Mehmet Ufuk YILMAZ, Serhat EROL, Hakan ARIK, Sülün ERMETE, Nur YÜCEL, Yasemin ÖZDOĞAN, Burcu SAMANYOLU YALÇIN

ENDOBRONŞİAL ULTRASON-TRANSBRONŞİAL İĞNE ASPİRASYONU; ÖĞRENME DÖNEMİ SONUÇLARI

Endobronşial ultrason-trans bronşial iğne aspirasyonu (EBUS-TBİA), başta akciğer kanseri olmak üzere mediastinal lenf nodlarını tutan hastalıkların tanısında kullanılan bir yöntemdir. Bu çalışmada amaç öğrenme döneminde elde edilen sonuçların değerlndirilmesidir. Ekim-2011 ve ocak-2014 tarihleri arasında 82 olguya ait EBUS-TBİA sonuçları retrospektif olarak incelendi. Elli iki (%63,5) olguya tanısal, 30 (%36.5) olguya akciğer kanseri evreleme amaçlı EBUS-TBİA uygulandı. En sık örneklenen istasyonlar subkarinal (7) lenf nodu (%61) ve sağ alt paratrakeal (4R) lenf nodu (%57.3) idi. Tanısal amaçlı EBUS-TBİA yapılan olgulardan, 37'sinde (%71) tanı konulurken, 9 (%17) olguya ek tetkikler ile tanı konuldu. Altı (%12) olgu takipten çıktığı için kesin sonuca ulaşılamadı. EBUS-TBİA ile tanı konulan 37 olguda tanısal dağılım: 19 olgu akciğer kanseri, 5 olgu toraks dışı kanserin metastazı, 5 olgu sarkoidoz, 2 olgu tüberküloz, 6 olgu benign lenf bezi büyümesi şeklinde idi. Akciğer kanseri evrelemesi için EBUS-TBİA yapılan 30 olgunun, 15'inde (%50) mediastinal lenf nodlarında metastaz saptandı. Metastaz saptanmayan 15 olgunun 10'una cerrahi (mediastinoskopi ve/veya torakotomi) uygulandı. Bu olguların 7'sinde (%70) lenf nodu metastazı saptanmazken, 3'ünde (%30) lenf nodu metastazı vardı. EBUS ile mediastinal lenf nodlarında metastaz saptanmayan 5 olguda, çeşitli nedenlerle (takipten çıkma, cerrahi red) alınan sonuç doğrulanamadı. Bu sonuçlara göre, duyarlılık %83, özgüllük %100, pozitif kestirim değeri %100, negatif kestirim değeri %70 olarak değerlendirildi. Hiçbir olguda komplikasyon gelişmedi. Sonuç olarak; EBUS-TBİA, öğrenme döneminde dahi güvenli tanısal yöntemdir. Başlangıç döneminde, akciğer kanserinin mediastinal evrelemesi için yapılan olgularda yalancı negatif sonuçlar olabilir. Metastaz saptanmayan olgularda sonuçların mediastinoskopi ile doğrulanması gerekir.

ENDOBRONCHIAL ULTRASOUND-TRANSBRONCHIAL NEEDLE ASPIRATION: LEARNING CURVE

Endobronchial ultrasound-trans bronchial needle aspiration (EBUS-TBNA), is a procedure for diagnoses of diseases affected the mediastinal lymph nodes. Aim of this study is to evaluate the diagnostic results of EBUS-TBNA in the learning period. We retrospectively analyzed the results of 82 EBUS-TBNA, performed from October 2011 to January 2014. Fifty-two (63.5%) procedures were performed for diagnosis of mediastinal lymph enlargement. And thirty (36.5%) procedures were performed for lung cancer staging. Subcarinal (61%) and right lower paratracheal (57,3%) stations were most sampled lymph nodes. Thirty-seven patients diagnosed with EBUS-TBNA, for 9 patients additional diagnostic procedures needed and 6 patients were lost to follow up. EBUS-TBNA diagnosed mediastinal metastases in 15 of the 30 (50 %) cases. Ten of remaining 15 patients underwent further surgical investigation. EBUS-TBNA was false negative for 3 patients. For remaining 7 patients, EBUS-TBNA and surgical diagnosis were same. According to these results sensitivity, specificity, positive predictive value and negative predictive values were 83%, 100%, 100%, 100% respectively. No complication occured during the procedures. As a result; EBUSTBNA is a safe diagnostic procedures even in the learning period. During learning period false negative results can be seen when performed for mediastinal staging of lung cancer. These results should be comfirmed with mediastinoscopy.

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