Endosonographisch gesteuerte Feinnadelpunktion bei mediastinalen und abdominellen Lymphknotenvergrößerungen

Zusammenfassung

Hintergrund und Fragestellung: Die endosonographisch gesteuerte Feinnadelpunktion (EUS-FNP) bietet nach Studiendaten bei der Dignitätsbeurteilung mediastinaler und abdomineller Lymphome eine risikoarme und hoch valide Problemlösung. Unbekannt ist, ob diese Ergebnisse auch im klinischen Alltag unter nicht spezialisierten Bedingungen reproduzierbar sind.

Patienten und Methodik: Wir analysierten retrospektiv die Ergebnisse von 141 EUS-FNP bei 121 Patienten mit mediastinalen (n = 119) oder abdominellen (n = 22) Lymphknotenvergrößerungen. Alle Punktionen wurden unter klinischen Routinebedingungen in einem kommunalen Krankenhaus durchgeführt. Als Goldstandard diente die histopathologische Aufarbeitung des Operationsresektates oder der klinische Verlauf.

Ergebnisse: Verwertbares Material wurde bei 124/141 Punktionen gewonnen (88 %). Die Ausbeuterate war unabhängig von der Größe des punktierten Lymphknoten, und stieg im Verlauf des Beobachtungszeitraums an (2002–2006: 77 %; 2007–2010: 98 %). Sensitivität und Spezifität für den Nachweis eines Malignoms betrugen 77 bzw. 100 %, die diagnostische Treffsicherheit 92 %. Auch hierbei zeigte sich eine Verbesserung der Ergebnisqualität mit zunehmender Routine (Anstieg der Sensitivität von 72 auf 80 %).

Folgerung: Wenngleich die Ergebnisse geringgradig schlechter als unter Studienbedingungen ausfallen, behauptet sich die EUS-FNP auch im klinischen Alltag als sichere und erfolgreiche Methode.

Abstract

Background: According to recent clinical trials, EUS-FNA has a high diagnostic yield in case of mediastinal and abdominal lymphadenopathy. However, it is questionable, if the results of centers of excellence can be maintained in daily clinical practice.

Methods: We retrospectively analyzed the results of 141 EUS-FNP in 121 patients (female 25, male 86; mean age 61,5 years, range 22–87) of 119 mediastinal and 22 abdominal lymph nodes, performed under routine conditions in daily clinical practice in a community hospital. Histopathological examination of operative specimens or clinical follow-up served as gold standard.

Results: In 124/141 (80 %) of cases, adequate specimens could be obtained, irrespective of lymph node size. During follow-up, the rate of adequate specimens obtained increased from 77 % (2002–2006) to 98 % (2007–2010). Sensitivity and specifity for the diagnosis of malignancy was 77 and 100 % (diagnostic accuracy 92 %). During follow-up, a relevant learning curve could be observed with a significant increase in sensitivity (72 to 80 %).

Conclusion: In comparison to the results of centers of excellence, our diagnostic accuracy is slightly inferior. However, even in daily routine praxis, EUS-FNP is a safe and accurate method of sampling mediastinal and abdominal lymph nodes.

Schlüsselwörter

Endosonographie - endosonographisch gesteuerte Punktion - EUS-FNP - Lymphom - Tumorstaging - klinischer Alltag

Keywords

endosonography - endoscopic ultrasound - endoscopic ultrasound-guided biopsy - EUS-FNA - Lymphoma - Staging - malignancy - clinical routine

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