Author/Editor		Triller, Nadja; Kern, Izidor
Title		Endobronhialni ultrazvok v diagnostiki sprememb dihalnih poti in sprememb v mediastinumu
Translated title		Endobronchial ultrasound in the diagnosis of tracheobronchial and mediastinal lesions
Type		članek
Source		Endoskopska revija
Vol. and No.		Letnik 7, št. 16-17
Publication year		2002
Volume		str. 41-6
Language		slo
Abstract		Background. Endobronchial ultrasound (EBUS) is a diagnostic procedure that allows visualisation of tracheobronchial and peribronchial lesions, mediastinal lymph nodes and adjacent vascular structures. EBUS improves the diagnostic yield of transbronchial needle aspiration (TBNA). We present our initial experience with the technique. Patients and methods. EBUS was performed in 31 subjects with intrapulmonary or mediastinal lesions detected on chest X-rays and/or CT scans. Bronchoscopy was performed under topical lidocaine mucosal anaesthesia. A radial 20 MHz ultrasound probe with a balloon catheter was advanced through the working channel of the fibre-optic bronchoscope. The balloon was filled with deaerated water to provide a medium for ultrasound transmission. After the region of interest had been localised, TBNA was performed. The aspirated material was examined by a cytopathologist. Results. From October 2001 to April 2002, 31 patients, 20 males and 11 females, aged from 23 to 78 years (median age 59 years), underwent EBUS. EBUS-guided TBNA of extramural masses and lymph nodes of the mediastinum was performed in 29 of our patients; in 2 patients aneurysms were found. Lymph node enlargement and involvement was diagnosed correctly in 21 of 25 patients (84%), and extramural tumours in 3 of 4 patients (75%); 16 patients had malignant diseases and 8 had benign lesions. In 5 patients with unclear findings, the ultimate diagnosis was made at surgery:adenocarcinoma, thymoma, two squamous cell carcinomas and Castlemans disease. No major complications were encountered after EBUS guided TBNA, the procedure was well tolerated. Conclusions. EBUS guided TBNA is well tolerated and has few complications. The diagnostic yield is high.
Summary		Izhodišča. Z endobronhialnim ultrazvokom (EBUZ) pregledujemo steno dihalnih poti ter okolne strukture, kot so bezgavke, tumorji in žile in spremembe v mediastinumu. Pod nadzorom EBUZ opravimo bronhoskopsko igelno aspiracijo (BIA) in tako izboljšamo občutljivost preiskave. Predstavljamo naše začetne izkušnje z novo diagnostično metodo. Bolniki in metode. Z EBUZ smo pregledali 31 bolnikov, ki so imeli spremembe ob centralnih dihalnih poteh in v mediastinumu, na rentgenogramu pljuč in/ali na posnetkih računalniške tomografije (CT). Preiskavo smo opravili v lokalni anesteziji z lidokainom. Ultrazvočno vrtljivo sondo (20 Mhz) z balonskim katetrom smo v dihalne poti uvedli skozi delovni kanal upogljivega bronhoskopa. Balonček smo napolnili s fiziološko raztopino in tako omogočili nemoten prehod ultrazvočnih valov (UV). Pazili smo, da v tekočini ni bilo zračnih mehurčkov. Z UZ smo oiskali najugodnejšo mesto za punkcijo in opravili BIA. Dobljeni aspirat smo citološko pregledali. Rezultati. Od oktobra 2001 do aprila 2002 smo pregledali 31 bolnikov (20 moških in 11 žensk) starih od 23 do 78 let (mediana 59). BIA pod nadzorom EBUZ je bila opravljena pri 29 bolnikih, pri dveh bolnikih smo našli žilno spremembo (anevrizma) in punkcije nismo opravili. Pri 25 bolnikih smo punktirali bezgavke. Pri 21 (84%) smo s citološkim pregledom punktata ugotovili naravo bolezni, pri 5 bolnikih pa smo bolezen ugotovili kirurško. Punktirali smo 4 tumorje, pri 3 (75%) smo s pregledom punktata ugotovili vrsto tumorja, en bolnik je bil napoten na kirurško diagnostiko. pri 16 bolnikih smo ugotovili maligno bolezen, pri 8 benigne spremembe. Pri petih bolnikih s citološko nejasnim izvidom smo s kirurškim posegom ugotovili timom, žleznega raka, dva ploščatocelična raka in Castlemanovo bolezen. Bolniki so preiskavo dobro prenašali, zapletov nismo imeli. Zaključki. Z EBUZ vodena BIA je varen poseg, bolniki ga dobro prenašajo, občutljivost BIA pod nadzorom UZ se poveča.
Descriptors		MEDIASTINAL DISEASES LUNG DISEASES BRONCHOSCOPY OXIMETRY BIOPSY, NEEDLE