Ahmet Sami BAYRAM, Ömer YERCİ, Cengiz GEBİTEKİN, Hüseyin DÜLGER, Şaduman Adım BALABAN, Mert AYGÜN, Mehmet Muharrem EROL

Combination of tissue biopsy and fine needle aspiration cytology reduces false negativity of mediastinoscopy for non-small cell lung cancer

Amaç: Bu çalışmada, doku biyopsileri ile ince iğne aspirasyonu (İİA) karşılaştırıldı ve bu kombinasyonun mediastinoskopideki yanlış negatiflik oranını azaltıp azaltmayacağı araştırıldı. Çalışma planı: Ocak 2004 ve Ekim 2005 tarihleri arasında servikal video mediastinoskopi uygulanan küçük hücreli dışı akciğer kanserli (KHDAK) 92 hasta bu prospektif çalışmaya dahil edildi. Aynı lenf nodundan hem doku biyopsisi hem de İİA yapıldı ve patolojik incelemeye gönderildi. Doku örnekleri ve İİA’lar Hematoksilen-Eosin ile boyandı. Tüm örnekler iki histopatolog tarafından incelendi. Bulgular: Doku biyopsisi örnekleri ile 54 hastada metastaza rastlanmaz iken, 38 hastada metastaz saptandı. İİA’da ise 48 hastada metastaza rastlanmaz iken, 44 hastada metastaz saptandı. Farklılık istatistiksel olarak anlamlı değil idi (p>0.05). Yanlış negatiflik oranları, İİA ve doku biyopsisi sonrası sırasıyla %5.4 ve %12 idi. Negatif İİA ve doku biyopsili 43 hastaya takiben torakotomi ile akciğer rezeksiyonu ve total sistematik lenf nodu diseksiyonu yapıldı. Mediastinal lenf nodu diseksiyonu sonrası iki olguda (%4.6) lenf nodu metastazı saptandı. Buna bağlı olarak iki yöntem kombine edildiğinde mediastinoskopinin yanlış negatifliği %4.6’ya indi. Tekniğe bağlı herhangi bir komplikasyon ile karşılaşılmadı. Sonuç: Mediastinal lenf nodlarının İİA’sı doku biyopsisi ile karşılaştırıldığında güvenli ve etkili bir yöntem olup, doku biyopsisi ile kombine edildiğinde mediastinoskopinin yanlış negatiflik oranını azaltabilir.

Küçük hücre dışı akciğer kanserinde doku biyopsisi ile ince iğne aspirasyon sitolojisinin kombinasyonu mediastinoskopinin yanlış negatiflik oranını azaltır

Background: This study aims to compare tissue biopsy with fine needle aspiration (FNA) and investigate whether the combination reduces false negativity of mediastinoscopy. Methods: Between January 2004 and October 2005, 92 patients with non-small cell lung cancer (NSCLC) who underwent cervical video mediastinoscopy were included in this prospective study. Tissue biopsy samples and FNAs were obtained from the same lymph node and were sent for a pathologic examination. Tissue samples and FNAs were stained with Hematoxilene-Eosine. All specimens were evaluated by two histopathologists. Results: Using tissue biopsy samples, no metastasis was found in 54 patients, while 38 patients were metastatic. Forty-eight patients had no metastasis, while 44 patients were metastatic using FNA samples. The difference was statistically non-significant (p>0.05). The false negativity of the FNA and tissue biopsy were 5.4% and 12%, respectively. Subsequently, 43 patients with negative FNA and tissue biopsy underwent lung resection with thoracotomy and sistematic lymph node dissection. Following lymph node dissection, lymph node metastases were found in two cases (4.6%). As a result, false negativity of mediastinoscopy was reduced to 4.6% when two techniques were combined. There was no complication related to the technique. Conclusion: The FNA of mediastinal lymph nodes is a safe and effective method, compared to tissue biopsy and reduces the false negativity of mediastinoscopy when combined with tissue biopsy.

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