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Mattes MD, Moshchinsky AB, Ahsanuddin S, Rizk NP, Foster A, Wu AJ, Ashamalla H, Weber WA, Rimner A. Ratio of Lymph Node to Primary Tumor SUV on PET/CT Accurately Predicts Nodal Malignancy in Non-Small-Cell Lung Cancer. Clin Lung Cancer 2015; 16:e253-8. [PMID: 26163919 DOI: 10.1016/j.cllc.2015.06.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 06/09/2015] [Accepted: 06/09/2015] [Indexed: 01/10/2023]
Abstract
UNLABELLED Thoracic lymph nodes with marginally elevated maximum standardized uptake value (SUVmax) on PET/CT a diagnostic challenge in staging non-small-cell lung cancer. We evaluated the ratio of lymph node to primary tumor SUVmax (SUVN/T) in predicting nodal malignancy among 132 sampled nodes from 85 patients both a primary tumor SUVmax > 2.5 and LN SUVmax 2.0 to 6.0. SUVN/T was more accurate than SUVmax for this subset of patients. INTRODUCTION/BACKGROUND Among non-small-cell lung cancers with appreciable functional activity, positron emission tomography/computed tomography (PET/CT) is the most accurate imaging modality for clinical staging. However, lymph nodes (LN) with marginally elevated standardized uptake value (SUV) present a diagnostic challenge. In this retrospective study, we hypothesized that normalizing the LN SUV by using the ratio of the LN to primary tumor SUVmax (SUVN/T) may be a better predictor of nodal malignancy than using SUVmax alone for nodes with low to intermediate SUV. PATIENTS AND METHODS We identified 172 patients with newly diagnosed non-small-cell lung cancer who underwent pathologic LN staging and PET/CT within 31 days before biopsy. Receiver operating characteristic curves with area under the curve (AUC) calculations were used to evaluate SUVmax and SUVN/T for their ability to predict nodal malignancy for both the entire cohort of 504 LNs and a subset of 132 LNs from 85 patients who had both primary tumor SUVmax > 2.5 and LN SUVmax 2.0 to 6.0. RESULTS In patients with primary tumor SUVmax > 2.5 and LN SUVmax 2.0 to 6.0, SUVN/T was significantly more accurate in predicting nodal malignancy (AUC, 0.846; 95% confidence interval, 0.775-0.917) than SUVmax (AUC, 0.653; 95% confidence interval, 0.548-0.759). The optimal cutoff value of SUVN/T to predict nodal malignancy was 0.28 (90% sensitivity, 68% specificity). Sensitivity was > 95% for SUVN/T < 0.21, whereas specificity was > 95% for SUVN/T > 0.50. CONCLUSION The ratio of LN SUV to primary tumor SUV on PET/CT is more accurate than SUVmax when assessing nodes of low to intermediate SUV.
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Affiliation(s)
- Malcolm D Mattes
- Department of Radiation Oncology, West Virginia University, Morgantown, WV.
| | | | - Salma Ahsanuddin
- Department of Radiation Oncology, New York Methodist Hospital, Brooklyn, NY
| | - Nabil P Rizk
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Amanda Foster
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Abraham J Wu
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Hani Ashamalla
- Department of Radiation Oncology, New York Methodist Hospital, Brooklyn, NY
| | - Wolfgang A Weber
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY
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Belfontali V, Vidal Fortuny J, Guigard S, Karenovics W, Triponez F. Video-Assisted Mediastinoscopy Under Continuous Intraoperative Neuromonitoring for Surgical Management of an Ectopic Parathyroid Adenoma: A Case Report. VideoEndocrinology 2015. [DOI: 10.1089/ve.2015.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Valentina Belfontali
- Thoracic and Endocrine Surgery Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - Jordi Vidal Fortuny
- Thoracic and Endocrine Surgery Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - Sebastien Guigard
- Thoracic and Endocrine Surgery Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - Wolfram Karenovics
- Thoracic and Endocrine Surgery Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - Frédéric Triponez
- Thoracic and Endocrine Surgery Unit, University Hospitals of Geneva, Geneva, Switzerland
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Abstract
Staging of the mediastinal and hilar lymph nodes plays a crucial role in identifying the best treatment option for patients with confirmed or suspected lung cancer and, in many cases, can simultaneously confirm a diagnosis of cancer. Noninvasive modalities, such as computed tomography (CT), positron emission tomography (PET) and PET-CT, are an important first step in this assessment. Ultimately, invasive staging is frequently required to confirm or rule out the presence of metastatic disease within the lymph nodes. The present focused review describes and compares noninvasive and invasive modalities for mediastinal staging in lung cancer.
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Utility of endobronchial ultrasound-guided transbronchial needle aspiration in diagnosis of intrathoracic lymphadenopathy in patients with human immunodeficiency virus infection. BIOMED RESEARCH INTERNATIONAL 2015; 2015:257932. [PMID: 25654091 PMCID: PMC4310302 DOI: 10.1155/2015/257932] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 09/18/2014] [Accepted: 09/27/2014] [Indexed: 02/01/2023]
Abstract
Objective. Intrathoracic lymphadenopathy (LAD) in patients with Human Immunodeficiency Virus (HIV) infection is common, with wide-ranging diagnoses, from benign to malignant causes. Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) is a relatively new technology with established applications in lung cancer, sarcoidosis, and tuberculosis. We sought to find out whether the addition of EBUS-TBNA to the diagnostic algorithm for LAD in HIV patients will reduce the need for mediastinoscopy. Methods. Retrospective chart review of all EBUS-TBNA procedures performed in our centre from August 2008 to December 2012. Results. 513 patients had EBUS-TBNA performed during this period. We identified nine HIV-infected patients who had LAD of unknown cause and underwent EBUS-TBNA. The procedure reduced the need for mediastinoscopy in eight patients (89%). Conclusions. Potential mediastinoscopies can be avoided by utilising EBUS-TBNA in HIV patients with LAD.
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Eckardt J, Licht PB. Endobronchial ultrasound-guided transbronchial needle aspiration is a sensitive method to evaluate patients who should not undergo pulmonary metastasectomy†. Interact Cardiovasc Thorac Surg 2015; 20:482-5; discussion 485. [PMID: 25564578 DOI: 10.1093/icvts/ivu443] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Pulmonary metastasectomy is considered an effective treatment in selected patients with extrapulmonary cancer and oligometastatic disease. We know that the presence of mediastinal lymph node metastases reduces survival significantly, but the mediastinum is rarely evaluated before metastasectomy in these patients. We prospectively evaluated how endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) could identify metastases to the mediastinal lymph nodes in patients referred for pulmonary metastasectomy. METHODS All patients with extrapulmonary cancer and oligometastatic disease confined to the lungs on positron emission tomography-computed tomography, and who were considered eligible for pulmonary metastasectomy, routinely underwent EBUS-TBNA of the mediastinal lymph nodes. If EBUS-TBNA did not reveal malignant spread, the patient subsequently underwent pulmonary metastasectomy with systematic sampling of mediastinal lymph nodes for histological evaluation. RESULTS One hundred and three eligible patients were referred for EBUS-TBNA during a 4-year period. The primary cancers were located in the colon/rectum (n = 64), kidney (n = 16) and other sites (n = 23). EBUS-TBNA sampled 248 lymph nodes and adequate cytology was obtained in 93 patients (90%). EBUS-TBNA found lymph node metastases in 17 patients (16.5%) and during subsequent pulmonary metastasectomy in the remaining 86 patients 1 (1.0%) had a lymph node metastasis. The sensitivity, specificity, NPV and PPV of EBUS-TBNA for diagnosis of mediastinal lymph node metastasis were 94.4, 100, 98.8 and 100%, respectively. CONCLUSIONS EBUS-TBNA is a sensitive minimally invasive modality for evaluation of mediastinal lymph node metastases in patients with oligometastatic pulmonary disease. It allows surgeons to select patients who will not benefit from pulmonary metastasectomy.
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Affiliation(s)
- Jens Eckardt
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
| | - Peter Bjørn Licht
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
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Woodard GA, Jablons DM. The Latest in Surgical Management of Stage IIIA Non-Small Cell Lung Cancer: Video-Assisted Thoracic Surgery and Tumor Molecular Profiling. Am Soc Clin Oncol Educ Book 2015:e435-e441. [PMID: 25993207 DOI: 10.14694/edbook_am.2015.35.e435] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Stage IIIA non-small cell lung cancer (NSCLC) remains a treatment challenge and requires a multidisciplinary care team to optimize survival outcomes. Thoracic surgeons play an important role in selecting operative candidates and assisting with pathologic mediastinal staging via cervical mediastinoscopy, endobronchial ultrasound, or esophageal ultrasound with fine needle aspiration. The majority of patients with stage IIIA disease will receive induction therapy followed by repeat staging before undergoing lobectomy or pneumonectomy; occasionally, a patient with an incidentally found, single-station microscopic IIIA tumor will undergo resection as the primary initial therapy. Multiple large clinical trials, including SWOG-8805, EORTC-8941, INT-0139, and ANITA, have shown 5-year overall survival rates of up to 30% to 40% using triple-modality treatments, and the best outcomes repeatedly are seen among patients who respond to induction treatment or who have tumors amenable to lobectomy instead of pneumonectomy. The need for a pneumonectomy is not a reason to deny patients an operation, because current operative mortality and morbidity rates are acceptably low at 5% and 30%, respectively. In select patients with stage IIIA disease, video-assisted thoracic surgery and open resections have been shown to have comparable rates of local recurrence and long-term survival. New developments in genetic profiling and personalized medicine are exciting areas of research, and early data suggest that molecular profiling of stage IIIA NSCLC tumors can accurately stratify patients by risk within this stage and predict survival outcomes. Future advances in treating stage IIIA disease will involve developing better systemic therapies and customizing treatment plans on the basis of an individual tumor's genetic profile.
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Affiliation(s)
- Gavitt A Woodard
- From the Department of Surgery, University of California, San Francisco, CA
| | - David M Jablons
- From the Department of Surgery, University of California, San Francisco, CA
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Determining factors in diagnosing pulmonary sarcoidosis by endobronchial ultrasound-guided transbronchial needle aspiration. Ann Thorac Surg 2014; 99:441-5. [PMID: 25497069 DOI: 10.1016/j.athoracsur.2014.09.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 09/17/2014] [Accepted: 09/19/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Although the role of endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) in pulmonary sarcoidosis has previously been investigated, the determining factors in diagnosing sarcoidosis by EBUS-TBNA without rapid on-site evaluation (ROSE) are unclear. METHODS Patients with clinically and radiographically suspected sarcoidosis underwent EBUS-TBNA without ROSE in a prospective study. Presence of non-caseating epithelioid cell granulomas was pathologic evidence of sarcoidosis. RESULTS The EBUS-TBNA was performed in 120 patients, 111 of whom had confirmed sarcoidosis. For the patients with sarcoidosis (62 stage I, 49 stage II) EBUS-TBNA provided sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 93.69%, 100%, 100%, 56.25%, and 94.17%, respectively, in the diagnosis of sarcoidosis. Diagnostic yield of EBUS-TBNA for sarcoidosis was associated with disease stage, but not associated with serum angiotensin converting enzyme level, number of lymph node stations sampled per patient, or total number of passes performed per patient. At EBUS-TBNA, 284 mediastinal and hilar lymph nodes were aspirated in 111 patients. Multivariate logistic regression revealed that short-axis diameter and more than 1 needle pass per lymph node were independent risk factors associated with positive pathology. No major procedure-related complications were observed. CONCLUSIONS Endobronchial ultrasound-guided transbronchial needle aspiration is a safe procedure with high sensitivity for diagnosing sarcoidosis, having a higher diagnostic yield in stage I than stage II. To obtain a higher diagnostic yield of EBUS-TBNA in pulmonary sarcoidosis without ROSE, operators should select the largest mediastinal or hilar lymph node accessible and puncture with 3 to 5 passes.
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Ofiara LM, Navasakulpong A, Beaudoin S, Gonzalez AV. Optimizing tissue sampling for the diagnosis, subtyping, and molecular analysis of lung cancer. Front Oncol 2014; 4:253. [PMID: 25295226 PMCID: PMC4170137 DOI: 10.3389/fonc.2014.00253] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 09/03/2014] [Indexed: 01/15/2023] Open
Abstract
Lung cancer has entered the era of personalized therapy with histologic subclassification and the presence of molecular biomarkers becoming increasingly important in therapeutic algorithms. At the same time, biopsy specimens are becoming increasingly smaller as diagnostic algorithms seek to establish diagnosis and stage with the least invasive techniques. Here, we review techniques used in the diagnosis of lung cancer including bronchoscopy, ultrasound-guided bronchoscopy, transthoracic needle biopsy, and thoracoscopy. In addition to discussing indications and complications, we focus our discussion on diagnostic yields and the feasibility of testing for molecular biomarkers such as epidermal growth factor receptor and anaplastic lymphoma kinase, emphasizing the importance of a sufficient tumor biopsy.
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Affiliation(s)
- Linda Marie Ofiara
- Respiratory Medicine Division, Department of Medicine, McGill University Health Centre, Montreal Chest Institute , Montreal, QC , Canada
| | - Asma Navasakulpong
- Respiratory Medicine Division, Department of Medicine, McGill University Health Centre, Montreal Chest Institute , Montreal, QC , Canada ; Pulmonary and Respiratory Critical Care Division, Faculty of Medicine, Prince of Songkla University , Hatyai , Thailand
| | - Stephane Beaudoin
- Respiratory Medicine Division, Department of Medicine, McGill University Health Centre, Montreal Chest Institute , Montreal, QC , Canada
| | - Anne Valerie Gonzalez
- Respiratory Medicine Division, Department of Medicine, McGill University Health Centre, Montreal Chest Institute , Montreal, QC , Canada
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Raddaoui E, Alhamad EH, Zaidi SN, Al-Habeeb FF, Arafah M. Utility and diagnostic accuracy of endobronchial ultrasound-guided transbronchial fine-needle aspiration cytology of mediastinal lesions: Saudi Arabian experience. Cytojournal 2014; 11:19. [PMID: 25191512 PMCID: PMC4141359 DOI: 10.4103/1742-6413.137760] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 04/12/2014] [Indexed: 12/25/2022] Open
Abstract
Objective: The objective of this study is to evaluate the cytological accuracy of endobronchial ultrasound-guided transbronchial fine-needle aspiration (EBUS-TFNA) of the mediastinal mass/nodular lesions. Study Design: Over 3½ years from inception at King Khalid University Hospital, a retrospective analysis of the cytological diagnoses of all the EBUS-TFNA procedures performed in 80 patients who had mediastinal mass/nodular enlargement. Cytology results were reviewed and correlated with the histologic follow-up. Results: Of the 80 patients who underwent EBUS-TFNA, 15 cases (18.75%) were positive for malignancy, 48 cases (60%) negative for malignancy and 17 cases (21.25%) unsatisfactory. Of the 48 cases, which were negative for malignancy, 24 (50%) cases were of granulomatous inflammation. The overall diagnostic yield of our EBUS-TFNA specimen was 78.75%. Forty-seven cases (58.75%) of 80 cases had histological follow-up biopsies. Among them, 32 cases (68%) had the same cytological and histological diagnosis and 15 cases (31.09%) had discordance between the cytology and the follow-up histological diagnosis. The sensitivity, specificity, and positive and negative predictive values for diagnosing granulomas by EBUS-TFNA are 77%, 82%, 83%, and 75% and for diagnosing malignancy are 71%, 100%, 100%, and 82%, respectively. Conclusion: Preliminary results show that cytological samples obtained through EBUS-TFNA are accurate and specific in making a diagnosis of the mediastinal mass/nodular lesions. Its optimum use depends on the effective collaboration between the cytotechnologist, pathologist, and the bronchoscopist.
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Affiliation(s)
- Emad Raddaoui
- Address: Department of Pathology, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia
| | - Esam H Alhamad
- Department of Pulmonary Medicine, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia
| | - Shaesta Naseem Zaidi
- Address: Department of Pathology, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia
| | - Fatmah F Al-Habeeb
- Address: Department of Pathology, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia
| | - Maha Arafah
- Address: Department of Pathology, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia
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Leong S, Shaipanich T, Lam S, Yasufuku K. Diagnostic bronchoscopy--current and future perspectives. J Thorac Dis 2014; 5 Suppl 5:S498-510. [PMID: 24163743 DOI: 10.3978/j.issn.2072-1439.2013.09.08] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 09/11/2013] [Indexed: 12/25/2022]
Abstract
Lung cancer is the leading cause of cancer-related mortality worldwide. Standard bronchoscopy has limited ability to accurately localise and biopsy pulmonary lesions that cannot be directly visualised. The field of advanced diagnostic bronchoscopy is rapidly evolving due to advances in electronics and miniaturisation. Bronchoscopes with smaller outer working diameters, coupled with miniature radial and convex ultrasound probes, allow accurate central and peripheral pulmonary lesion localisation and biopsy while at the same time avoiding vascular structures. Increases in computational processing power allow three-dimensional reconstruction of computed tomographic raw data to enable virtual bronchoscopy (VB), providing the bronchoscopist with a preview of the bronchoscopy prior to the procedure. Navigational bronchoscopy enables targeting of peripheral pulmonary lesions (PPLs) via a "roadmap", similar to in-car global positioning systems. Analysis of lesions on a cellular level is now possible with techniques such as optical coherence tomography (OCT) and confocal microscopy (CM). All these tools will hopefully allow earlier and safer lung cancer diagnosis and in turn better patient outcomes. This article describes these new bronchoscopic techniques and reviews the relevant literature.
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Affiliation(s)
- Steven Leong
- Department of Thoracic Medicine, University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Queensland, Australia 4032
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The Safety and Efficacy of Mediastinoscopy When Performed by General Thoracic Surgeons. Ann Thorac Surg 2014; 97:1878-83; discussion 1883-4. [DOI: 10.1016/j.athoracsur.2014.02.049] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 02/20/2014] [Accepted: 02/25/2014] [Indexed: 11/21/2022]
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Pipkin M, Keshavjee S. Staging of the Mediastinum. Lung Cancer 2014. [DOI: 10.1002/9781118468791.ch12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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José RJ, Shaw P, Taylor M, Lawrence DR, George PJ, Janes SM, Navani N. Impact of EBUS-TBNA on modalities for tissue acquisition in patients with lung cancer. QJM 2014; 107:201-6. [PMID: 24259720 PMCID: PMC3930811 DOI: 10.1093/qjmed/hct233] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The impact of the introduction of Endobronchial ultrasound with real-time guided transbronchial needle aspiration (EBUS-TBNA) on the use of diagnostic modalities for tissue acquisition in patients with lung cancer is unknown. METHODS A retrospective review of 328 consecutive patients diagnosed with lung cancer at a university teaching hospital, where they first presented in London in 2007, 2009 and 2011. EBUS was introduced in 2008. RESULTS In total, 316 patients were included in the analysis. Comparing 2007 with 2011 data, there has been a significant reduction in standard bronchoscopy (P < 0.0001) and mediastinoscopy (P = 0.02). The proportion of cases diagnosed by EBUS-TBNA significantly increased from 0% in 2007 to 26.7% in 2009 and 25.4% in 2011 (P < 0.0001). In the same period there has also been an increased trend in the proportion of patients going directly to surgery without pathological confirmation with a 9.6% increase in diagnoses obtained at thoracotomy (P = 0.0526). CONCLUSION The use of diagnostic modalities that provide information on diagnosis and staging in a single intervention are increasing. At our hospital, the use of EBUS-TBNA for providing a lung cancer diagnosis is increasing and this has led to a significant reduction in standard bronchoscopies and mediastinoscopies. These changes in practice may have implications for future service provision, training and commissioning.
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Affiliation(s)
- R J José
- Department of Thoracic Medicine, University College London Hospital, 250 Euston road, London NW1 2PG, UK.
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Plönes T, Elze M, Kayser G, Pfeifer D, Burger M, Zissel G. mRNA and miRNA analyses in cytologically positive endobronchial ultrasound-guided transbronchial needle aspiration: Implications for molecular staging in lung cancer patients. Cancer Cytopathol 2014; 122:292-8. [DOI: 10.1002/cncy.21398] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 11/24/2013] [Accepted: 12/20/2013] [Indexed: 12/21/2022]
Affiliation(s)
- Till Plönes
- Department of Thoracic Surgery; Lung Clinic Merheim; University Medical Center Witten/Herdecke; Köln Germany
| | - Mirjam Elze
- Department of Thoracic Surgery; Center for Surgery; Medical Center-University of Freiburg; Freiburg Germany
| | - Gian Kayser
- Center for Pathology; Medical Center-University of Freiburg; Freiburg Germany
| | - Dietmar Pfeifer
- Department of Medicine I; Center for Medicine, Medical Center-University of Freiburg; Freiburg Germany
| | - Meike Burger
- Department of Medicine I; Center for Medicine, Medical Center-University of Freiburg; Freiburg Germany
| | - Gernot Zissel
- Department of Pneumology; Center for Medicine, Medical Center-University of Freiburg; Freiburg Germany
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Moonim MT, Breen R, Fields PA, Santis G. Diagnosis and subtyping of de novo and relapsed mediastinal lymphomas by endobronchial ultrasound needle aspiration. Am J Respir Crit Care Med 2014; 188:1216-23. [PMID: 24047336 DOI: 10.1164/rccm.201303-0462oc] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE The current management of lymphoma requires accurate diagnosis and subtyping of de novo lymphoma and of relapsed or refractory lymphoma in known cases. The role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the clinical management of lymphomas is unclear. OBJECTIVES To investigate the use of EBUS-TBNA in the diagnosis of de novo and relapsed mediastinal lymphomas. METHODS A total of 2,256 consecutive patients who underwent EBUS-TBNA in a tertiary center between February 2008 and April 2013 were prospectively evaluated. The diagnostic accuracy and clinical use of EBUS-TBNA in 100 cases of de novo or suspected relapsed mediastinal lymphoma was investigated by comparing EBUS-TBNA diagnosis with the final diagnosis. MEASUREMENTS AND MAIN RESULTS De novo mediastinal lymphoma was correctly diagnosed by EBUS-TBNA in 45 (88%) of 51 and relapsed lymphoma in 15 (100%) of 15 lymphoma cases. EBUS-TBNA accurately established a diagnosis other than lymphoma in 32 (97%) of 33 patients with suspected lymphoma relapse. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of EBUS-TBNA in the diagnosis of mediastinal lymphoma were 89%, 97%, 98%, 83%, and 91%, respectively. Sensitivity of EBUS-TBNA in subtyping lymphomas into high-grade non-Hodgkin lymphoma, low-grade non-Hodgkin lymphoma, and Hodgkin lymphoma was 90%, 100%, and 79%, respectively. EBUS-TBNA diagnosis was adequate for clinical management in 84 (84%) of 100 cases. CONCLUSIONS Multimodality evaluation of EBUS-TBNA can be successful in the diagnosis of de novo mediastinal lymphomas and is ideally suited in distinguishing lymphoma relapse from alternative pathologies; it is least sensitive in subtyping Hodgkin lymphoma.
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Dhillon SS, Dhillon JK, Yendamuri S. Mediastinal staging of non-small-cell lung cancer. Expert Rev Respir Med 2014; 5:835-50; quiz 851. [DOI: 10.1586/ers.11.75] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Çetinkaya E, Özgül MA, Tutar N, Özgül G, Çam E, Bilaçeroglu S. The Diagnostic Utility of Real-Time EBUS-TBNA for Hilar and Mediastinal Lymph Nodes in Conventional TBNA Negative Patients. Ann Thorac Cardiovasc Surg 2014; 20:106-12. [DOI: 10.5761/atcs.oa.12.02072] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Comparison of endobronchial ultrasound and/or endoesophageal ultrasound with transcervical extended mediastinal lymphadenectomy for staging and restaging of non-small-cell lung cancer. J Thorac Oncol 2013; 8:630-6. [PMID: 23584295 DOI: 10.1097/jto.0b013e318287c0ce] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND To compare the diagnostic yield of endobronchial ultrasound (EBUS) and/or endoesophageal ultrasound (EUS) with transcervical extended mediastinal lymphadenectomy (TEMLA) for primary staging and repeated staging (restaging) of non-small-cell lung cancer (NSCLC). METHODS In this retrospective study, all consecutive patients undergoing primary staging and restaging after neoadjuvant chemo- or chemo-radiotherapy for NSCLC with EBUS, EUS, or EBUS combined with EUS (CUS) with fine needle aspiration biopsy and cytological examination and subsequent TEMLA from January 1, 2007 to December 31 2010, were included. RESULTS Primary staging was performed in 623 patients: EBUS in 351, EUS in 72, and CUS in 200 patients. TEMLA was performed for primary staging in 276 patients. There was no mortality and morbidity after EBUS or EUS. One patient died after TEMLA and morbidity rate after TEMLA was 7.2%. There was a significant difference between EBUS or EUS and TEMLA for sensitivity (87.8% and 96.2%; p < 0.01) and negative predictive value (82.5% and 99.6%; p < 0.01) in favor of TEMLA. In the restaging group, endoscopic staging was performed in 88 patients and TEMLA in 78 patients. There was a significant difference between EBUS or EUS and TEMLA for sensitivity (64.3% and 100%; p < 0.01) and negative predictive value (82.1% and 100%; p < 0.01) in favor of TEMLA. CONCLUSIONS The results of this largest reported series comparing the endoscopic and surgical primary staging and restaging of NSCLC showed a significantly higher diagnostic yield of TEMLA when compared with that of EBUS or EUS.
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Bagan P, Mordant P, Pricopi C, Le Pimpec Barthes F, Riquet M. [Metastatic thoracic lymph node carcinoma from extra-thoracic malignancy or from unknown primary site]. REVUE DE PNEUMOLOGIE CLINIQUE 2013; 69:363-367. [PMID: 24210159 DOI: 10.1016/j.pneumo.2013.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 06/29/2013] [Indexed: 06/02/2023]
Abstract
Malignant mediastinal lymph nodes without pulmonary disease may be lymphomatous or the metastases from thoracic or extrathoracic malignancy. More rarely, metastatic lymph nodes are without primary site. Surgery is generally diagnostic, restricted to confirming the metastatic process, because of too numerous and disseminated or unresectable lymph nodes. Radical surgery consisting in lymphadenectomy can be effective in case of mediastinal lymph node malignancy without other extra- and intrathoracic disease. We observed in our experience and in several case reports long-term good results in such cases. We suggest that including surgery in the multimodality treatment of mediastinal metastatic lymph nodes may be advisable in selected patients.
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Affiliation(s)
- P Bagan
- Service de chirurgie thoracique et transplantation pulmonaire, hôpital européen Georges-Pompidou, hôpitaux universitaires Paris-Ouest, 20, rue Leblanc, 75015 Paris, France.
| | - P Mordant
- Service de chirurgie thoracique et transplantation pulmonaire, hôpital européen Georges-Pompidou, hôpitaux universitaires Paris-Ouest, 20, rue Leblanc, 75015 Paris, France
| | - C Pricopi
- Service de chirurgie thoracique et transplantation pulmonaire, hôpital européen Georges-Pompidou, hôpitaux universitaires Paris-Ouest, 20, rue Leblanc, 75015 Paris, France
| | - F Le Pimpec Barthes
- Service de chirurgie thoracique et transplantation pulmonaire, hôpital européen Georges-Pompidou, hôpitaux universitaires Paris-Ouest, 20, rue Leblanc, 75015 Paris, France
| | - M Riquet
- Service de chirurgie thoracique et transplantation pulmonaire, hôpital européen Georges-Pompidou, hôpitaux universitaires Paris-Ouest, 20, rue Leblanc, 75015 Paris, France
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70
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Vyas KS, Davenport DL, Ferraris VA, Saha SP. Mediastinoscopy: trends and practice patterns in the United States. South Med J 2013; 106:539-44. [PMID: 24096946 DOI: 10.1097/smj.0000000000000000] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Historically, mediastinoscopy has been the gold standard for the staging of lung cancer. A practice gap exists as the result of a variation in knowledge concerning current trends and practice patterns of mediastinoscopy usage. In addition, there are regional variations in practice-based learning and patient care. Lessons learned during surgeries performed on patients with lung cancer and other advances such as positron emission tomography and endobronchial ultrasound could be universally applied to improve surgeons' management of patient care. The purpose of this study was to assess contemporary practices in the staging of lung cancer. METHODS We queried the Society of Thoracic Surgeons National Database for data regarding mediastinoscopy usage, yield, and variation, both by year and region. RESULTS Cases with mediastinoscopy, as a percentage of all cases performed in the database, have significantly decreased from 14.6% in 2006 to 11.4% in 2010 (P < 0.001). The 5-year median rate of mediastinoscopy in lung cancer patients at 163 centers was 15.3% (interquartile range 5.2%-31.7%), indicating significant variation among centers. The overall median center rate also decreased over time from 21.4% (2006) to 10.0% (2010). CONCLUSIONS With advances in minimally invasive procedures and imaging, mediastinoscopy usage has declined significantly. Our findings are likely to be relevant to both clinical practice and practice guidelines.
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Affiliation(s)
- Krishna S Vyas
- From the College of Medicine, and the Department of Surgery, University of Kentucky, Lexington
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71
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Sayar A, Çitak N, Büyükkale S, Metin M, Kök A, Yurt S, Çelikten A, Gürses A. Impact of extended cervical mediastinoscopy in staging of left lung carcinoma. Thorac Cancer 2013; 4:361-368. [DOI: 10.1111/1759-7714.12026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
- Adnan Sayar
- Yedikule Thoracic Surgery and Chest Disease Education and Research Hospital; Istanbul Turkey
| | - Necati Çitak
- Yedikule Thoracic Surgery and Chest Disease Education and Research Hospital; Istanbul Turkey
| | - Songül Büyükkale
- Yedikule Thoracic Surgery and Chest Disease Education and Research Hospital; Istanbul Turkey
| | - Muzaffer Metin
- Yedikule Thoracic Surgery and Chest Disease Education and Research Hospital; Istanbul Turkey
| | - Abdulaziz Kök
- Yedikule Thoracic Surgery and Chest Disease Education and Research Hospital; Istanbul Turkey
| | - Sibel Yurt
- Yedikule Thoracic Surgery and Chest Disease Education and Research Hospital; Istanbul Turkey
| | - Alper Çelikten
- Yedikule Thoracic Surgery and Chest Disease Education and Research Hospital; Istanbul Turkey
| | - Atilla Gürses
- Yedikule Thoracic Surgery and Chest Disease Education and Research Hospital; Istanbul Turkey
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72
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Block MI, Tarrazzi FA. Invasive mediastinal staging: endobronchial ultrasound, endoscopic ultrasound, and mediastinoscopy. Semin Thorac Cardiovasc Surg 2013; 25:218-27. [PMID: 24331144 DOI: 10.1053/j.semtcvs.2013.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2013] [Indexed: 12/25/2022]
Abstract
Accurate mediastinal staging is essential to determining the optimal therapeutic strategy for many patients with lung cancer. Computed tomography and positron emission tomography are first steps, but frequently tissue sampling is recommended to confirm the radiographic findings. Mediastinoscopy has been the gold standard for thirty years, but the new technologies of esophageal endoscopic ultrasound and endobronchial ultrasound provide a less invasive method for biopsy. These techniques enable needle aspiration sampling of nearly all mediastinal and hilar lymph nodes, and experience with them is now sufficiently mature to conclude that they can be equivalent if not preferable to mediastinoscopy. The keys to achieving accurate results are skillful execution combined with sound clinical judgment regarding when to use which techniques. Patients with lung cancer are best served by clinicians experienced with all three methods for invasive mediastinal staging.
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Affiliation(s)
- Mark I Block
- Division of Thoracic Surgery, Memorial Healthcare System, Hollywood, Florida.
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73
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Tutar N, Büyükoğlan H, Yılmaz İ, Kanbay A, Önal Ö, Bilgin M, Canöz Ö, Demir R, Oyak FS, Gülmez İ, Çetinkaya E. Learning curve of conventional transbronchial needle aspiration. CLINICAL RESPIRATORY JOURNAL 2013; 8:79-85. [DOI: 10.1111/crj.12041] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 06/12/2013] [Accepted: 07/09/2013] [Indexed: 02/02/2023]
Affiliation(s)
- Nuri Tutar
- Department of Pulmonary Medicine; School of Medicine; Erciyes University; Kayseri Turkey
| | - Hakan Büyükoğlan
- Department of Pulmonary Medicine; School of Medicine; Erciyes University; Kayseri Turkey
| | - İnsu Yılmaz
- Department of Pulmonary Medicine; School of Medicine; Erciyes University; Kayseri Turkey
| | - Asiye Kanbay
- Department of Pulmonary Medicine; School of Medicine; Medeniyet University; İstanbul Turkey
| | - Ömer Önal
- Department of Thoracic Surgery; School of Medicine; Erciyes University; Kayseri Turkey
| | - Mehmet Bilgin
- Department of Thoracic Surgery; School of Medicine; Erciyes University; Kayseri Turkey
| | - Özlem Canöz
- Department of Pathology; School of Medicine; Erciyes University; Kayseri Turkey
| | - Ramazan Demir
- Department of Pulmonary Medicine; School of Medicine; Erciyes University; Kayseri Turkey
| | - Fatma Sema Oyak
- Department of Pulmonary Medicine; School of Medicine; Erciyes University; Kayseri Turkey
| | - İnci Gülmez
- Department of Pulmonary Medicine; School of Medicine; Erciyes University; Kayseri Turkey
| | - Erdoğan Çetinkaya
- Department of Pulmonary Medicine; School of Medicine; Karabük University; Karabük Turkey
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Sun J, Teng J, Yang H, Li Z, Zhang J, Zhao H, Garfield DH, Han B. Endobronchial ultrasound-guided transbronchial needle aspiration in diagnosing intrathoracic tuberculosis. Ann Thorac Surg 2013; 96:2021-7. [PMID: 24035300 DOI: 10.1016/j.athoracsur.2013.07.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 06/16/2013] [Accepted: 07/01/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure that has enabled mediastinal and hilar lymph node assessment with a high sensitivity, but its role in the diagnosis of intrathoracic tuberculosis (TB) has not been established. METHODS We prospectively studied 59 patients suspected of having TB with thoracic lymph node lesions or intrapulmonary lesions accessible by EBUS-TBNA at a clinical center for thoracic medicine from January 2010 to December 2011. Bronchoscopic findings, EBUS-TBNA procedures, pathologic findings, and microbiologic results were recorded. RESULTS Of 59 eligible patients, 41 patients had TB, 5 had lung cancer, 7 had inflammation, and 6 had sarcoidosis. Sensitivity was 85%, specificity was 100%, positive and negative predictive values were 100% and 75%, respectively, and accuracy was 90% by EBUS-TBNA for TB. Pathologic findings were consistent with TB in 80% of patients (33 of 41), and in 27% (11 of 41) the smear was positive. A total of 37 patients with TB had cultures, of whom 17 (46%) were positive. There were 80 mediastinal and hilar lymph nodes and 5 intrapulmonary lesions that were biopsied in the 41 patients with TB. Multivariate logistic regression revealed that short-axis diameter was an independent risk factor associated with positive pathology, smear, and culture (p < 0.05). Additionally, pathology showing necrosis was an independent risk factor associated with a positive culture. CONCLUSIONS Endobronchial ultrasound-guided transbronchial needle aspiration has a high diagnostic yield in the investigation of suspected intrathoracic TB by means of aspiration of intrathoracic lymph nodes and tracheobronchial wall-adjacent lung lesions.
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Affiliation(s)
- Jiayuan Sun
- Department of Endoscopy Center and Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, PR China
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75
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A Prediction Model for Pathologic N2 Disease in Lung Cancer Patients with a Negative Mediastinum by Positron Emission Tomography. J Thorac Oncol 2013; 8:1170-80. [DOI: 10.1097/jto.0b013e3182992421] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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76
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77
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Linear EBUS in staging non-small cell lung cancer and diagnosing benign diseases. J Bronchology Interv Pulmonol 2013; 20:66-76. [PMID: 23328148 DOI: 10.1097/lbr.0b013e31827d1514] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
As an evolving technique, linear endobronchial ultrasound is becoming the first choice and standard of care not only to diagnose the malignant and benign mediastinal lesions but also to stage non-small cell lung cancer. Lung cancer is the leading cause of cancer-related mortality in both men and women. The disease causes more death compared with colorectal, breast, and prostate cancers combined in the United States. Staging of lung cancer determines the prognosis. The type of lung cancer has changed in the past few decades. The frequency of adenocarcinoma has increased, whereas squamous cell carcinoma now is less frequent. Determining the cell type and its molecular characteristics allow targeted treatments in adenocarcinoma. The diagnosis of indeterminate mediastinal lymph nodes or masses and staging lung cancer might be challenging. This article will review the principles and clinical utility of endobronchial ultrasound in mediastinal lesions.
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78
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Silvestri GA, Gonzalez AV, Jantz MA, Margolis ML, Gould MK, Tanoue LT, Harris LJ, Detterbeck FC. Methods for staging non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143:e211S-e250S. [PMID: 23649440 DOI: 10.1378/chest.12-2355] [Citation(s) in RCA: 936] [Impact Index Per Article: 85.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Correctly staging lung cancer is important because the treatment options and prognosis differ significantly by stage. Several noninvasive imaging studies and invasive tests are available. Understanding the accuracy, advantages, and disadvantages of the available methods for staging non-small cell lung cancer is critical to decision-making. METHODS Test accuracies for the available staging studies were updated from the second iteration of the American College of Chest Physicians Lung Cancer Guidelines. Systematic searches of the MEDLINE database were performed up to June 2012 with the inclusion of selected meta-analyses, practice guidelines, and reviews. Study designs and results are summarized in evidence tables. RESULTS The sensitivity and specificity of CT scanning for identifying mediastinal lymph node metastasis were approximately 55% and 81%, respectively, confirming that CT scanning has limited ability either to rule in or exclude mediastinal metastasis. For PET scanning, estimates of sensitivity and specificity for identifying mediastinal metastasis were approximately 77% and 86%, respectively. These findings demonstrate that PET scanning is more accurate than CT scanning, but tissue biopsy is still required to confirm PET scan findings. The needle techniques endobronchial ultrasound-needle aspiration, endoscopic ultrasound-needle aspiration, and combined endobronchial ultrasound/endoscopic ultrasound-needle aspiration have sensitivities of approximately 89%, 89%, and 91%, respectively. In direct comparison with surgical staging, needle techniques have emerged as the best first diagnostic tools to obtain tissue. Based on randomized controlled trials, PET or PET-CT scanning is recommended for staging and to detect unsuspected metastatic disease and avoid noncurative resections. CONCLUSIONS Since the last iteration of the staging guidelines, PET scanning has assumed a more prominent role both in its use prior to surgery and when evaluating for metastatic disease. Minimally invasive needle techniques to stage the mediastinum have become increasingly accepted and are the tests of first choice to confirm mediastinal disease in accessible lymph node stations. If negative, these needle techniques should be followed by surgical biopsy. All abnormal scans should be confirmed by tissue biopsy (by whatever method is available) to ensure accurate staging. Evidence suggests that more complete staging improves patient outcomes.
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Affiliation(s)
| | - Anne V Gonzalez
- Montreal Chest Institute, McGill University Health Centre, Montreal, QC, Canada
| | - Michael A Jantz
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, FL
| | | | - Michael K Gould
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Lynn T Tanoue
- Section of Pulmonary and Critical Care Medicine, New Haven, CT
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79
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Fang W. Invited commentary. Ann Thorac Surg 2013; 96:245-6. [PMID: 23816073 DOI: 10.1016/j.athoracsur.2013.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 04/06/2013] [Accepted: 04/11/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, 241 Huaihai Rd W, Shanghai, China 200030.
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80
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Endobronchial Ultrasound-guided Transbronchial Needle Aspiration in an Unselected Cohort. J Bronchology Interv Pulmonol 2013; 20:140-6. [DOI: 10.1097/lbr.0b013e31828f4617] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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81
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Yendamuri S, Demmy TL. Reply to the editor. J Thorac Cardiovasc Surg 2013; 145:1150-1151. [PMID: 23497953 DOI: 10.1016/j.jtcvs.2013.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 01/11/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Sai Yendamuri
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, NY
| | - Todd L Demmy
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, NY
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Okachi S, Imai N, Imaizumi K, Hase T, Shindo Y, Sakamoto K, Aso H, Wakahara K, Hashimoto I, Ito S, Hashimoto N, Sato M, Kondo M, Hasegawa Y. Endobronchial ultrasound transbronchial needle aspiration in older people. Geriatr Gerontol Int 2013; 13:986-92. [DOI: 10.1111/ggi.12043] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Shotaro Okachi
- Department of Respiratory Medicine; Nagoya University Graduate School of Medicine; Nagoya; Japan
| | - Naoyuki Imai
- Department of Respiratory Medicine; Nagoya University Graduate School of Medicine; Nagoya; Japan
| | - Kazuyoshi Imaizumi
- Department of Internal Medicine, Division of Respiratory Medicine and Clinical Allergy; Fujita Health University; Toyoake; Aichi; Japan
| | - Tetsunari Hase
- Department of Respiratory Medicine; Nagoya University Graduate School of Medicine; Nagoya; Japan
| | | | - Koji Sakamoto
- Department of Respiratory Medicine; Nagoya University Graduate School of Medicine; Nagoya; Japan
| | - Hiromichi Aso
- Department of Respiratory Medicine; Nagoya University Graduate School of Medicine; Nagoya; Japan
| | - Keiko Wakahara
- Department of Respiratory Medicine; Nagoya University Graduate School of Medicine; Nagoya; Japan
| | - Izumi Hashimoto
- Department of Internal Medicine, Division of Respiratory Medicine and Clinical Allergy; Fujita Health University; Toyoake; Aichi; Japan
| | - Satoru Ito
- Department of Respiratory Medicine; Nagoya University Graduate School of Medicine; Nagoya; Japan
| | - Naozumi Hashimoto
- Department of Respiratory Medicine; Nagoya University Graduate School of Medicine; Nagoya; Japan
| | - Mitsuo Sato
- Department of Respiratory Medicine; Nagoya University Graduate School of Medicine; Nagoya; Japan
| | - Masashi Kondo
- Department of Respiratory Medicine; Nagoya University Graduate School of Medicine; Nagoya; Japan
| | - Yoshinori Hasegawa
- Department of Respiratory Medicine; Nagoya University Graduate School of Medicine; Nagoya; Japan
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83
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Liberman M, Duranceau A, Grunenwald E, Thiffault V, Khereba M, Ferraro P. Initial experience with a new technique of endoscopic and ultrasonographic access for biopsy of para-aortic (station 6) mediastinal lymph nodes without traversing the aorta. J Thorac Cardiovasc Surg 2012; 144:787-92; discussion 792-3. [PMID: 22980629 DOI: 10.1016/j.jtcvs.2012.07.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Revised: 06/11/2012] [Accepted: 07/09/2012] [Indexed: 02/03/2023]
Abstract
OBJECTIVES All lymph node stations but the para-aortic are accessible by a combination of endoscopic ultrasound and endobronchial ultrasound. We recently described an echographic-endoscopic technique for the biopsy of para-aortic (station 6) lymph nodes without traversing the thoracic aorta. This study reviewed our initial experience with this new technique. METHODS This first-in-human evaluation of the biopsy of station 6 mediastinal lymph nodes with curvilinear endoscopic ultrasound without arterial puncture used a retrospective case series design to study 12 consecutive patients who underwent this new technique. Station 6 lymph nodes were approached with a long fine needle aspiration approach (6-8 cm) through the proximal esophagus. The needle was passed through the esophagus into the mediastinum just medial to the left subclavian artery. It was then directed toward the para-aortic location (6-8 cm trajectory) to reach and enter the para-aortic lymph nodes without piercing the aorta or great vessels. RESULTS Successful cytologic diagnoses of station 6 lymph nodes were obtained in all cases (lymphocytes in all samples). No morbidity resulted from the procedure, nor was any observed at 30 days after the procedure. Patient anatomy may preclude safe access in certain situations. CONCLUSIONS Endoscopic ultrasound access of para-aortic (station 6) lymph nodes allows complete, minimally invasive mediastinal lymph node staging and diagnosis without traversal of the aorta. This technique, the final piece of the puzzle required for complete staging of the mediastinum with nonsurgical endoscopic techniques, is reproducible and safe.
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Affiliation(s)
- Moishe Liberman
- Division of Thoracic Surgery, Department of Surgery, CHUM Endoscopic Tracheobronchial and Oesophageal Center, University of Montréal, Montréal, Québec, Canada.
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Tedde ML, Figueiredo VR, Terra RM, Minamoto H, Jatene FB. Endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis and staging of mediastinal lymphadenopathy: initial experience in Brazil. J Bras Pneumol 2012; 38:33-40. [PMID: 22407038 DOI: 10.1590/s1806-37132012000100006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 09/21/2011] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a new method for the diagnosis and staging of mediastinal lymph nodes. The objective of this study was to evaluate the preliminary results obtained with EBUS-TBNA in the diagnosis of lesions and mediastinal lymph node staging. METHODS We evaluated patients with tumors or mediastinal adenopathy, diagnosed with or suspected of having lung cancer. The procedures were performed with the patients under sedation or under general anesthesia. Material was collected by EBUS-TBNA, after which it was prepared on slides, fixed in either absolute alcohol (for cytology) or formalin (for cell-block analysis). RESULTS We included 50 patients (30 males). The mean age was 58.3 ± 13.5 years. We performed 201 biopsies of 81 lymph nodes or mediastinal masses (mean of 2.5 punctures/biopsy). The quantity of material was considered sufficient for cytology in 37 patients (74%), 21 (57%) of whom were thus diagnosed with malignancy. Of the remaining 16 patients, 1 was diagnosed with tuberculosis, 6 entered clinical follow-up, and 9 underwent further investigation (2 diagnosed with neoplasm-false-negative results). The yield was higher when the procedure was performed for diagnostic purposes, as well as being higher in patients with lesions in multiple stations and in biopsies involving the subcarinal lymph node station. One patient had endobronchial bleeding, which was resolved with local measures. There were no deaths among the patients evaluated. CONCLUSIONS This preliminary experience shows that EBUS-TBNA is a safe procedure. Our diagnostic yield, although lower than that reported in the literature, was consistent with the learning curve for the method.
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Affiliation(s)
- Miguel Lia Tedde
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
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Ofiara LM, Navasakulpong A, Ezer N, Gonzalez AV. The importance of a satisfactory biopsy for the diagnosis of lung cancer in the era of personalized treatment. ACTA ACUST UNITED AC 2012; 19:S16-23. [PMID: 22787407 DOI: 10.3747/co.19.1062] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Advances in molecular biology are improving the understanding of lung cancer and changing the approach to treatment. A satisfactory biopsy that allows for histologic characterization and mutation analysis is becoming increasingly important. Most patients with lung cancer are diagnosed at an advanced stage, and diagnosis is often based on a small biopsy or cytology specimen. Here, we review the techniques available for making a diagnosis of lung cancer, including bronchoscopy, ultrasound-guided bronchoscopy, mediastinoscopy, transthoracic needle aspiration, thoracentesis, and medical thoracoscopy. We also discuss the indications, complications, and tissue yields of those techniques, especially as they pertain to testing for molecular markers.
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Affiliation(s)
- L M Ofiara
- Division of Respiratory Medicine, McGill University Health Centre, Montreal General Hospital, Montreal, QC
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86
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Eckardt J. Endobronchial ultrasound-guided transbronchial needle aspiration of lesions in mediastinum. J Thorac Dis 2012; 2:125-8. [PMID: 22263032 DOI: 10.3978/j.issn.2072-1439.2010.02.03.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2010] [Accepted: 09/12/2010] [Indexed: 11/14/2022]
Abstract
BACKGROUND Lesions in mediastinum can represent malignancy and warrants further workup. Commonly a diagnosis is achieved by conventional bronchoscopy, transbronchial needle aspiration or CT guided fine needle aspiration, however a number of patients remain undiagnosed despite these common investigations METHODS During a period of 36 months 601 patients underwent EBUS at our institution. Two hundred ninety three patients had an established diagnosis of lung cancer and were referred to us for mediastinal staging. The remaining patients had a radiologically suspicious intrathoracic lesion of which 107 had an undiagnosed lesion in mediastinum. All patients had been investigated by previous chest CT and bronchoscopy including brush cytology but remained undiagnosed. RESULTS Of the 107 patients with undiagnosed lesions in the mediastinum 89 enlarged lymph nodes and 18 mediastinal tumours. Forty-eight of the 89 patients (54%) with enlarged mediastinal lymph nodes were diagnosed by EBUS of the remaining 41 patients 11 went on to more invasive methods. In patients with undiagnosed tumours in mediastinum we achieved a final diagnosis by EBUS in 14 of the 18 patients (78%) and 3 went on to more invasive methods. CONCLUSION EBUS provides a final diagnosis in 78% of patients with tumour in mediastinum and in more than half of patients with enlarged lymph nodes despite previous workup.
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Affiliation(s)
- Jens Eckardt
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
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87
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Borges N, Saha S. The value of mediastinoscopy in the management of thoracic disease. Indian J Thorac Cardiovasc Surg 2012. [DOI: 10.1007/s12055-012-0144-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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88
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[Role of endoscopic ultrasound (EUS) and endobronchial ultrasound (EBUS) for the evaluation of mediastinal adenopathy]. Bull Cancer 2012; 99:761-70. [PMID: 22713588 DOI: 10.1684/bdc.2012.1606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Mediastinal lymphadenopathy may be detected by CT-scan or positron emission tomography. Malignant (e.g, lung cancer, metastatic cancer, lymphoma), infectious (e.g, tuberculosis, histoplasmosis), and systemic processes (e.g, sarcoidosis) can cause mediastinal adenopathy. In the posterior and inferior mediastinum, endoscopic ultrasound visualizes and directs transesophageal fine needle aspiration of adenopathy. In the anterior mediastinum, endobronchial ultrasound visualizes and directs transbronchial fine needle aspiration of adenopathy. We discuss the role of EUS and EBUS in the evaluation of mediastinal adenopathy according to their anatomical localization.
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89
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Billè A, Longman C, Pilling J. Aortic pseudoaneurysm: a rare complication of mediastinoscopy. Gen Thorac Cardiovasc Surg 2012; 61:160-2. [PMID: 22648911 DOI: 10.1007/s11748-012-0116-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 04/26/2012] [Indexed: 10/28/2022]
Abstract
Mediastinoscopy still represents the gold standard in mediastinal lymph node staging in patients with lung cancer. It is an invasive procedure, where complications are unusual. This case report shows an uncommon complication after mediastinoscopy: pseudoaneurysm of the aortic arch and its minimally invasive endovascular stenting treatment in order to facilitate the recovery and to allow minimal delay to oncological treatment.
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Affiliation(s)
- Andrea Billè
- Department of Thoracic Surgery, Guy's and St Thomas' Hospital, London, SE1 9RT, UK.
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90
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Navani N, Lawrence DR, Kolvekar S, Hayward M, McAsey D, Kocjan G, Falzon M, Capitanio A, Shaw P, Morris S, Omar RZ, Janes SM. Endobronchial ultrasound-guided transbronchial needle aspiration prevents mediastinoscopies in the diagnosis of isolated mediastinal lymphadenopathy: a prospective trial. Am J Respir Crit Care Med 2012; 186:255-60. [PMID: 22652031 DOI: 10.1164/rccm.201203-0393oc] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
RATIONALE Patients with isolated mediastinal lymphadenopathy (IML) are a common presentation to physicians, and mediastinoscopy is traditionally considered the "gold standard" investigation when a pathological diagnosis is required. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is established as an alternative to mediastinoscopy in patients with lung cancer. OBJECTIVE To determine the efficacy and health care costs of EBUS-TBNA as an alternative initial investigation to mediastinoscopy in patients with isolated IML. METHODS Prospective multicenter single-arm clinical trial of 77 consecutive patients with IML from 5 centers between April 2009 and March 2011. All patients underwent EBUS-TBNA. If EBUS-TBNA did not provide a diagnosis, then participants underwent mediastinoscopy. MEASUREMENTS AND MAIN RESULTS EBUS-TBNA prevented 87% of mediastinoscopies (95% confidence interval [CI], 77-94%; P < 0.001) but failed to provide a diagnosis in 10 patients (13%), all of whom underwent mediastinoscopy. The sensitivity and negative predictive value of EBUS-TBNA in patients with IML were 92% (95% CI, 83-95%) and 40% (95% CI, 12-74%), respectively. One patient developed a lower respiratory tract infection after EBUS-TBNA, requiring inpatient admission. The cost of the EBUS-TBNA procedure per patient was £1,382 ($2,190). The mean cost of the EBUS-TBNA strategy was £1,892 ($2,998) per patient, whereas a strategy of mediastinoscopy alone was significantly more costly at £3,228 ($5,115) per patient (P < 0.001). The EBUS-TBNA strategy is less costly than mediastinoscopy if the cost per EBUS-TBNA procedure is less than £2,718 ($4,307) per patient. CONCLUSIONS EBUS-TBNA is a safe, highly sensitive, and cost-saving initial investigation in patients with IML. Clinical trial registered with ClinicalTrials.gov (NCT00932854).
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Affiliation(s)
- Neal Navani
- Centre for Respiratory Research, University College London, London, UK.
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91
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Nasir B, Cerfolio RJ, Bryant AS. Endobronchial ultrasound (EBUS) with tranbronchial needle aspiration (TBNA) versus mediastinoscopy for mediastinal staging in non-small cell lung cancer (NSCLC) thoracic cancer. Thorac Cancer 2012; 3:131-138. [DOI: 10.1111/j.1759-7714.2011.00106.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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92
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MAGE qPCR Improves the Sensitivity and Accuracy of EBUS-TBNA for the Detection of Lymphatic Cancer Spread. J Thorac Oncol 2012; 7:690-7. [DOI: 10.1097/jto.0b013e31824294de] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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93
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Lankarani A, Wallace MB. Endoscopic ultrasonography/fine-needle aspiration and endobronchial ultrasonography/fine-needle aspiration for lung cancer staging. Gastrointest Endosc Clin N Am 2012; 22:207-19, viii. [PMID: 22632944 DOI: 10.1016/j.giec.2012.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This article reviews different techniques available for diagnosis and staging of patients with non-small cell lung cancer (NSCLC). The advantages and disadvantages of each staging method are highlighted. The role of the gastroenterologist in NSCLC staging is explored. A new algorithm is proposed for the staging of NSCLC that incorporates endoscopic and endobronchial ultrasonography for mediastinal staging in patients with intrathoracic disease.
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Affiliation(s)
- Ali Lankarani
- Department of Gastroenterology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL 32224, USA
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94
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Sanz-Santos J, Andreo F, Castellà E, Llatjós M, de Castro PL, Astudillo J, García-Luján R, Serra P, Monsó E. Representativeness of nodal sampling with endobronchial ultrasonography in non-small-cell lung cancer staging. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:62-68. [PMID: 22137179 DOI: 10.1016/j.ultrasmedbio.2011.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 08/20/2011] [Accepted: 10/12/2011] [Indexed: 05/31/2023]
Abstract
The objective of our study was to determine the procedure-related requirements of mediastinal node sampling with endobronchial ultrasonography with real-time transbronchial needle aspiration (EBUS-TBNA) that would provide negative predictive value (NPV) for the identification of stage III disease in non-small-cell lung cancer (NSCLC) high enough to consider the technique equivalent to cervical mediastinoscopy. Representative EBUS-TBNA was defined as a sampling procedure obtaining satisfactory samples from normal nodes in regions 4R, 4L and 7 or diagnosing malignancy in mediastinal nodes. NPV was estimated using the results of postsurgical staging in patients who underwent surgery as a reference. Two-hundred ninety-six patients staged with EBUS-TBNA were included. Representative samples from regions 4R, 4L and 7 showing nonmalignant cytology were obtained from 98 patients (33.1%) and EBUS-TBNA detected N2/N3 disease in 150 (50.7%). Accordingly, an EBUS-TBNA procedure accomplishing the representativeness criteria required for sampling was attained in 248 of the participating patients (83.8%). The NPV of the procedure in this setting was 93.6%, with false-negative results only found in 5 patients, four of them with nodal metastasis out of the reach of EBUS-TBNA (regions 5, 8 and 9). In conclusion, representative sampling of regions 4R, 4L and 7 is achieved in more than 80% of patients staged using EBUS-TBNA, and in the procedures that attain this requirement a NPV >90% for mediastinal malignancy is reached, a figure equivalent to cervical mediastinoscopy.
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Affiliation(s)
- J Sanz-Santos
- Department of Pneumology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
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95
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Endobronchial ultrasound-guided transbronchial needle aspiration for the diagnosis of intrathoracic lymphadenopathy in patients with extrathoracic malignancy: a multicenter study. J Thorac Oncol 2011; 6:1505-9. [PMID: 21792077 DOI: 10.1097/jto.0b013e318223c3fe] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Mediastinal lymphadenopathy in patients with an extrathoracic malignancy is a common clinical scenario. Invasive sampling of intrathoracic lymph nodes may be performed by mediastinoscopy or endoscopic ultrasound-guided fine needle aspiration. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an alternative to mediastinoscopy and endoscopic ultrasound in patients with lung cancer and sarcoidosis. The utility of EBUS-TBNA in patients with extrathoracic malignancy was evaluated. METHODS Consecutive patients who were suspected to have intrathoracic lymph node metastases from an extrathoracic malignancy underwent EBUS-TBNA. When EBUS-TBNA did not provide a specific diagnosis, patients underwent mediastinoscopy or clinical follow-up of at least 6 months duration. RESULTS One hundred sixty-one patients meeting the inclusion criteria underwent EBUS-TBNA in five UK centers over a 3-year period. EBUS-TBNA diagnosed mediastinal or hilar metastases in 71 (44%) patients, new lung cancer in 20 (12%) patients, and sarcoidosis in 14 (9%) patients. The sensitivity, negative predictive value for malignancy, and overall accuracy for EBUS-TBNA were 87%, 73% and 88%, respectively. One hundred ten (68%) patients in the study had a final diagnosis of malignant intrathoracic lymphadenopathy. CONCLUSION Because of the high prevalence of alternative diagnoses, pathological evaluation is important in patients with extrathoracic malignancy and suspected mediastinal or hilar lymph node metastases. EBUS-TBNA is a safe and sensitive technique and may be considered a first-line investigation in these patients.
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96
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Pop D, Venissac N, Nadeemy AS, Guiraudet P, Mouroux J. Video-assisted mediastinoscopy in superior vena cava obstruction: to fear or not to fear? J Thorac Oncol 2011; 7:386-9. [PMID: 22139391 DOI: 10.1097/jto.0b013e3181e50457] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION We investigate the safety and efficacy of video-assisted mediastinoscopy (VAM) used for diagnosis of the superior vena cava syndrome. METHODS In a 7-year period, we have done 447 VAM for malignant causes. We have compared, in a retrospective study from a prospectively maintained database, the differences between the groups with (first group) or without (second group) superior vena cava syndrome in terms of operative time, preoperative and postoperative complications, and results of pathologic examination. Statistical differences between the groups were calculated by χ2 test. RESULTS Mean operative time for first (31 patients) and second (416 patients) groups was 18 and 34 minutes, respectively (p < 0.00). Mean hospital stay was 1.2 days in both the groups. Mortality rates for the first and second groups were 0 and 0.5% (p = 0.31); major morbidity rates were 0 and 0.7% (p = 0.50); and minor morbidity rates were 6.4 and 1.7% (p = 0.27), respectively. In the superior vena cava syndrome group, most of the lymph nodes biopsied were in paratracheal superior sites (81%); histology showed small cell lung cancer in 51.6%, non-small cell lung cancer in 25.8%, and lymphoma in 22.6%. CONCLUSIONS VAM represents an important diagnostic tool in superior vena cava syndrome. Once decided to be used, we think that video technique is a good option with high rate of efficacy and low rates of mortality and morbidity.
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Affiliation(s)
- Daniel Pop
- Thoracic Surgery Department, Pasteur Hospital, Nice, France.
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97
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Cetinkaya E, Seyhan EC, Ozgul A, Gencoglu A, Ozgul G, Cam E, Kamiloglu E. Efficacy of convex probe endobronchial ultrasound (CP-EBUS) assisted transbronchial needle aspiration for mediastinal staging in non-small cell lung cancer cases with mediastinal lymphadenopathy. Ann Thorac Cardiovasc Surg 2011; 17:236-42. [PMID: 21697783 DOI: 10.5761/atcs.oa.10.01659] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 04/25/2011] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a sampling method for the patients with non-small cell lung cancer (NSCLC) that have enlarged mediastinal lymph nodes that are detected with computed tomography (CT). We aimed to investigate the value of EBUS-TBNA in sampling enlarged mediastinal lymph nodes in the patient with NSCLC. PATIENTS AND METHOD From January 2007 to May 2009, patients were diagnosed NSCLC with CT scans showing enlarged lymph nodes (node >1 cm) or a positron emission tomography (PET/CT) finding of the mediastinum underwent EBUS-TBNA. RESULTS EBUS-TBNA was successfully performed in all 52 patients (mean age, 52 years; 45 men) from 93 mediastinal lymph nodes. EBUS detected lymph node metastasis in 40 patients (77%). 12 patients (23%) with negative lymph node samples were underwent mediastinoscopy. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of EBUS-TBNA in the detection of mediastinal metastasis were 95 %, 100%, 100%, 83%, and 96%, respectively. EBUS-TBNA was uneventful, and there were no complications. CONCLUSION EBUS-TBNA is an effective, safe and minimally invasive procedure following PET/CT or CT scanning in the mediastinal staging of potentially operable NSCLC.
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Affiliation(s)
- Erdogan Cetinkaya
- Yedikule Teaching Hospital for Chest Diseases and Thoracic Surgery, Istanbul, Turkey
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98
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Nikolaidis N, Roubelakis A, Shambrook JS, Ohri SK, Kaarne M, Weeden DF. An unusual complication from hemostatic packing to control bleeding during cervical mediastinoscopy and an off-pump approach for the later exploration of the superior vena caval injury. Ann Thorac Surg 2011; 92:1117-8. [PMID: 21871314 DOI: 10.1016/j.athoracsur.2011.03.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2011] [Revised: 03/02/2011] [Accepted: 03/07/2011] [Indexed: 11/15/2022]
Abstract
Cervical mediastinoscopy has been widely used and is considered a safe method for the histologic diagnosis and staging of many conditions. Hemorrhage still remains one of the main possible complications, and hemostasis is usually achieved without any further surgical intervention. We present a previously unreported complication of absorbable hemostatic gauze packing, which led to superior vena caval injury and multiple pulmonary emboli, necessitating further surgical repair with the use of a veno-venous shunt.
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Affiliation(s)
- Nicolas Nikolaidis
- Department of Cardiothoracic Surgery, Southampton University Hospital, Southampton, United Kingdom
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99
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Role of EUS for the evaluation of mediastinal adenopathy. Gastrointest Endosc 2011; 74:239-45. [PMID: 21802583 DOI: 10.1016/j.gie.2011.03.1255] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 03/30/2011] [Indexed: 12/11/2022]
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100
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Jernlås B, Nyberger H, Ek L, Öhman R, Jönsson P, Nozohoor S. Diagnostic yield and efficacy of endobronchial ultrasound-guided transbronchial needle aspiration in mediastinal lymphadenopathy. CLINICAL RESPIRATORY JOURNAL 2011; 6:88-95. [PMID: 21651742 DOI: 10.1111/j.1752-699x.2011.00251.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is an emerging minimally invasive option for pathologic examination of intrathoracic lymphadenopathy as well as for staging lung cancer. OBJECTIVES To evaluate the diagnostic yield and possible learning curve effects on diagnostic performance using EBUS-TBNA in mediastinal lymphadenopathy. METHODS A retrospective analysis was performed on 243 consecutive patients who underwent EBUS-TBNA over a 4-year period. Demographic and clinical data and pathology results were analysed for different time frames in order to evaluate potential learning curve effects. The procedures were performed by two experienced bronchoscopists at a single university medical centre. RESULTS Samples were representative in 83% (200/243) of the patients. The overall diagnostic yield was 66% (n = 161/243). The diagnostic accuracy of EBUS-TBNA for detecting malignancy was 98.0% and for lung cancer 98.5%. The sensitivity, specificity, positive and negative predictive values for lung cancer stage ≥N1 and malignant disease were 100% for the first three studied periods and slightly less favourable in the most recent study period. Representative samples were obtained more frequently in the latter study periods (P < 0.001). CONCLUSION EBUS-TBNA is a safe method with a learning curve that is easily overcome, although previous experience with ultrasound may be necessary. The diagnostic yield of EBUS-TBNA is in accordance with previously reported yield of standard cervical mediastinoscopy. At present, however, the relationship between EBUS-TBNA and mediastinoscopy appears to be complementary rather than substitutive.
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