Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for the Evaluation of Suspected Lymphoma

被引:121
|
作者
Steinfort, Daniel P. [1 ]
Conron, Matthew [2 ]
Tsui, Alpha [3 ]
Pasricha, Sant-Rayn [4 ]
Renwick, William E. P. [4 ]
Antippa, Phillip [5 ]
Irving, Louis B.
机构
[1] Royal Melbourne Hosp, Dept Resp Med, Med Res Ctr, Parkville, Vic 3050, Australia
[2] St Vincents Hosp, Dept Resp Med, Fitzroy, Vic 3065, Australia
[3] Royal Melbourne Hosp, Dept Pathol, Parkville, Vic 3050, Australia
[4] Royal Melbourne Hosp, Dept Haematol, Parkville, Vic 3050, Australia
[5] Royal Melbourne Hosp, Dept Cardiothorac Surg, Parkville, Vic 3050, Australia
基金
英国医学研究理事会;
关键词
Bronchoscopy; Cytology; Lymphadenopathy; Lymphoma; Small volume specimens; CELL LUNG-CANCER; FLOW-CYTOMETRY; LYMPHOPROLIFERATIVE DISORDERS; DIAGNOSIS; MEDIASTINOSCOPY; SARCOIDOSIS; DISEASE; BIOPSY; ACCURACY; CYTOLOGY;
D O I
10.1097/JTO.0b013e3181d873be
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background: Evidence regarding the utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the assessment of isolated mediastinal lymphadenopathy (IMLN) is evolving. Its diagnostic accuracy in the evaluation of suspected lymphoma remains uncertain. Methods: We reviewed a prospectively recorded database of consecutive patients with suspected lymphoma who underwent EBUS-TBNA to evaluate IMLN. Patients in whom EBUS-TBNA was nondiagnostic subsequently underwent surgical biopsy or a minimum of 6 months radiologic surveillance. Results: Ninety-eight patients underwent EBUS-TBNA for evaluation of IMLN. Clinicoradiologic features suggested sarcoidosis as the likely diagnosis in 43 patients. In the remaining 55 patients, EBUS-TBNA achieved definitive diagnosis in 42 patients (76%; 95% confidence interval [CI] 55-90). Lymphoma was ultimately diagnosed in 21 of 55 patients (38%). EBUS-TBNA demonstrated lymphoma in 16 (76%) patients; however, four patients required further surgical biopsy to completely characterize lymphoma subtypes. Surgical biopsy was required to diagnose specific lymphoma subtypes not readily amenable to diagnosis with low volume specimens. Sensitivity and specificity for definitive diagnosis of lymphoma were 57% (95% CI 37-76) and 100% (95% CI 91-100), respectively. Conclusions: Although the diagnostic accuracy of EBUS-TBNA for lymphoma is lower than that for the lung cancer staging, the procedure is an appropriate investigative technique for the patients with IMLN because of the low incidence of lymphoma in this population, and the significant proportion of such patients (76%) in whom surgical biopsy is obviated.
引用
收藏
页码:804 / 809
页数:6
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