-guided tissue acquisition (EUS-TA) are accurate procedures for the diagnosis and staging of mediastinal lymph nodes (MLNs) in lung cancer. However, the respective contribution of separate and combined procedures in diagnosis and staging has not been fully studied. The aim of this study was to assess their respective performances.
METHODS: Patients with suspected malignant MLNs in lung cancer or recurrence identified by PET-CT who underwent combined EBUS-TBNA and EUS-TA were retrospectively reviewed.
RESULTS: A total of 141 patients underwent both procedures. Correct diagnosis was obtained in 82% with EBUS-TBNA, 91% with EUS-TA, and 94% with the combined procedure. The overall sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of EBUS-TBNA, EUS-TA, and the combined procedure for diagnosing malignancy were [75%, 100%, 100%, 58%], [87%, 100%, 100%, 75%], and [93%, 100%, 100%, 80%], respectively, with a significantly better sensitivity of the combined procedure (p < 0.0001). Staging (82/141 patients) was correctly assessed in 74% with EBUS-TBNA, 68% with EUS-TA, and 85% with the combined procedure. The overall sensitivity, specificity, PPV, and NPV of EBUS-TBNA, EUS-TA, and the combined procedure for lung cancer staging were [62%, 100%, 100%, 55%], [54%, 100%, 100%, 50%], and [79%, 100%, 100%, 68%], respectively, significantly better in terms of sensitivity for the combined procedure (p < 0.001).
CONCLUSIONS: The combined EBUS-EUS approach in lung cancer patients showed better accuracy and sensitivity in diagnosis and staging when compared with EBUS-TBNA and EUS-TA alone.