Background: The treatment of lung cancer depends on histological and/or cytological evaluation of the mediastinal lymph nodes. Endobronchial ultrasound/transbronchial needle aspiration-biopsy (EBUS/TBNA-TBNB) is the only minimally invasive technique for a diagnostic exploration of the mediastinum. The aim of this study is to analyze the reliability of EBUS in the preoperative staging of non-small cell lung cancer (NSCLC). Methods: A prospective study was conducted from December 2019 to December 2022 on 217 NSCLC patients, who underwent preoperative mediastinal staging using EBUS/TBNA-TBNB according to the ACCP and ESTS guidelines. The following variables were analyzed in order to define the performance of the endoscopic technique—comparing the final staging of lung cancer after pulmonary resection with the operative histological findings: clinical characteristics, lymph nodes examined, number of samples, and likelihood ratio for positive and negative outcomes. Results: No morbidity or mortality was noted. All patients were discharged from hospital on day one. In 201 patients (92.6%), the preoperative staging using EBUS and the definitive staging deriving from the evaluation of the operative specimen after lung resection were the same; the same number of patients were detected in downstaging and upstaging (8 and 8, 7.4%). The sensitivity, specificity, positive and negative predictive value, and diagnostic accuracy were 90%, 90%, 82%, 94%, and 90%, respectively. The likelihood ratio for positive and negative results was 9 and 0.9, respectively, confirming cancer when present and excluding it when absent. Conclusions: EBUS is the only low-invasive and easy procedure for mediastinal staging. The possibility to check the method in each of its phases—through direct visualization of the vessels regardless of their location in relation to the lymph nodes—makes it safe both for the endoscopist and for the patient. Certainly, the cytologist/histologist and/or operator must have adequate expertise in order not to negatively affect the outcome of the method, although three procedures appear to reduce the impact of the individual professional involved on performance.
背景：肺癌的治疗取决于对纵隔淋巴结的组织学和/或细胞学评估。支气管内超声/经支气管针吸活检（EBUS/TBNA-TBNB）是唯一可用于纵隔诊断性探查的微创技术。本研究旨在分析EBUS在非小细胞肺癌（NSCLC）术前分期中的可靠性。方法：自2019年12月至2022年12月，对217例NSCLC患者开展前瞻性研究，所有患者均根据ACCP和ESTS指南，采用EBUS/TBNA-TBNB进行术前纵隔分期。为明确该内镜技术的效能——通过将肺切除术后肺癌的最终分期与手术组织学结果进行比较——分析了以下变量：临床特征、受检淋巴结、样本数量以及阳性和阴性结果的似然比。结果：研究中未出现并发症或死亡病例。所有患者均于术后第一天出院。201例患者（92.6%）的EBUS术前分期与肺切除术后手术标本评估得出的最终分期一致；降期与升期患者数量相同（各8例，占7.4%）。该技术的敏感性、特异性、阳性和阴性预测值以及诊断准确率分别为90%、90%、82%、94%和90%。阳性和阴性结果的似然比分别为9和0.9，表明该方法在癌症存在时能有效确认，在不存在时能有效排除。结论：EBUS是唯一用于纵隔分期的低侵入性且操作简便的技术。通过直接可视化血管（无论其相对于淋巴结的位置）来核查操作各阶段的可能性，使其对内镜医师和患者均安全可靠。当然，细胞学家/组织学家和/或操作者必须具备足够的专业知识，以免对检查结果产生负面影响，尽管三项操作似乎能降低相关人员个体专业水平对技术表现的影响。
肿瘤(癌症)患者之家