Background: Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is well known as an important technique for diagnosis and staging of lung cancer. But a standard protocol to deal with patients who have a negative pathology result still needs to be defined. Herein, we describe the subsequent procedures of these patients in a single center.
Methods: A total of 1,412 patients with clinical suspected lung cancer and mediastinal metastasis who underwent EBUS-TBNA were collected between September 2010 and December 2016. Among them, 51 patients with nonspecific pathology result were included and retrospectively analyzed.
Results: The 51 patients were stratified into five groups by clinical characterize and follow-up procedures: (1) Diagnosed by other bronchoscopy procedures group (9 cases). Abnormalities of tracheobronchial tree were found during visual examination in the majority of patients (8 cases). Biopsy, endobronchial brushing, bronchoalveolar lavage, and transbronchial lung biopsy (TBLB) were used to get a specific diagnosis. (2) EBUS-TBNA re-biopsy group (11 cases). Patients in this group had normal mucosal appearance and airway lumen. Re-biopsy were performed on patients in this group. (3) Surgery group (6 cases). Patients underwent surgery after negative result of EBUS-TBNA. Five of them were confirmed with non-nodal metastasis after surgery. (4) Underwent other pathology diagnosis group (15 cases). patients in this group had other metastasis sites besides midiastinal lymph node. Computed tomography (CT)-guided fine-needle aspiration and lymph node biopsy were performed. (5) Follow-up group (10 cases). None invasive procedure was used in this group. The median follow up time was 38 months. One patient was diagnosed lymphoma during the follow up.
Conclusions: Diagnostic procedures should be chosen based on the clinical character in EBUS-TBNA negative patients with suspected lung cancer. Long time follow-up is very important in patients whose diagnosis is apparently unknown.
【中文题目：临床疑诊肺癌纵隔淋巴结转移EBUS-TBNA阴性患者的处理】 【中文摘要：背景与目的 超声气管镜针吸活检（endobronchial ultrasound guided tranbronchial needle aspiration, EBUS-TBNA）是肺癌诊断和分期的重要手段，但经活检阴性结果的患者后续处理尚无标准流程。本文通过分析来自单中心的临床疑诊肺癌纵隔淋巴结转移但EBUS-TBNA病理结果阴性患者，以探讨此类患者处理方式。方法 对北京协和医院2010年9月-2016年12月进行EBUS-TBNA的1,412例患者资料进行分析，选取临床疑诊肺癌纵隔淋巴结转移但EBUS-TBNA病理诊断阴性的患者51例进行回顾性分析。结果 入选51例患者按临床情况和后续处理方式分为以下5组：①经同一次气管镜下其他检查组（9例）：该组患者大多（8例）存在镜下异常表现，通过活检、毛刷、灌洗或经支气管镜肺活检（transbronchial lung biopsy, TBLB）取得明确诊断；②再次EBUS-TBNA组（11例）：该组患者气管粘膜及管腔大致正常，再次行EBUS-TBNA取得诊断；③手术治疗组（6例）：该组患者因EBUS结果除外纵隔淋巴结转移，接受手术治疗。其中5例术后确诊无淋巴结转移癌；④进行其他病理检查组（15例）：该组患者有其他部位转移，针对可能的转移灶进行计算机断层扫描（computed tomography, CT）引导下穿刺、淋巴结活检等确诊。⑤随访组（10例）：该组患者未进行其他有创检查，中位随访时间38个月，其中1例随访中诊断为淋巴瘤。结论 对于经EBUS-TBNA未能确定诊断而临床怀疑肺癌的患者，应该根据患者的具体情况，综合多种方式进行诊断。对于暂时无法确诊的患者，仍需要长期随访。 】 【中文关键词：超声内镜引导下的经支气管针吸活检；病理阴性；肺肿瘤】.
Keywords: Endobronchial ultrasound guided transbronchial needle aspiration; Lung neoplasms; Non-specific pathology.