鼻咽癌放疗后内镜超声引导下咽后淋巴结细针抽吸术:一种新型准确诊断技术
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摘要
背景与目的鼻咽癌(nasopharyngeal carcinoma,NPC)患者接受放射治疗后普遍出现咽后淋巴结(retropharyngeal lymph nodes,RLNs)增大。病理学检查结果决定了对增大RLNs最佳治疗方案的选择。然而,在临床上RLN取样难度大。我们最近开发了一种内镜超声引导下细针抽吸(endoscopic ultrasound-guided fine needle aspiration,EUS-FNA)的新型微创技术,可取到足够的RLN组织用以病理学或细胞学诊断。方法纳入30例经核磁共振成像(magnetic resonance imaging,MRI)检测疑似放疗后出现RLN转移的NPC患者。EUS探头经鼻孔置入鼻咽,然后使用EUS扫描咽后间隙并在颈动脉鞘前定位RLN,随后进行EUS-FNA。对EUS-FNA法从RLN组织取样的安全性和有效性进行评估。结果采用EUS-FNA法成功地对所有患者进行了组织取样。在30例患者中,23例经1次EUS-FNA取样后通过病理学或细胞学检查确认了活检组织中存在癌细胞。有7例患者经1次EUS-FNA活检后未确认存在癌细胞,随后再次采用EUS-FNA活检重新分析,又有2例被确认存在癌细胞;另外5例未确认存在癌细胞的患者密切随访3个月,每月进行1次MRI。随访3个月后,3例患者由于RLNs直径保持稳定或减小而被认为未患肿瘤;剩余2例表现出疾病进展的患者进行了第3次EUS-FNA活检,进一步确认为癌细胞阳性。本文所报道的整个队列中,EUS-FNA过程无任何严重并发症发生。结论采用EUS-FNA法对疑似NPC复发患者的RLNs取样是一种安全有效的诊断方法。
引文
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15.Thomas T,Kaye PV,Ragunath K,Aithal G.Efficacy,safety,and predictive factors for a positive yield of EUS-guided Trucut biopsy:a large tertiary referral center experience.Am JGastroenterol.2009;104(3):584-91.
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19.Li JJ,He LJ,Luo GY,Liu LZ,Huang XX,Pan K,et al.Fine-needle aspiration of a retropharyngeal lymph node guided by endoscopic ultrasonography.Endoscopy.2015;47 Suppl 1UCTN:E449-50.
20.Su Y,Zhao C,Li WJ,Deng XY,Zeng RF,Cui NJ,et al.CT-guided needle biopsy through mandibular area for the diagnosis of nasopharyngeal carcinoma in the parapharyngeal space.Chin J Cancer.2010;29(8):768-73.
2.Kato H,Kanematsu M,Watanabe H,Mizuta K,Aoki M.Metastatic retropharyngeal lymph nodes:comparison of CT and MR imaging for diagnostic accuracy.Eur J Radiol.2014;83(7):1157-62.
3.Liu LZ,Zhang GY,Xie CM,Liu XW,Cui CY,Li L.Magnetic resonance imaging of retropharyngeal lymph node metastasis in nasopharyngeal carcinoma:patterns of spread.Int J Radiat Oncol Biol Phys.2006;66(3):721-30.
4.Ma J,Liu L,Tang L,Zong J,Lin A,Lu T,et al.Retropharyngeal lymph node metastasis in nasophar yngeal carcinoma:prognostic value and staging categories.Clin Cancer Res.2007;13(5):1445-52.
5.Zhang GY,Liu LZ,Wei WH,Deng YM,Li YZ,Liu XW.Radiologic criteria of retropharyngeal lymph node metastasis in nasopharyngeal carcinoma treated with radiation therapy.Radiology.2010;255(2):605-12.
6.Allen AM,Haddad RI,Tishler RB.Retropharyngeal nodes in hypopharynx cancer on positron emission tomography.J Clin Oncol.2007;25(5):599-601.
7.Chan SC,Lin CY,Ng SH,Chang JT,Wang HM,Liao CT,et al.18F-FDG PET for retropharyngeal lymph node metastasis in oropharyngeal and hypopharyngeal cancers:impact on diagnosis and prediction analysis.Nucl Med Commun.2010;31(3):260-5.
8.Butta L,Lombardi D,Marconi A,Nicolai P.Transoral excision of a retropharyngeal lymph node under rigid endoscopic control.Ann Otol Rhinol Laryngol.2010;119(4):211-4.
9.Chan JY,Chow VL,Wong ST,Wei WI.Surgical salvage for recurrent retropharyngeal lymph node metastasis in nasopharyngeal carcinoma.Head Neck.2013;35(12):1726-31.
10.Kamiyama R,Saikawa M,Kishimoto S.Significance of retropharyngeal lymph node dissection in hypopharyngeal cancer.Jpn J Clin Oncol.2009;39(10):632-7.
11.Grosu HB,Morice RC,Sarkiss M,Bashoura L,Eapen GA,Jimenez CA,et al.Safety of flexible bronchoscopy,rigid bronchoscopy,and endobronchial ultrasound-guided transbronchial needle aspiration in patients with malignant space-occupying brain lesions.Chest.2015;147(6):1621-8.
12.Navani N,Nankivell M,Lawrence DR,Lock S,Makker H,Baldwin DR,et al.Lung cancer diagnosis and staging with endobronchial ultrasoundguided transbronchial needle aspiration compared with conventional approaches:an open-label,pragmatic,randomised controlled trial.Lancet Respir Med.2015;3(4):282-9.
13.VanderLaan PA,Wang HH,Majid A,Folch E.Endobronchial ultrasoundguided transbronchial needle aspiration(EBUS-TBNA):an overview and update for the cytopathologist.Cancer Cytopathol.2014;122(8):561-76.
14.Abe Y,Kawakami H,Oba K,Hayashi T,Yasuda I,Mukai T,et al.Effect of a stylet on a histological specimen in EUS-guided fine-needle tissue acquisition by using 22-gauge needles:a multicenter,prospective,randomized,controlled trial.Gastrointest Endosc.2015;82(5):837-44.
15.Thomas T,Kaye PV,Ragunath K,Aithal G.Efficacy,safety,and predictive factors for a positive yield of EUS-guided Trucut biopsy:a large tertiary referral center experience.Am JGastroenterol.2009;104(3):584-91.
16.Shanmugaratnam K.Histological typing of tumours of the upper respiratory tract and ear.Berlin:Springer Science&Business Media;2012.
17.Eisenhauer EA,Therasse P,Bogaerts J,Schwartz LH,Sargent D,Ford R,et al.New response evaluation criteria in solid tumours:revised RECIST guideline(version 1.1).Eur J Cancer.2009;45(2):228-47.
18.Therasse P,Arbuck SG,Eisenhauer EA,Wanders J,Kaplan RS,Rubinstein L,et al.New guidelines to evaluate the response to treatment in solid tumors.European Organization for Research and Treatment of Cancer,National Cancer Institute of the United States,National Cancer Institute of Canada.J Natl Cancer Inst.2000;92(3):205-16.
19.Li JJ,He LJ,Luo GY,Liu LZ,Huang XX,Pan K,et al.Fine-needle aspiration of a retropharyngeal lymph node guided by endoscopic ultrasonography.Endoscopy.2015;47 Suppl 1UCTN:E449-50.
20.Su Y,Zhao C,Li WJ,Deng XY,Zeng RF,Cui NJ,et al.CT-guided needle biopsy through mandibular area for the diagnosis of nasopharyngeal carcinoma in the parapharyngeal space.Chin J Cancer.2010;29(8):768-73.