İntratorasik lezyonlarda endobronşiyal ultrason rehberliğinde transbronşiyal iğne aspirasyonu tanısal değeri
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Tarih
2022
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Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Endobronşiyal ultrasonografi rehberliğinde transbronşiyal iğne aspirasyonu biyopsisinin mediastinal patolojilerdeki tanısal değerini ve tanısal verime etki eden faktörleri değerlendirmek amacıyla çalışmamızı planlanladık. Gerçek zamanlı konveks prob rehberliğinde alınan biyopsileri değerlendirdik. 2015-2020 yılları arasında endobronşiyal ultrasonografi yapılan 232 hasta retrospektif olarak değerlendirildi. Sonografik bulguları nedeniyle biyopsi yapılmayan 25 hasta çalışmaya dahil edilmedi. 207 hastaya endobronşiyal ultrasonografi rehberliğinde transbronşiyal iğne aspirasyonu biyopsi yapıldı. Biyopsi yapılan hastalar çalışmaya dahil edildi. 63 hastaya endobronşiyal ultrasonografi sonrasında tanısal amaçlı ek cerrahi işlem uygulandı. Çalışmamızda 207 hastanın 111 ’ine (%53,6) endobronşiyal ultrasonografi- transbronşiyal iğne aspirasyonu işlemi ile tanı konulduğu saptandı. Endobronşiyal ultrasonografi-transbronşiyal iğne aspirasyonu ile patolojik tanı konulmayan 96 hastanın 80’i gerçek negatif olarak tanımlanırken, 16 hastada invaziv yöntemlerle patolojik tanılar konulmuş ve bu hastalar yalancı negatif olarak tanımlanmıştır. Bu sonuçlara göre çalışmamızda, endobronşiyal ultrasonografi rehberliğinde transbronşiyal iğne aspirasyonu biyopsisinin sensivitesi %87,4, negatif prediktif değeri %83,3, tanısal verimi ise %92,2 olarak saptanmıştır. En sık konulan tanı akciğer kanseri (%37,6), akciğer kanserleri arasında da en sık patolojik alt tip olarak adenokanser saptadık. Patolojik tanılara göre tanısallık oranları incelendiğinde akciğer kanserinin tanısallık oranları diğer patolojik tanılara göre daha yüksek saptanmıştır (p<0,001). Benign tanılar içinde de sarkoidoz tanısal verimi diğer tanılara göre anlamlı yüksek saptandı (p=0,010). En çok örneklenen istasyonlar 7 ve 4R numaralı lenf nodlarıydı. Hastaların %61,7’sinden toplamda 143 adet 7 numaralı lenf nodundan örnek alındı. En çok örnek alınan lenf nodlarının aynı zamanda tanısallık açısından diğer lenf nodları ile kıyaslandığında daha yüksek olduğunu ve anlamlı fark gösterdiğini tespit ettik (7 ve 4R için sırasıyla p=0,023, p=0,026). Lenf nodlarından alınan örnek sayısı değerlendirildiğinde 3 ve üzeri örnek alınmasının tanısal veriminin anlamlı derecede daha fazla olduğu görüldü (p<0,001). Komplikasyonlar değerlendirildiğinde endobronşiyal ultrasonografi rehberliğinde transbronşiyal iğne aspirasyonu yapılan hastalarımızın hiç birinde hastane yatışı veya yoğun bakım ihtiyacı olmamıştır. Sonuç olarak endobronşiyal ultrasonografi rehberliğinde transbronşiyal iğne aspirasyonu, mediastinal lenfadenopatiler ve intratorasik patolojilerde tanısal verimi yüksek, komplikasyon oranı düşük güvenilir bir yöntemdir.
The aim of this study is to evaluate the diagnostic value of transbronchial needle aspiration under the guidance of endobronchial ultrasonography in mediastinal pathologies and the factors affecting the diagnostic yield. We evaluated biopsies taken under the guidance of real-time convex probe. 232 patients who underwent endobronchial ultrasonography between 2015 and 2020 were evaluated retrospectively. 25 patients who did not undergo biopsy due to ultrasound findings were not included in the study. Endobronchial ultrasonography guided transbronchial needle aspiration biopsy was performed in 207 patients. Patients who underwent biopsy were included in the study. Additional diagnostic surgical procedures were performed in 63 patients after endobronchial ultrasonography. In our study, it was found that 111 (53.6%) of 207 patients were diagnosed using the endobronchial ultrasonography-transbronchial needle aspiration procedure. While 80 of 96 patients without pathological diagnosis with endobronchial ultrasonography-transbronchial needle aspiration were defined as true negative, pathological diagnoses were made in 16 patients using invasive methods and these patients were defined as false negative. According to these results, the sensitivity 87.4%, negative predictive value 83.3%, and diagnostic yield 92.2%. The most common diagnosis was lung cancer (37.6%), and we found adenocarcinoma as the most common pathological subtype among lung cancers. When the pathological diagnoses were examined, the diagnostic rate of lung cancer was found to be higher than other pathological diagnoses (p<0.001). Among benign diagnoses, the diagnostic yield of sarcoidosis was found to be significantly higher than other diagnoses (p=0.010). The most sampled stations were lymph nodes 7 and 4R. A total of 143 lymph nodes 7 were sampled from 61.7% of the patients. We found that the most sampled lymph nodes were also higher in diagnostic terms compared to other lymph nodes and showed a significant difference (p=0,023 for 7, p=0,026 for 4R). When the number of samples taken from lymph nodes were evaluated, it was seen that the diagnostic yield of 3 or more samples was significantly higher (p<0.001). When the complications were evaluated, none of our patients who underwent endobronchial ultrasonography-transbronchial needle aspiration needed hospitalization or critical care. In conclusion, the endobronchial ultrasonography-transbronchial needle aspiration is a reliable method with high diagnostic yield and low complication rate in mediastinal lymphadenopathies and intrathoracic pathologies.
The aim of this study is to evaluate the diagnostic value of transbronchial needle aspiration under the guidance of endobronchial ultrasonography in mediastinal pathologies and the factors affecting the diagnostic yield. We evaluated biopsies taken under the guidance of real-time convex probe. 232 patients who underwent endobronchial ultrasonography between 2015 and 2020 were evaluated retrospectively. 25 patients who did not undergo biopsy due to ultrasound findings were not included in the study. Endobronchial ultrasonography guided transbronchial needle aspiration biopsy was performed in 207 patients. Patients who underwent biopsy were included in the study. Additional diagnostic surgical procedures were performed in 63 patients after endobronchial ultrasonography. In our study, it was found that 111 (53.6%) of 207 patients were diagnosed using the endobronchial ultrasonography-transbronchial needle aspiration procedure. While 80 of 96 patients without pathological diagnosis with endobronchial ultrasonography-transbronchial needle aspiration were defined as true negative, pathological diagnoses were made in 16 patients using invasive methods and these patients were defined as false negative. According to these results, the sensitivity 87.4%, negative predictive value 83.3%, and diagnostic yield 92.2%. The most common diagnosis was lung cancer (37.6%), and we found adenocarcinoma as the most common pathological subtype among lung cancers. When the pathological diagnoses were examined, the diagnostic rate of lung cancer was found to be higher than other pathological diagnoses (p<0.001). Among benign diagnoses, the diagnostic yield of sarcoidosis was found to be significantly higher than other diagnoses (p=0.010). The most sampled stations were lymph nodes 7 and 4R. A total of 143 lymph nodes 7 were sampled from 61.7% of the patients. We found that the most sampled lymph nodes were also higher in diagnostic terms compared to other lymph nodes and showed a significant difference (p=0,023 for 7, p=0,026 for 4R). When the number of samples taken from lymph nodes were evaluated, it was seen that the diagnostic yield of 3 or more samples was significantly higher (p<0.001). When the complications were evaluated, none of our patients who underwent endobronchial ultrasonography-transbronchial needle aspiration needed hospitalization or critical care. In conclusion, the endobronchial ultrasonography-transbronchial needle aspiration is a reliable method with high diagnostic yield and low complication rate in mediastinal lymphadenopathies and intrathoracic pathologies.
Açıklama
Anahtar Kelimeler
Endobronşiyal ultrasonografi, Transbronşiyal iğne aspirasyonu, Mediasten, Endobronchial ultrasound, Transbronchial needle aspiration biopsy, Mediastinum
