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作 者:张月明[1] 程贵余[2] 张智慧[3] 吕宁[4] 李晓燕[1] 邹霜梅[4] 薛丽燕[4] 张蕾[1] 倪晓光[1] 赖少清[1] 贺舜[1] 于桂香[1] 鞠凤环[1] 荀华英[1] 王贵齐[1]
机构地区:[1]中国医学科学院中国协和医科大学肿瘤医院内镜科,北京100021 [2]中国医学科学院中国协和医科大学肿瘤医院胸外科,北京100021 [3]中国医学科学院中国协和医科大学肿瘤医院细胞学室,北京100021 [4]中国医学科学院中国协和医科大学肿瘤医院病理科,北京100021
出 处:《中华消化内镜杂志》2008年第12期621-625,共5页Chinese Journal of Digestive Endoscopy
基 金:卫生部部署(管)临床学科重点项目(2007-2009)
摘 要:目的初步探讨内镜超声引导下细针穿刺抽吸术(EUS—FNA)在纵隔肿大淋巴结、纵隔不明原因占位定性诊断及肺癌N分期中的应用价值。方法应用22G穿刺针对61例患者经食管行EUS.FNA,穿刺物均行病理及细胞学检查。结果EUS—FNA诊断阳性率为93.4%(57/61),细胞学及病理诊断阳性率分别为85.2%(52/61)和83.6%(51/61)。100.0%(26/26)临床疑诊肺癌纵隔淋巴结转移而经支气管镜等检查未能提供病理或细胞学证据者均通过EUS-FNA得到诊断,其中21例诊断为肺癌、5例排除肺癌诊断为良性疾病;86.4%(19/22)纵隔不明原因占位明确定性;85.7%(6/7)有恶性肿瘤病史影像学检查疑诊纵隔淋巴结转移者,EUS—FNA病理及细胞学结果支持转移;6例经支气管镜检查已获得明确病理细胞学诊断的肺癌病例但影像学提示纵隔淋巴结肿大,为明确N分期行EUS—FNA,结果均为阳性,改变了原计划治疗方案。本组无一例EUS-FNA相关并发症发生。结论对于明确纵隔肿大淋巴结、纵隔不明原因占位定性诊断及肺癌N分期,EUS—FNA是一种较为安全、有效的诊断方法。Objective To evaluate the efficacy of endoscopic ultrasound guided fine-needle aspiration (EUS-FNA) in diagnosis of enlarged mediastinal lymph nodes (LNs) , mediastinal occupying lesion of unknown origin, as well as in N-staging for lung cancer. Methods EUS-FNA was performed via esophagus with a 22-gauge needle in 61 patients, followed by pathological and cytological examinations. Results The positive diagnosis rate of EUS-FNA was 93.4% (57/61), and the cytological and pathological diagnostic accuracy were 85. 2% (52/61) and 83. 6% (51/61), respectively. Of 61 patients, 26 were suspected as having lung cancer with mediastinal lymph nodes metastasis, but the bronchoscopy failed to confirm the diagnosis. EUS-FNA diagnosed lung cancer in 21 and benign lesion in 5. Of 22 patients with mediastinal occupying lesions of unknown origin, 19 (86.4%) were diagnosed by EUS-FNA. Of 7 patients with malignant tumor history and enlarged mediastinal lymph nodes, EUS-FNA confirmed mediastinal metastasis in 6 (85.7%). Six cases of lung cancer with suspected mediastinal lymph nodes metastasis were confirmed by EUS-FNA and the corresponding therapy regimen was modified. No complications related to EUS-FNA procedure occurred. Conclusion EUS-FNA is a safe and effective method for diagnosis of enlarged medistinal LNs, mediastinal lesion of unkown origin and N-stage of lung cancer.
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