Nilgün Yilmaz DEMİRCİ, Can ÖZTÜRK

EBUS-TBİA ESNASINDA DOPPLER MOD İLE DEĞERLENDİRİLEN VASKÜLER İMAJ PATERNİNİN BENİGN VE MALİGN LENF NODU AYIRIMINDAKİ DEĞERİ

Giriş: Endobronşiyal ultrasonografi kılavuzluğunda transbronşial iğne aspirasyonu (EBUS-TBİA), lenf nodu tanısı için yüksek verim sağlayan minimal invaziv bir prosedürdür. Bu çalışmanın amacı benign ve malign lenf nodunun (LN) ayırıcı tanısında EBUS-TBİA sırasında lenf bezlerinin doppler mod özelliklerinin kullanımını değerlendirmektir. Gereç ve Yöntem: EBUS, altta yatan hastalığa bakılmaksızın mediastinal lenfadenopatisi bulunan 151 hastaya uygulandı. LN' nin özelliklerini öngörmek için şu kriterler değerlendirildi; çap, şekil, sınır özellikleri, ekojenite, merkezi hiler yapı ve kan akışı. Kan akımı ölçütleri histopatolojik sonuçlar ile korele edildi ve duyarlılık, özgüllük, pozitif ve negatif prediktif değerler (PPV ve NPV) hesaplandı. Bulgular: Yüz elli bir hastada 229 LN analiz edildi. LN' larının %83.3' ü malign, %16.7'si benign olarak değerlendirilmişti. Grade 0 ve I kanlanmayı "benign", Grade II ve III kanlanmayı "malign" olarak tanımladığımızda duyarlılık, özgüllük, NPV, PPV ve tanısal doğruluk oranı sırasıyla %83.2, %66.7, %69.7, %82.3 ve %74.0 idi. Tartışma: Rutin EBUS işlemleri sırasında ultrason kriterlerinin değerlendirilmesi kolaylıkla uygulanabilir ve tekrar edilebilir. Power / Renkli Doppler modu ile LN' nin kanlanmasının değerlendirilmesi klinisyene doğru hedefte zaman tasarrufu açısından yardımcı olacaktır.

Anahtar Kelimeler:

Endobronşiyal ultrason, Doppler ultrasonografi, Mediastinal lenf nodu, metastaz

THE VALUE OF THE VASCULAR IMAGING PATTERN ASSESSED BY THE DOPPLER MODE DURING EBUS-TBNA IN DIFFERENTIATING BETWEEN BENIGN AND MALIGNANT LYMPH NODES

Introduction: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure with a high yield for lymph node diagnosis. The aim of this study was to assess the utility of doppler mode features of lymph nodes during EBUS-TBNA in differentiating benign and malignant lymph node (LN). Material and Methods: EBUS was performed in 151 patients with mediastinal lymphadenopathy irrespective of the underlying disease. The following criteria were evaluated to predict feature of LN: diameter, shape, distinct margin, echogenicity, central hilar structure and blood flow in a LN. Blood flow criteria were correlated with the histopathological results and the sensitivity, specificity, positivenegative predictive values (PPV and NPV) and diagnostic accuracy rate were calculated. Results: Two hundred twenty nine LN in 151 patients were analysed. 83.3% of LNs were found malignant, 16.7% of LNs were found benign. When we defined Grade 0 and I as benignand Grade II and III as malignant the sensitivity, specificity, NPV, PPV, and diagnostic accuracy rate were 83.2%, 66.7%, 69.7%, 82.3% and 74.0%, respectively. Discussion: The assessment of ultrasound criteria during routine EBUS examinations is feasible and reproducible. Vascular image patterns of LN using Power/Color Doppler mode will help the clinician in terms of time saving at right target.

Keywords:

Endobronchial ultrasound, Doppler ultrasound imaging, Mediastinal lymph node, metastasis,

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