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The journal «ONCOSURGERY» 2013, Vol.5, No 3

Endobronchial ultrasound with transbronchial fine-needle aspiration biopsy of mediastinal lymph nodes

Sekhniaidze DD1, Petrov VG2, Desyatkov ЕN1, Zuev VJu1, Sinyakov АG1

1) Tyumen Regional Oncological Dispensary,
2) Tyumen State Medical Academy, Surgical Department,
Tyumen, Russia
Contact: Sekhniaidze DD, e-mail:

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS TBNA) of mediastinal lymph nodes – a new technology used in the diagnosis of mediastinal lymphadenopathy. From February 2011 to February 2013 in the Tyumen regional oncologic center was 26 EBUS FNA in patients with mediastinal lymphadeno pathies. Verification is achieved in 21 cases. Sensitivity was 81%, specificity of 100%. EBUS TBNA is an effective, minimally invasive and safe method for the morphological verification of mediastinal lymphadenopathy.

Objective. To evaluate the efficiency of endobronchial ultrasonography with transbronchial fine-needle aspiration biopsy of mediastinal lymph nodes (EU FAB) for morphological verifying of mediastinal lymphadenopathy (MLA).

Material and methods. The results of EU TAB performed from 2011 to 2012 were assessed in 26 patients. The study included 20 males and 6 females. The average age was 59.32 y.o. (44-79). Most investigations (21) were performed in patients with lung cancer for staging. In 5 cases the investigation was performed because of suspicion of lymphoma and sarcoidosis. The average size of lymph nodes in the study group accounted for 22±11.5 mm.

For the first two cases EU TAB was performed under local anesthesia. For following 24 investigations the method of combined bronchoscopy in the operative room under general anesthesia with high frequency ventilation was performed.

Results. In 26 patients with EU TAB the involvement of 21 lymph nodes was verified. The negative result was in 5 cases. The analysis of negative results showed that in 2 cases EU TAB was performed under local anesthesia, in 1 case there was a change of assistant for operational reasons and only 1 case seemed to be without indirect impact of "human factor". In all 5 negative results of EU TAB diagnostic surgical intervention was performed to verify lymph node metastases. In all 5 cases the diagnosis was verified morphologically. There were no complications of EU TAB.

There were following distribution for morphological types: squamous cell cancer – 13, adenocarcinoma – 3, bronchioloalveolar cancer – 1, small-cell cancer – 3, undifferentiated cancer – 1, sarcoidosis – 3, non-specific lymph node hyperplasia in the setting of Chronic Obstructive Pulmonary Disease – 1.

The assessed of accuracy of morphological study of lymph node metastasis depending on groups of lymph nodes was performed. Lymph nodes classification by T.Naruke was used. According to this classification the needle biopsy was performed in following groups of lymph nodes: 4R(n=10), 4L(n=4), 7(n=10), 10R(n=1), 10L(n=1). Note that, 4 of false-negative results were obtained in lymph nodes of group 7.

Conclusion. EU TAB is minimally invasive, efficient and safe for morphological verifying of MLA. The specificity of the method is 100%, the sensitivity – 81%. This allows to recommend EU TAB for morphological verifying of MLA as routine minimally invasive method for preoperative examination of patients with lung cancer.

KEY WORDS: mediastinal lymphadenopathy, endobronchial ultrasonography, transbronchial biopsy of mediastinal lymph nodes.

References

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