Recep DEMİRHAN, Banu SALEPÇİ, Dilek ECE, Ali FİDAN, Coşkun DOĞAN, Sevda CÖMERT ŞENER, Benan ÇAĞLAYAN

A comparision of endobronchial ultrasound-guided transbronchial needle aspiration and integrated positron emission tomography-computed tomography in the diagnosis of malignant mediastinal/hilar lymph nodes

Amaç: Bu çalışmanın amacı, entegre pozitron emisyon tomografisi- bilgisayarlı tomografi (PET-BT) ve endobronşiyal ultrasonografi rehberliğinde yapılan transbronşiyal iğne aspirasyonunun (EBUS-TBİA) malign mediastinal/hiler lenf nodlarının tanısındaki duyarlılığı, özgüllüğü ve tanı değerini saptamak ve birbirleri ile kıyaslamaktır. Çalışma planı: Ekim 2008 - Nisan 2011 tarihleri arasında bilinen primer malignitesi veya malignite şüphesi olup, bilgisayarlı toraks tomografisinde büyümüş ve PET-BTde hipermetabolik hiler/mediastinal lenfnodu saptanan ve sitolojik tanı için EBUS-TBİA yapılmış 131 olgunun (96 erkek, 35 kadın; ort. yaş 58.3±8.4 yıl; dağılım 42-75) dosyası retrospektif olarak incelendi. EBUS-TBİA ile kesin tanı konulamayan olgulara mediastinoskopi/video yardımlı torakoskopik cerrahi (VYTC) gibi daha invazif girişimler uygulandı. PET-BTde malignite için standart maksimum alım (SUDmax) sınır değeri ≥3.0 olarak belirlendi. Malign mediastinal/hiler lenf nodlarının tanısında PET-BT ve EBUS-TBİAnın duyarlılık, özgüllük, tanı değeri ve negatif ve pozitif öngördürücü değerleri hesaplandı. Sonuçlar birbirleri ile karşılaştırıldı. Bulgular: Toplam 131 hastada 191 lenf nodu istasyonundan aspirasyon yapıldı. Yüz kırk iki malign lenf nodundan 134üne EBUS-TBİA ile malignite tanısı konulurken, 127sinin PET-BTde SUD max değerinin ≥3.0 olduğu görüldü. EBUS-TBİA ve PET-BTnin malign mediastinal ve hiler lenf nodlarının tanısındaki duyarlılık, özgüllük, tanı değeri ve negatif ve pozitif öngördürücü değerleri sırasıyla %94.3, %100, %95.8, %85.9, %100 ve %89.4, %18.3, %71.2, %37.5, %76.0 idi. EBUS-TBİA ve PET-BTnin birlikte kullanımı ile duyarlılık %100e ulaştı. Sonuç: EBUS-TBİAnın duyarlılık, özgüllük, tanı doğruluğu ve negatif öngördürücü değeri ve pozitif öngördürücü değeri PET-BTden daha yüksektir. Klasik bilgilere göre PET-BTnin yanlış pozitiflik oranının yüksek olması nedeni ile mediastinal evrelemede histolojik doğrulamasının yapılması gerekmektedir. EBUS-TBİA, PET-BT pozitif mediastinal/hiler lenf nodlarının histolojik doğrulamasında etkin, güvenilir ve minimal invasiv bir yöntemdir

Malign mediastinal ve hiler lenf nodlarının tanısında endobronş iyal ultrasonografi rehberliğinde yapılan transbronşiyal iğne aspirasyonunun ve pozitron emisyon tomografisi-bilgisayarlı tomografinin karşılaştırılması

Background: In this study, we aimed to identify the sensitivity, specificity and diagnostic accuracy of integrated positron emission tomography- computed tomography (PET-CT) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of malignant mediastinal/hilar lymph nodes and to compare with each other. Methods: Records of 131 patients (96 males, 35 females; mean age 58.3±8.4 years; range 42 to 75 years) with known primary or suspected malignancy who had enlarged and hypermetabolic hilar/mediastinal lymph nodes detected by thoracic CT and at PET-CT and in whom EBUS-TBNA performed for cytologic confirmation of the malignancy between October 2008 and April 2011 were retrospectively analyzed. More invasive procedures including mediastinoscopy/video-assisted thoracoscopic surgery (VATS) were performed in patients who did not receive definite diagnosis using EBUS- TBNA. The maximum standardised uptake value (SUVmax) cut-off level of PET-CT was considered ≥3.0. The sensitivity, specificity, diagnostic accuracy, and negative and positive predictive values of PET-CT and EBUS-TBNA in diagnosis of malignant hilar/mediastinal lymph nodes were calculated. The results were compared with each other. Results: A total of 191 lymph node stations of 131 patients were aspirated from the LN stations. Of the 142 lymph nodes, 134 were diagnosed with malignancy using EBUS-TBNA, while SUV max value was ≥3.0 in 127 by PET-CT. The sensitivity, spesificity, diagnostic accuracy, and negative and positive predictive values of EBUS-TBNA and PET-CT were 94.3%, 100%, 95.8%, 85.9%, 100% and 89.4%, 18.3%, 71.2%, 37.5%, 76.0%, respectively. With combined use of EBUS-TBNA and PET-CT, the sensitivity increased to 100%. Conclusion: The sensitivity, specificity, diagnostic accuracy, and negative predictive value and positive predictive value of EBUS-TBNA is higher than PET-CT. Based on conventional data, histological confirmation of PET-CT is necessary in mediastinal staging, due to high level of false positivity of PET-CT. EBUS-TBNA is an effective, reliable and minimally invasive method for histologic confirmation of PET-CT-positive malignant mediastinal/hilar lymph nodes.

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