Mehmet BAYRAM, Güngör ÇAMSARI, Aygün GÜR, Gülcihan ÖZKAN, Mehmet TUTAR, Dilek BAKAN

The impact of ultrasonography-guided fine needle aspiration of no palpable supraclavicular lymph nodes on diagnosis and staging in advanced lung cancer

Akciğer kanserinin doğru tanı ve evrelemesi hastalığın prognozunu etkilemede ve uygun küratif veya palyatif tedavinin seçiminde esas rolü oynamaktadır. Bu amaçla çeşitli invaziv ve noninvaziv teknikler uygulanmaktadır. Bu çalışmada, bilgisayarlı tomografide mediastinal lenf nodu olan akciğer kanserli hastalarda palpe edilemeyen supraklaviküler lenf nodlarının sıklığını ve ultrasonografi eşliğinde iğne aspirasyonunun tanı ve evrelemeye etkisini araştırmak amaçlanmıştır. Bu çalışmada, palpe edilen supraklaviküler lenf nodu bulunmayan ve bilgisayarlı tomografide en az 2 istasyonda genişlemiş lenf nodu bulunan akciğer kanserli hastalara supraklaviküler ultrasonografi uygulandı. Supraklaviküler lenf nodu bulunması halinde ultrasonografi eşliğinde ince iğne aspirasyonu yapıldı. Çalışmaya alınan 40 hastanın 16 (%40)’sında ultrasonografi eşliğinde ince iğne aspirasyonu ile supraklaviküler lenf nodu metastazı sitolojik olarak gösterildi. Bilgisayarlı tomografide üst paratrakeal lenfadenomegali varlığı supraklaviküler metastazlı grupta anlamlı olarak yüksek bulundu. Uzak metastaz varlığı, hücre tipi ve evre yönünden supraklaviküler metastazlı grup ile supraklaviküler metastaz bulunmayan grup arasında istatistiksel fark bulunmadı. Üç hastada ultrasonografi eşliğinde ince iğne aspirasyonu tek tanı yöntemi idi. Patolojik boyutta mediastinal lenf nodu olan akciğer kanserli hastaların üçte birinden daha fazlasında supraklaviküler lenf nodu metastazı tespit edildi. Ultrasonografi eşliğinde ince iğne aspirasyonu, mediastinal lenf nodu olan akciğer kanserli hastalarda basit, güvenli, standart tanı yöntemlerine göre daha az invaziv prosedür olarak görülmüştür.

İleri evre akciğer kanserinde palpe edilemeyen supraklaviküler lenf nodlarının ultrasonografi eşliğinde iğne aspirasyonunun tanı ve evrelemeye etkisi

Diagnosis and accurate staging of lung cancer is essential for selection of appropriate curative or palliative therapy and affects patient prognosis. Both invasive and non invasive procedures are used for this purpose. We aimed to assess the frequency of no palpable supraclavicular lymph node metastases in lung cancer patients with enlarged mediastinal lymph nodes, and their impact on diagnosis and staging using ultrasound in this study. Lung cancer patients with no palpable supraclavicular lymph nodes and at least 2 enlarged mediastinal lymph nodes on computerized tomography underwent supraclavicular ultrasound examination. Ultrasound-guided fine needle aspiration (US-guided FNA) was performed when enlarged lymph nodes were present. Supraclavicular lymph node metastasis was confirmed cytologically via US-guided FNA in 16 (40%) of 40 patients. Upper paratracheal lymphadenomegaly was significantly higher in patients with supraclavicular metastases than in those without. No statistical significant differences were observed in the stage, cell types, and metastases of patients with or without supraclavicular metastases. In 3 patients US-guided FNA was used for diagnosis. More than one-third of lung cancer patients with enlarged mediastinal lymph nodes had supraclavicular lymph node metastases in present study. US-guided FNA is an easier, safer, and less invasive procedure than standard techniques used to diagnose lung cancer patients with enlarged mediastinal lymph nodes.

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