Kemal BAKIR, Şermin BÖREKÇİ, Nevin UYSAL, Erhan EKİNCİ, Sabri ZİNCİRKESER, Osman ELBEK, Nazan BAYRAM, Öner DİKENSOY, Maruf ŞANLI

Combined transbronchial needle aspiration and PET/CT for mediastinal staging of lung cancer

Bu çalışmada pozitron emisyon tomografi/bilgisayarlı tomografi (PET/BT) incelemesi rehber alınarak uygulanan transbronşiyal iğne aspirasyonu (TBİA) işleminin akciğer kanseri evrelemesindeki yerini saptamayı amaçladık. Mart 2006-Mart 2008 tarihleri arasında prospektif olarak, Gaziantep Üniversitesi Tıp Fakültesi Göğüs Hastalıkları Kliniğine başvuran, akciğer kanseri ön tanısı düşünülen, toraks BT’de 1 cm’den büyük lenfadenopati saptanan ve PET/BT tetkikinde SUVmax ≥ 2.5 olan 25 hasta çalışmaya dahil edildi. Toplam 43 lenf nodu istasyonundan TBİA örneklemesi yapıldı. Mediasten değerlendirmesinde mediastinoskopi sonucu altın standart olarak kabul edildi. TBİA yönteminin mediastinal evrelemedeki duyarlılık, özgüllük, pozitif prediktif, negatif prediktif ve doğruluk değerleri sırasıyla; %67, %100, %100, %76 ve %84 olarak bulundu. Yeterli TBİA örneklemesi yapılan 19 olgunun; 13 (%69)’ünde başlangıç klinik evresi TBİA sonrası gerilemiş, mediastinoskopi sonrası 17 (%89)’sinin evrelemesinin doğru olarak yapıldığı saptanmıştır. Yirmi beş olgunun 6 (%24)’sında TBİA ile mediastinoskopi ihtiyacı ortadan kalkmıştır. Pozitif TBİA sonucunu öngörebilecek klinik faktörlerden sadece PET SUVmax değerinin TBİA pozitifliğini etkilediği saptandı [OR= 1.27 (1.004-1.610), p= 0.046]. PET SUVmax ≥ 5’in TBİA pozitifliğini yaklaşık 11 kat artırdığı gösterilmiştir [OR= 10.68 (1.91-59.62), p< 0.01]. Sonuç olarak; akciğer kanseri olgularının doğru olarak evrelendirilmesinde mediastinoskopiye kıyasla daha az invaziv ve komplikasyonu daha az bir işlem olan TBİA’nın kullanılabileceği, PET/BT tetkiki ile birlikte uygulanmasının TBİA’nın duyarlılığını artırdığı, özellikle SUVmax ≥ 5 olan lenf nodlarında TBİA pozitifliğinin anlamlı oranda yükseldiği ve TBİA’nın mediastinoskopi ihtiyacını azalttığı sonucuna varılmıştır.

Akciğer kanserinin evrelemesinde PET/BT ile kombine edilen transbronşiyal iğne aspirasyon biyopsisinin yeri

In this study, we aimed to evaluate the performance of transbronchial needle aspiration (TBNA) combined with positron emission tomography/computed tomography (PET/CT) for the staging of lung cancer. Twenty-five patients having lymphadenopathies greater than 1 cm on thorax CT and maximum standardized uptake value (SUVmax) ≥ 2.5 on PET/CT were included in this prospective study performed between March 2006 and March 2008. Forty-three lymphnode stations were sampled by using TBNA. Surgical histology, as confirmed by mediastinoscopy, was accepted as the “gold standard”. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of combined TBNA and PET/CT for correct lymph node staging were 67%, 100%, 100%, 76% and 84%; respectively. The initial clinical staging was downstaged after TBNA in 13/19 (69%) patients with adequate TBNA samples, whereas staging was correct in 17/19 (89%) patients assessed by combined TBNA and PET/CT. Staging was completed by TBNA, without mediastinoscopy, in 6/25 (24%) patients. Among the clinical factors that were assessed, only the PET SUVmax was associated with positive TBNA results [odds ratio (OR) 1.27, 95% CI 1.004-1.61, p= 0.046]. A PET SUVmax ≥ 5 was eleven times more likely in patients with positive TBNA results [OR 10.68, 95% CI 1.91-59.62, p< 0.01]. In conclusion, the combination of TBNA with PET/CT increased the sensitivity of TBNA. Combined TBNA and PET/CT may also allow adequate mediastinal staging of lung cancer in most patients with enlarged lymph nodes, and reduce the need for mediastinoscopy. The SUVmax cut off point for a positive TBNA result was ≥ 5.

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