Vergleich von endobronchialem Ultraschall (EBUS) und Mediastinoskopie (MSK) beim Staging des Lungenkarzinoms

Zusammenfassung

Ein mediastinaler Lymphknotenbefall ist von entscheidender Bedeutung für die Prognose und Therapie des nicht metastasierten Lungenkarzinoms. Der Stellenwert von endobronchialem Ultraschall mit transbronchialer Nadelaspiration (EBUS) und Mediastinoskopie (MSK) wird zwischen Pneumologen und Thoraxchirurgen oft kontrovers diskutiert. In dieser retrospektiven Studie wurde die diagnostische Genauigkeit des EBUS und der Mediastinoskopie bei Patienten mit einem gesicherten Lungenkarzinom untersucht. Zwischen Januar 2009 und Juli 2011 erfolgten bei 544 Lungenkrebspatienten 111 EBUS-Untersuchungen (z. T. in Kombination mit transoesophagealem Ultraschall mit Feinnadelaspiration (EUS) ) und 88 Mediastinoskopien. Die diagnostische Genauigkeit des EBUS (94 %) war der Mediastinoskopie (86 %) signifikant überlegen (p < 0,05). Der negative prädiktive Wert beim EBUS und MSK betrugen jeweils 83 %, die Sensitivität 94 % bzw. 58 %, die Prävalenz eines N2 /3-Stadiums 84 % bzw. 32 % und die Komplikationsrate 0 % bzw. 3,4 %. Aufgrund der zumindest vergleichbaren diagnostischen Genauigkeit sollte die EBUS-TBNA (nach Möglichkeit in Kombination mit EUS) das erste Verfahren zur histologischen Beurteilung des Mediastinums bei Lungenkrebspatienten sein.

Abstract

Diagnostic findings of mediastinal metastasis are an important factor for the prognosis of and therapy for lung cancer. In this retrospective study we examined the role of endobronchial ultrasound with transbronchial needle aspiration (EBUS) and mediastinoscopy (MS) in patients with confirmed lung cancer. Between 01 /2009 and 07 /2011 we performed 111 EBUS procedures [partly in combination with transoesophageal endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA)] and 88 mediastinoscopies. The diagnostic accuracy of EBUS (94 %) was superior to that of MS (86 %) (p < 0.05). The negative predictive value of EBUS and MS was 83 % for both, the sensitivity was 94 % vs. 58 %, the prevalence of N2 /N3 was 84 % vs. 32 % and the rate of complications was 0 % vs. 3 %. Due to the at least similar accuracy the EBUS should be the first diagnostic procedure for histological staging of the mediastinum in patients with lung cancer.

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