Araştırma Makalesi
Mediastinal ve hiler lenfadenopatilerde endobronşiyal ultrason eşliğinde kullanılan power Doppler modunun benign ve malign lenf nodu ayırımına katkısı
Öz
Amaç: Bu çalışma ile konveks prob endobronşiyal ultrasonografi (EBUS) eşliğinde tanısal amaçlı ince iğne aspirasyon yapılan olgularda, power Doppler modunun mediastinal ve hiler lenfadenopatilerde malign ve benign ayrımına katkısı araştırıldı.
Gereç ve Yöntemler: Mart 2018 ile Şubat 2019 tarihleri arasında EBUS yapılan olguların tıbbi dosyaları retrospektif olarak incelendi. Toplam 85 olguya ait 143 lenf nodunun örnekleme sonuçları çalışmaya dahil edildi. Kesin tanısı olan olguların demografik özellikleri, örneklenen lenf bezlerinin EBUS’daki radyolojik ve sonografik özellikleri kayıt edildi. Mediastinal lenf nodlarının EBUS ile değerlendirilmesi sonucunda power Doppler modunun malign lenf nodu belirlemedeki duyarlığı, özgüllüğü, negatif ve pozitif prediktif değeri hesaplandı.
Bulgular: Çalışmaya dahil edilen 85 hastanın 62’si (%73) erkek ve 23’ü (%27) kadın olup, yaş ortalaması 62±10,4 (dağılım: 37-80) yıl idi. Vasküler patern değerlendirmesi sonucunda malignite açısından negatif lenf nodu sayısı 87 (%60,8) iken, pozitif olarak değerlendirilen lenf nodu sayısı 56 (%39,2) olarak saptandı. Kesin tanıları ile vasküler patern analizi karşılaştırıldığında, EBUS eşliğinde kullanılan power Doppler modunun benign ve malign lenf nodu ayrımında katkısı istatistiksel olarak anlamlı bulundu (p<0,01).
Sonuç: Konveks prob EBUS, eş zamanlı görüntülemeye ve transbronşiyal ince iğne aspirasyon uygulamalarına olanak sağlamasının yanı sıra, lenf nodlarının sonografik özelliklerini tanımlayarak ilk örneklenecek lenf nodunu tespit edebilir. Bu da, işlem süresinin kısalmasını ve hastanın alacağı anestezi miktarının azalmasını sağlayabilir.
Anahtar Kelimeler
Mediastinal lenf nodu mediastinal evreleme Power doppler Ultrasonografi
Kaynakça
- 1. Fujiwara T, Yasufuku K, Nakajima T, Chiyo M, Yoshida S, Suziki S, et al. The utility of sonographic features during endobronchial ultrasound-guided transbronchial needle aspiration for lymph node staging in patients with lung cancer: a standard endobronchial ultrasound image classification system. Chest. 2010;138(3):641-7. PMID: 20382710
- 2. Nakajima T, Yasufuku K, Iyoda A, Yoshida S, Suziki M, Sekine Y, et al. The evaluation of lymph node metastasis by endobronchial ultrasound-guided transbronchial needle aspiration: crucial for selection of surgical candidates with metastatic lung tumors. J Thorac Cardiovasc Surg. 2007;134( 6 ):1485-90. PMID: 18023670
- 3. Vaidya PJ, Kate AH, Chhajed PN. Endobronchial ultrasound‐guided transbronchial needle aspiration: the standard of care for evaluation of mediastinal and hilar lymphadenopathy. J Cancer Res Ther. 2013; 9(4):549–51. PMID: 24518694
- 4. Steinfort DP, Conron M, Tsui A, Pasricha SR, Renwick WE, Antippa P, et al. Endobronchial ultrasound-guided transbronchial needle aspiration forthe evaluation of suspected lymphoma. J Thorac Oncol. 2010;5(6):804-9. PMID: 20521347
- 5. Alici IO, Yılmaz DN, Yılmaz A, Karakaya j, Özaydın E. The sonographic features of malignant mediastinal lymph nodes anda proposal for an olgarithmic approach for sampling during endobronchial ultrasound. Clin Respir J. 2016;10(5):606-13. PMID: 25619495
- 6. Taş E, Çuhalı D. Gürsel AO. The Comparision of the Diagnostic Values of Fine Needle Aspiration Biopsy and Color Doppler Ultrasonography in Neck Masses (Prospective Study). KBB ve BBC Dergisi. 2007;15(2):60-4.
- 7. Vaidya PJ, Kate AH, Yasufuku K, Chhajed PN. Endobronchial ultrasound-guided transbronchial needle aspiration in lung cancer diagnosis and staging. Expert Rev Respir Med. 2015;9(1):45-53. PMID: 25496515
- 8. Na DG, Lim HK, Byun HS, Kim HD, Ko YH, Baek JH. Differential diagnosis of cervical lymphadenopathy: usefulness of color Doppler sonography. AJR Am J Roentgenol. 1997;168(5):1311-6. PMID: 9129432
- 9. Ayata Z, Apaydın M, Varer M, Sarsılmaz A, Çallı Ç, Rezanko T. Differential diagnosis in cervical lymphadenopathies: efficacy of B-mode, color and power Doppler ultrasonography. Kulak Burun Bogaz Ihtis Derg 2009;19(4):173-78.
- 10. Detterbeck F, Puchalski J, Rubinowitz A, Cheng D. Classification of the thoroughness of mediastinal staging of lung cancer. Chest. 2010;137(2):436-42.
- 11. Vilmann P, Clementsen PF, Colella S, Siemsen M, De Leyn P, Dumonceau JM et al. Combined endobronchial and oesophageal endosonography for the diagnosis and staging of lung cancer. European Society of Gastrointestinal Endoscopy (ESGE) Guideline, in cooperation with the European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS). Eur Respir J. 2015;46(1):40-60. PMID: 26034128
- 12. Goldstraw P, Chansky K, Crowley J, Rami-Porta R, Asamura H, Eberhardt WE et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol. 2016;11(1):39–51. PMID: 26762738
- 13. Nakajima T, Anayama T, Shingyoji M, Kimura H, Yoshino I, Yasufuku K. Vascular image patterns of lymph nodes for the prediction of metastatic disease during EBUS-TBNA for mediastinal staging of lung cancer. J Thorac Oncol. 2012;7(6):1009-14. PMID: 22525556
- 14. Zhou J, Zhu SY, Liu RC, Luo F, Shu DX. Vascularity index of laryngeal cancer derived from 3-D ultrasound: a predicting factor for the in vivo assessment of cervical lymph node status. Ultrasound Med Biol. 2009;35(10):1596–600. PMID: 19632759
- 15. Voit C, Van Akkooi AC, Schäfer-Hesterberg G, Schoengen A, Kowalczyk K, Roewert JC, et al. Ultrasound morphology criteria predict metastatic disease of the sentinel nodes in patients with melanoma. J Clin Oncol. 2010;28 (5):847–52. PMID: 20065175
- 16. Demirci NY, Öztürk C. The value of the vascular imagıng pattern assessed by the doppler mode during EBUS-TBNA nn differentiating between benign and malignant lymph nodes. İzmir Göğüs Hastanesi Dergisi, 2017;31(2):87-92.
The contribution of power Doppler mode of endobronchial ultrasound (EBUS) used in mediastinal and hilar lymphadenopathies in the differentiation of benign and malignant lymph nodes
Öz
Aim: The aim of this study was to investigate the contribution of power Doppler mode used in the differentiation of malignant and benign lymph nodes in patients with mediastinal and hilar lymphadenopathies undergoing diagnostic fine needle aspiration under the guidance of convex probe endoscopic ultrasound (EBUS).
Material and Methods: Medical files of patients who underwent EBUS between March 2018 and February 2019 were retrospectively analyzed. A total of 143 lymph nodes of 85 patients were included in the study. The demographic characteristics of the patients with a definite diagnosis and EBUS radiological and sonographic characteristics of the sampled lymph nodes were recorded. As a result of the evaluation of mediastinal lymph nodes with EBUS, the sensitivity, specificity, negative and positive predictive values were calculated for power Doppler mode in the detection of malignant lymph nodes.
Results: Of a total of 85 patients, 62 (73%) were males and 23 (27%) were females with a mean age of 62±10.4 (range, 37 to 80) years. In the vascular pattern evaluation, 87 (60.8%) lymph nodes were negative and 56 (39.2%) were positive for malignancy. Comparing final diagnoses and vascular pattern analysis results revealed a statistically significant difference between benign and malignant lymph nodes in favor of power Doppler mode under the guidance of EBUS (p <0.01).
Conclusion: Convex probe EBUS can identify the first lymph node to be sampled based on sonographic characteristics of lymph nodes and allow simultaneous imaging and transbronchial fine needle aspiration procedures. Therefore, it may shorten the procedural time and reduce the amount of anesthesia to be used.
Anahtar Kelimeler
Mediastinal lymph node mediastinal staging Power doppler Ultrasonography
Kaynakça
- 1. Fujiwara T, Yasufuku K, Nakajima T, Chiyo M, Yoshida S, Suziki S, et al. The utility of sonographic features during endobronchial ultrasound-guided transbronchial needle aspiration for lymph node staging in patients with lung cancer: a standard endobronchial ultrasound image classification system. Chest. 2010;138(3):641-7. PMID: 20382710
- 2. Nakajima T, Yasufuku K, Iyoda A, Yoshida S, Suziki M, Sekine Y, et al. The evaluation of lymph node metastasis by endobronchial ultrasound-guided transbronchial needle aspiration: crucial for selection of surgical candidates with metastatic lung tumors. J Thorac Cardiovasc Surg. 2007;134( 6 ):1485-90. PMID: 18023670
- 3. Vaidya PJ, Kate AH, Chhajed PN. Endobronchial ultrasound‐guided transbronchial needle aspiration: the standard of care for evaluation of mediastinal and hilar lymphadenopathy. J Cancer Res Ther. 2013; 9(4):549–51. PMID: 24518694
- 4. Steinfort DP, Conron M, Tsui A, Pasricha SR, Renwick WE, Antippa P, et al. Endobronchial ultrasound-guided transbronchial needle aspiration forthe evaluation of suspected lymphoma. J Thorac Oncol. 2010;5(6):804-9. PMID: 20521347
- 5. Alici IO, Yılmaz DN, Yılmaz A, Karakaya j, Özaydın E. The sonographic features of malignant mediastinal lymph nodes anda proposal for an olgarithmic approach for sampling during endobronchial ultrasound. Clin Respir J. 2016;10(5):606-13. PMID: 25619495
- 6. Taş E, Çuhalı D. Gürsel AO. The Comparision of the Diagnostic Values of Fine Needle Aspiration Biopsy and Color Doppler Ultrasonography in Neck Masses (Prospective Study). KBB ve BBC Dergisi. 2007;15(2):60-4.
- 7. Vaidya PJ, Kate AH, Yasufuku K, Chhajed PN. Endobronchial ultrasound-guided transbronchial needle aspiration in lung cancer diagnosis and staging. Expert Rev Respir Med. 2015;9(1):45-53. PMID: 25496515
- 8. Na DG, Lim HK, Byun HS, Kim HD, Ko YH, Baek JH. Differential diagnosis of cervical lymphadenopathy: usefulness of color Doppler sonography. AJR Am J Roentgenol. 1997;168(5):1311-6. PMID: 9129432
- 9. Ayata Z, Apaydın M, Varer M, Sarsılmaz A, Çallı Ç, Rezanko T. Differential diagnosis in cervical lymphadenopathies: efficacy of B-mode, color and power Doppler ultrasonography. Kulak Burun Bogaz Ihtis Derg 2009;19(4):173-78.
- 10. Detterbeck F, Puchalski J, Rubinowitz A, Cheng D. Classification of the thoroughness of mediastinal staging of lung cancer. Chest. 2010;137(2):436-42.
- 11. Vilmann P, Clementsen PF, Colella S, Siemsen M, De Leyn P, Dumonceau JM et al. Combined endobronchial and oesophageal endosonography for the diagnosis and staging of lung cancer. European Society of Gastrointestinal Endoscopy (ESGE) Guideline, in cooperation with the European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS). Eur Respir J. 2015;46(1):40-60. PMID: 26034128
- 12. Goldstraw P, Chansky K, Crowley J, Rami-Porta R, Asamura H, Eberhardt WE et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol. 2016;11(1):39–51. PMID: 26762738
- 13. Nakajima T, Anayama T, Shingyoji M, Kimura H, Yoshino I, Yasufuku K. Vascular image patterns of lymph nodes for the prediction of metastatic disease during EBUS-TBNA for mediastinal staging of lung cancer. J Thorac Oncol. 2012;7(6):1009-14. PMID: 22525556
- 14. Zhou J, Zhu SY, Liu RC, Luo F, Shu DX. Vascularity index of laryngeal cancer derived from 3-D ultrasound: a predicting factor for the in vivo assessment of cervical lymph node status. Ultrasound Med Biol. 2009;35(10):1596–600. PMID: 19632759
- 15. Voit C, Van Akkooi AC, Schäfer-Hesterberg G, Schoengen A, Kowalczyk K, Roewert JC, et al. Ultrasound morphology criteria predict metastatic disease of the sentinel nodes in patients with melanoma. J Clin Oncol. 2010;28 (5):847–52. PMID: 20065175
- 16. Demirci NY, Öztürk C. The value of the vascular imagıng pattern assessed by the doppler mode during EBUS-TBNA nn differentiating between benign and malignant lymph nodes. İzmir Göğüs Hastanesi Dergisi, 2017;31(2):87-92.
Toplam 16 adet kaynakça vardır.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | İç Hastalıkları |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 2 Mart 2020 |
| Gönderilme Tarihi | 13 Ekim 2019 |
| Kabul Tarihi | 3 Ocak 2020 |
| Yayımlandığı Sayı | Yıl 2020 Cilt: 4 Sayı: 1 |
Cited By
Imaging Microbubbles With Contrast-Enhanced Endobronchial Ultrasound
Ultrasound in Medicine & Biology
https://doi.org/10.1016/j.ultrasmedbio.2023.08.020
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