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Endobronchial ultrasound-guided transbronchial needle aspiration: Indian perspective. J Bronchology Interv Pulmonol 2015; 21:284-7. [PMID: 25321446 DOI: 10.1097/lbr.0000000000000096] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Van Schil PE, De Waele M, Hendriks JM, Lauwers PR. Approaches in patients with locally advanced NSCLC: a surgeon's perspective. Lung Cancer 2015. [DOI: 10.1183/2312508x.10010414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
The purpose of this article is to provide an update on evidence-based methods for mediastinal staging in patients with lung cancer. This is a review of the recently published studies and a summary of relevant guidelines addressing the role of CT scan, PET scan, endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA), and mediastinoscopy as pertinent to lung cancer staging and restaging. The focus is on how these diagnostic methods fit into the best algorithm for patients with chest imaging abnormalities suspected of malignant disease. Several studies, meta-analyses, and systematic reviews specifically targeted the role of PET scan, EBUS-TBNA, and mediastinoscopy for detecting mediastinal lymph node involvement in patients suffering from lung cancer. Based on the recommendations from the currently published guidelines, algorithms of care are proposed for staging and restaging of the mediastinum.
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54
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Van Schil PE, Balduyck B, De Waele M, Hendriks JM, Hertoghs M, Lauwers P. Surgical treatment of early-stage non-small-cell lung cancer. EJC Suppl 2015. [PMID: 26217120 PMCID: PMC4041566 DOI: 10.1016/j.ejcsup.2013.07.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Surgical resection remains the standard of care for functionally operable early-stage non-small-cell lung cancer (NSCLC) and resectable stage IIIA disease. The role of invasive staging and restaging techniques is currently being debated, but they provide the largest biopsy samples which allow for precise mediastinal staging. Different types of operative procedures are currently available to the thoracic surgeon, and some of these interventions can be performed by video-assisted thoracic surgery (VATS) with the same oncological results as those by open thoracotomy. The principal aim of surgical treatment for NSCLC is to obtain a complete resection which has been precisely defined by a working group of the International Association for the Study of Lung Cancer (IASLC). Intraoperative staging of lung cancer is of utmost importance to decide on the extent of resection according to the intraoperative tumour (T) and nodal (N) status. Systematic nodal dissection is generally advocated to evaluate the hilar and mediastinal lymph nodes which are subdivided into seven zones according to the most recent 7th tumour-node-metastasis (TNM) classification. Lymph-node involvement not only determines prognosis but also the administration of adjuvant therapy. In 2011, a new multidisciplinary adenocarcinoma classification was published introducing the concepts of adenocarcinoma in situ and minimally invasive adenocarcinoma. This classification has profound surgical implications. The role of limited or sublobar resection, comprising anatomical segmentectomy and wide wedge resection, is reconsidered for early-stage lesions which are more frequently encountered with the recently introduced large screening programmes. Numerous retrospective non-randomised studies suggest that sublobar resection may be an acceptable surgical treatment for early lung cancers, also when performed by VATS. More tailored, personalised therapy has recently been introduced. Quality-of-life parameters and surgical quality indicators become increasingly important to determine the short-term and long-term impact of a surgical procedure. International databases currently collect extensive surgical data, allowing more precise calculation of mortality and morbidity according to predefined risk factors. Centralisation of care has been shown to improve results. Evidence-based guidelines should be further developed to provide optimal staging and therapeutic algorithms.
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Affiliation(s)
- Paul E Van Schil
- Antwerp University Hospital, Department of Thoracic and Vascular Surgery, Edegem, Antwerp, Belgium
| | - Bram Balduyck
- Antwerp University Hospital, Department of Thoracic and Vascular Surgery, Edegem, Antwerp, Belgium
| | - Michèle De Waele
- Antwerp University Hospital, Department of Thoracic and Vascular Surgery, Edegem, Antwerp, Belgium
| | - Jeroen M Hendriks
- Antwerp University Hospital, Department of Thoracic and Vascular Surgery, Edegem, Antwerp, Belgium
| | - Marjan Hertoghs
- Antwerp University Hospital, Department of Thoracic and Vascular Surgery, Edegem, Antwerp, Belgium
| | - Patrick Lauwers
- Antwerp University Hospital, Department of Thoracic and Vascular Surgery, Edegem, Antwerp, Belgium
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Zielinski M. Current methods of staging and restaging of the mediastinal nodes in non-small-cell lung cancer. World J Respirol 2015; 5:166-175. [DOI: 10.5320/wjr.v5.i2.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 04/13/2015] [Accepted: 07/08/2015] [Indexed: 02/06/2023] Open
Abstract
To analyze the current methods of primary staging and repeated staging (restaging) of the mediastinal nodes in non-small-cell lung cancer (NSCLC), all methods currently used for staging of NSCLC are analyzed. These methods include imaging techniques [computer tomography (CT), positron emission tomography (PET) combined with CT (PET/CT)], endoscopic/ultrasound techniques (endobronchial ultrasound/transbronchial needle aspiration) and endoscopic ultrasound/fine needle aspiration and surgical techniques [standard cervical mediastinoscopy, video-assisted mediastinoscopy, extended mediastinoscopy, video-assisted mediastinoscopic lymphadenectomy, transcervical extended mediastinal lymphadenectomy, anterior mediastinotomy (Chamberlain procedure) and video-assisted thoracic surgery]. The diagnostic yield of Chest CT is regarded insufficient for both, primary staging and restaging. The PET/CT became a standard imaging technique preceding curative surgery of radical chemo-radiotherapy. The issue of intraoperative staging is also described. Finally, the author’s proposed algorithm of staging, both for primary staging and restaging after neoadjuvant therapy is presented. Detailed staging of NSCLC enables selection of patients with early stage disease for curative surgical/multimodality treatment and helps to avoid unnecessary surgery in advanced disease.
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Hegde P, Liberman M. Echo-endoscopic lymph node staging in lung cancer: an endoscopic alternative. Expert Rev Anticancer Ther 2015; 15:1063-73. [DOI: 10.1586/14737140.2015.1067143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Czarnecka K, Yasufuku K. The role of endobronchial ultrasound/esophageal ultrasound for evaluation of the mediastinum in lung cancer. Expert Rev Respir Med 2015; 8:763-76. [PMID: 25395019 DOI: 10.1586/17476348.2014.985210] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The introduction: of ultrasound-based, minimally invasive techniques (Endobronchial Ultrasound guided Transbronchial Needle Aspiration (EBUS-TBNA) and Esophageal Ultrasound guided Fine Needle Aspiration) has revolutionized care of patients with lung cancer needing mediastinal lymph node sampling. When combined, the techniques offer safe and accurate assessment of mediastinum, with accuracy surpassing that of the pervious gold standard - cervical mediastinoscopy. EBUS-TBNA can be used for mediastinal restaging in both, patients with suspected recurrence following treatment for primary lung cancer and followingneoadjuvant therapy in preparation for definitive surgical intervention. Both EBUS-TBNA and esophageal ultrasound guided fine needle aspiration techniques have been shown to provide sufficient material for molecular and DNA testing, extending their role beyond initial evaluation of the mediastinum to help direct and personalize medical treatment and predict response to therapy. In the future, assessing sonographic features of lymph nodesmay become useful in predicting nodal metastasis, further increasing the sensitivity of these techniques for detection of metastatic disease.
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Affiliation(s)
- Kasia Czarnecka
- Division of Respirology and Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
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58
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Vilmann P, Frost Clementsen P, Colella S, Siemsen M, De Leyn P, Dumonceau JM, Herth FJ, Larghi A, Vazquez-Sequeiros E, Hassan C, Crombag L, Korevaar DA, Konge L, Annema JT. Combined endobronchial and esophageal endosonography for the diagnosis and staging of lung cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline, in cooperation with the European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg 2015; 48:1-15. [DOI: 10.1093/ejcts/ezv194] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Vilmann P, Clementsen PF, Colella S, Siemsen M, De Leyn P, Dumonceau JM, Herth FJ, Larghi A, Vazquez-Sequeiros E, Hassan C, Crombag L, Korevaar DA, Konge L, Annema JT. Combined endobronchial and oesophageal endosonography for the diagnosis and staging of lung cancer. Eur Respir J 2015; 46:40-60. [DOI: 10.1183/09031936.00064515] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 04/27/2015] [Indexed: 12/25/2022]
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Stamatis G. Staging of lung cancer: the role of noninvasive, minimally invasive and invasive techniques. Eur Respir J 2015; 46:521-31. [PMID: 25976686 DOI: 10.1183/09031936.00126714] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 04/07/2015] [Indexed: 12/25/2022]
Abstract
Accurate staging and restaging of primary tumour and mediastinal nodes in patients with lung cancer is of significant importance. For primary tumours, computed tomography (CT) scans of the chest are recommended. Positron emission tomography (PET) imaging should be used in patients with curative intent treatment to evaluate metastatic disease. Diagnosis of the primary tumour should be performed using bronchoscopy or CT-guided transthoracic needle aspiration. In patients with enlarged mediastinal nodes and no distant metastasis, invasive staging of the mediastinum is required. For suspicious N2 or N3 disease, endoscopic needle techniques, such as endobronchial ultrasound and transbronchial needle aspiration, oesophageal ultrasound and fine needle aspiration, or a combination of both, are preferred to any surgical staging technique. In cases of suspicious nodes and negative results using needle aspiration techniques, invasive surgical staging using mediastinoscopy or video-assisted thoracic surgery should be performed. In central tumours or N1 nodes, preoperative invasive staging is indicated.Restaging after induction therapy remains a controversial topic. Today, neither CT, PET nor PET/CT scans are accurate enough to make final further therapeutic decisions for mediastinal nodal involvement. An invasive technique providing cytohistological information is still recommended.
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Affiliation(s)
- Georgios Stamatis
- Dept of Thoracic Surgery and Endoscopy, Ruhrlandklinik, West German Lung Center of the University Duisburg Essen, Essen, Germany
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61
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Zhang J, Ren Y. Endobronchial ultrasound-guided transbronchial needle aspiration: a maturing technique. J Thorac Dis 2015; 6:1665-7. [PMID: 25589957 DOI: 10.3978/j.issn.2072-1439.2014.12.35] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 12/06/2014] [Indexed: 12/30/2022]
Affiliation(s)
| | - Yangang Ren
- China Medical University, Shenyang 110001, China
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62
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Vaidya PJ, Kate AH, Yasufuku K, Chhajed PN. Endobronchial ultrasound-guided transbronchial needle aspiration in lung cancer diagnosis and staging. Expert Rev Respir Med 2014; 9:45-53. [PMID: 25496515 DOI: 10.1586/17476348.2015.992784] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Lung cancer is one of the most prevalent types of cancer in the world. A complete diagnosis of lung cancer involves tissue acquisition for pathological subtype, molecular diagnosis and accurate staging of the disease to guide appropriate therapy. Real-time endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is minimally invasive and relatively safe procedure, which can be done on an outpatient basis under moderate sedation. EBUS-TBNA has been shown to be a safe modality to obtain tissue for diagnosis, staging and molecular profiling in lung cancer. EBUS-TBNA stands out in comparison with other modalities for tissue acquisition in lung cancer. EBUS-TBNA performed with the patient under moderate sedation yields sufficient tissue for sequential molecular analysis in most patients. In this review, we describe the role of EBUS-TBNA in various aspects of diagnosis and staging of lung cancer in the present era along with its future aspects.
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Affiliation(s)
- Preyas J Vaidya
- Institute of Pulmonology, Medical Research and Development, Mumbai, India
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63
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Colella S, Vilmann P, Konge L, Clementsen PF. Endoscopic ultrasound in the diagnosis and staging of lung cancer. Endosc Ultrasound 2014; 3:205-12. [PMID: 25485267 PMCID: PMC4247527 DOI: 10.4103/2303-9027.144510] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 01/03/2014] [Indexed: 12/25/2022] Open
Abstract
We reviewed the role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and esophageal ultrasound guided fine needle aspiration (EUS-FNA) in the pretherapeutic assessment of patients with proven or suspected lung cancer. EUS-FNA and EBUS-TBNA have been shown to have a good diagnostic accuracy in the diagnosis and staging of lung cancer. In the future, these techniques in combination with positron emission tomography/computed tomographic may replace surgical staging in patients with suspected and proven lung cancer, but until then surgical staging remains the gold standard for adequate preoperative evaluation.
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Affiliation(s)
- Sara Colella
- Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark
| | - Peter Vilmann
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Herlev, Denmark
| | - Lars Konge
- Centre for Clinical Education, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
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64
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Inage T, Nakajima T, Yoshino I. Staging lung cancer: role of endobronchial ultrasound. LUNG CANCER (AUCKLAND, N.Z.) 2014; 5:67-72. [PMID: 28210144 PMCID: PMC5217511 DOI: 10.2147/lctt.s46195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Accurate staging is the first step in the management of lung cancer. Nodal staging is quite important for physicians to be able to judge the primary operability of patients harboring no distant metastasis. For many years, mediastinoscopy has been considered a "gold standard" modality for nodal staging. Mediastinoscopy is known to be a highly sensitive procedure for mediastinal staging and has been performed worldwide, but is invasive. Because of this, clinicians have sought a less invasive modality for nodal staging. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive modality for diagnosis and staging of lung cancer. EBUS-TBNA is a needle biopsy procedure that has accessibility compatible with the reach of the convex-probe EBUS scope, so N1 nodes are also assessable. The diagnostic yield is similar to that of mediastinoscopy, and the core obtained by the dedicated needle biopsy can be used for histological assessment to determine the subtypes of lung cancer. The samples can also be used to test for various biomarkers using immunohistochemistry, polymerase chain reaction for DNA/complementary DNA, and in situ hybridization, and the technique is useful for selecting candidates for specific molecular-targeted therapeutic agents. According to the newly published American College of Chest Physicians guideline, EBUS-TBNA is now considered "the best first test" for nodal staging in patients with radiologically suspicious nodes. Appropriate training and thorough clinical experience is required to be able to perform correct nodal staging using this procedure.
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Affiliation(s)
- Terunaga Inage
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takahiro Nakajima
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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65
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Rintoul RC, Ahmed R, Dougherty B, Carroll NR. Linear endobronchial ultrasonography: a novelty turned necessity for mediastinal nodal assessment. Thorax 2014; 70:175-80. [DOI: 10.1136/thoraxjnl-2014-205635] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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66
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Abstract
Proponents of the endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) propose that in this era of EBUS-TBNA, training for conventional transbronchial needle aspiration (C-TBNA) should be abandoned. The authors of this editorial provide the opposing view. C-TBNA has a short and a steep learning curve and adds to the diagnostic yield of flexible bronchoscopy in a cost-effective fashion. Considering its simplicity, availability, affordability, safety, and several unique indications, C-TBNA continues to contribute to the welfare of patients worldwide. It should remain as an integral part of pulmonary fellowship training programs.
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67
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Hashemi SMS, Dahele M, Daniels JMA, Smit EF. Complications of endoscopic ultrasound-guided needle aspiration. Acta Oncol 2014; 53:1265-8. [PMID: 24666266 DOI: 10.3109/0284186x.2014.887855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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68
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Zaric B, Stojsic V, Sarcev T, Stojanovic G, Carapic V, Perin B, Zarogoulidis P, Darwiche K, Tsakiridis K, Karapantzos I, Kesisis G, Kougioumtzi I, Katsikogiannis N, Machairiotis N, Stylianaki A, Foroulis CN, Zarogoulidis K. Advanced bronchoscopic techniques in diagnosis and staging of lung cancer. J Thorac Dis 2014; 5 Suppl 4:S359-70. [PMID: 24102008 DOI: 10.3978/j.issn.2072-1439.2013.05.15] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 05/22/2013] [Indexed: 12/18/2022]
Abstract
The role of advanced brochoscopic diagnostic techniques in detection and staging of lung cancer has steeply increased in recent years. Bronchoscopic imaging techniques became widely available and easy to use. Technical improvement led to merging in technologies making autofluorescence or narrow band imaging incorporated into one bronchoscope. New tools, such as autofluorescence imagining (AFI), narrow band imaging (NBI) or fuji intelligent chromo endoscopy (FICE), found their place in respiratory endoscopy suites. Development of endobronchial ultrasound (EBUS) improved minimally invasive mediastinal staging and diagnosis of peripheral lung lesions. Linear EBUS proven to be complementary to mediastinoscopy. This technique is now available in almost all high volume centers performing bronchoscopy. Radial EBUS with mini-probes and guiding sheaths provides accurate diagnosis of peripheral pulmonary lesions. Combining EBUS guided procedures with rapid on site cytology (ROSE) increases diagnostic yield even more. Electromagnetic navigation technology (EMN) is also widely used for diagnosis of peripheral lesions. Future development will certainly lead to new improvements in technology and creation of new sophisticated tools for research in respiratory endoscopy. Broncho-microscopy, alveoloscopy, optical coherence tomography are some of the new research techniques emerging for rapid technological development.
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Affiliation(s)
- Bojan Zaric
- Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Serbia
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Fiz JA, Monte-Moreno E, Andreo F, Auteri SJ, Sanz-Santos J, Serra P, Bonet G, Castellà E, Manzano JR. Fractal dimension analysis of malignant and benign endobronchial ultrasound nodes. BMC Med Imaging 2014; 14:22. [PMID: 24920158 PMCID: PMC4061455 DOI: 10.1186/1471-2342-14-22] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 06/06/2014] [Indexed: 12/28/2022] Open
Abstract
Background Endobronchial ultrasonography (EBUS) has been applied as a routine procedure for the diagnostic of hiliar and mediastinal nodes. The authors assessed the relationship between the echographic appearance of mediastinal nodes, based on endobronchial ultrasound images, and the likelihood of malignancy. Methods The images of twelve malignant and eleven benign nodes were evaluated. A previous processing method was applied to improve the quality of the images and to enhance the details. Texture and morphology parameters analyzed were: the image texture of the echographies and a fractal dimension that expressed the relationship between area and perimeter of the structures that appear in the image, and characterizes the convoluted inner structure of the hiliar and mediastinal nodes. Results Processed images showed that relationship between log perimeter and log area of hilar nodes was lineal (i.e. perimeter vs. area follow a power law). Fractal dimension was lower in the malignant nodes compared with non-malignant nodes (1.47(0.09), 1.53(0.10) mean(SD), Mann–Whitney U test p < 0.05)). Conclusion Fractal dimension of ultrasonographic images of mediastinal nodes obtained through endobronchial ultrasound differ in malignant nodes from non-malignant. This parameter could differentiate malignat and non-malignat mediastinic and hiliar nodes.
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Affiliation(s)
- José Antonio Fiz
- Pulmonology Department, Hospital Universitari Germans Trias Pujol, Planta 8, Carretera del Canyet s/n, 08916, Badalona, Spain.
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Senturk A, Babaoglu E, Kilic H, Hezer H, Dogan HT, Hasanoglu HC, Bilaceroglu S. Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in the Diagnosis of Lymphoma. Asian Pac J Cancer Prev 2014; 15:4169-73. [DOI: 10.7314/apjcp.2014.15.10.4169] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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71
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Yamamoto T, Sakairi Y, Nakajima T, Suzuki H, Tagawa T, Iwata T, Mizobuchi T, Yoshida S, Nakatani Y, Yoshino I. Comparison between endobronchial ultrasound-guided transbronchial needle aspiration and 18F-fluorodeoxyglucose positron emission tomography in the diagnosis of postoperative nodal recurrence in patients with lung cancer. Eur J Cardiothorac Surg 2014; 47:234-8. [DOI: 10.1093/ejcts/ezu214] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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72
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Adequacy of lymph node transbronchial needle aspirates using convex probe endobronchial ultrasound for multiple tumor genotyping techniques in non-small-cell lung cancer. J Thorac Oncol 2014; 8:1438-1444. [PMID: 24128714 DOI: 10.1097/jto.0b013e3182a471a9] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Adequate tumor acquisition is essential to identify somatic molecular alterations in non-small-cell lung cancer (NSCLC), such as epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase (ALK) translocations. The success and failure rates for tumor genotyping of tissue obtained from fine-needle aspirates of nodal tissue using a convex probe endobronchial ultrasound (CP-EBUS) and other diagnostic modalities in routine NSCLC care have not been described. METHODS Clinicopathologic data, tumor genotype success and failure rates were retrospectively compiled and analyzed from 207 patient-tumor samples sent for routine tumor genotype in clinical practice, including 42 patient-tumor samples obtained from hilar or mediastinal lymph nodes using CP-EBUS. RESULTS The median age of the patients was 65 years, 62.3% were women, 77.8% were white, 26.6% were never smokers, 73.9% had advanced NSCLC, and 84.1% had adenocarcinoma histology. Tumor tissue was obtained from CP-EBUS-derived hilar or mediastinal nodes in 42 cases (20.2% of total). In this latter cohort, the overall success rate for EGFR mutation analysis was 95.2%, for Kirsten rat sarcoma viral oncogene homolog (KRAS) mutation 90.5%, and for ALK fluorescence in situ hybridization 90.5%. In the complete 207 tumors, the success rate for EGFR was 92.3%, for KRAS 91.8%, and for ALK 89.9%. The failure rates were not significantly different when comparing CP-EBUS-derived nodal tissue versus all other samples or versus surgical biopsies of mediastinal nodes, but were significantly lower than image-guided percutaneous transthoracic core-needle biopsies. CONCLUSIONS The success rate of multiple tumor genomic analyses techniques for EGFR, KRAS, and ALK gene abnormalities using routine lung cancer tissue samples obtained from hilar or mediastinal lymph nodes by means of CP-EBUS exceeds 90%, and this method of tissue acquisition is not inferior to other specimen types. Tumor genotype techniques are feasible in most CP-EBUS-derived samples and therefore further expansion of routine tumor genotype for the care of patients with NSCLC may be possible using targeted sample acquisition through CP-EBUS.
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73
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VanderLaan PA, Wang HH, Majid A, Folch E. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA): An overview and update for the cytopathologist. Cancer Cytopathol 2014; 122:561-76. [DOI: 10.1002/cncy.21431] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 03/27/2014] [Indexed: 12/12/2022]
Affiliation(s)
- Paul A. VanderLaan
- Department of Pathology, Division of Cytopathology, Beth Israel Deaconess Medical Center; Harvard Medical School; Boston Massachusetts
| | - Helen H. Wang
- Department of Pathology, Division of Cytopathology, Beth Israel Deaconess Medical Center; Harvard Medical School; Boston Massachusetts
| | - Adnan Majid
- Department of Surgery, Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center; Harvard Medical School; Boston Massachusetts
| | - Erik Folch
- Department of Surgery, Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center; Harvard Medical School; Boston Massachusetts
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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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75
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De Leyn P, Dooms C, Kuzdzal J, Lardinois D, Passlick B, Rami-Porta R, Turna A, Van Schil P, Venuta F, Waller D, Weder W, Zielinski M. Revised ESTS guidelines for preoperative mediastinal lymph node staging for non-small-cell lung cancer. Eur J Cardiothorac Surg 2014; 45:787-98. [PMID: 24578407 DOI: 10.1093/ejcts/ezu028] [Citation(s) in RCA: 511] [Impact Index Per Article: 51.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Accurate preoperative staging and restaging of mediastinal lymph nodes in patients with potentially resectable non-small-cell lung cancer (NSCLC) is of paramount importance. In 2007, the European Society of Thoracic Surgeons (ESTS) published an algorithm on preoperative mediastinal staging integrating imaging, endoscopic and surgical techniques. In 2009, the International Association for the Study of Lung Cancer (IASLC) introduced a new lymph node map. Some changes in this map have an important impact on mediastinal staging. Moreover, more evidence of the different mediastinal staging technique has become available. Therefore, a revision of the ESTS guidelines was needed. In case of computed tomography (CT)-enlarged or positron emission tomography (PET)-positive mediastinal lymph nodes, tissue confirmation is indicated. Endosonography [endobronchial ultrasonography (EBUS)/esophageal ultrasonography (EUS)] with fine-needle aspiration (FNA) is the first choice (when available), since it is minimally invasive and has a high sensitivity to rule in mediastinal nodal disease. If negative, surgical staging with nodal dissection or biopsy is indicated. Video-assisted mediastinoscopy is preferred to mediastinoscopy. The combined use of endoscopic staging and surgical staging results in the highest accuracy. When there are no enlarged lymph nodes on CT and when there is no uptake in lymph nodes on PET or PET-CT, direct surgical resection with systematic nodal dissection is indicated for tumours ≤ 3 cm located in the outer third of the lung. In central tumours or N1 nodes, preoperative mediastinal staging is indicated. The choice between endoscopic staging with EBUS/EUS and FNA or video-assisted mediastinoscopy depends on local expertise to adhere to minimal requirements for staging. For tumours >3 cm, preoperative mediastinal staging is advised, mainly in adenocarcinoma with high standardized uptake value. For restaging, invasive techniques providing histological information are advisable. Both endoscopic techniques and surgical procedures are available, but their negative predictive value is lower compared with the results obtained in baseline staging. An integrated strategy using endoscopic staging techniques to prove mediastinal nodal disease and mediastinoscopy to assess nodal response after induction therapy needs further study.
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Affiliation(s)
- Paul De Leyn
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
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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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Szlubowski A, Zieliński M, Soja J, Filarecka A, Orzechowski S, Pankowski J, Obrochta A, Jakubiak M, Węgrzyn J, Cmiel A. Accurate and safe mediastinal restaging by combined endobronchial and endoscopic ultrasound-guided needle aspiration performed by single ultrasound bronchoscope. Eur J Cardiothorac Surg 2014; 46:262-6. [PMID: 24420366 DOI: 10.1093/ejcts/ezt570] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES The aim of this prospective trial was to assess the diagnostic utility of combined endobronchial (EBUS) and endoscopic (EUS) ultrasound-guided needle aspiration by use of a single ultrasound bronchoscope (CUSb-NA) in non-small-cell lung cancer (NSCLC) restaging in patients after induction therapy. METHODS In a consecutive group of NSCLC patients with pathologically confirmed N2 disease (clinical stage IIIa and IIIb) who underwent induction chemotherapy, CUSb-NA was performed. All of the patients with negative or suspected for metastases (uncertain) diagnosed by endoscopy underwent subsequently transcervical extended mediastinal lymphadenectomy (TEMLA) as a confirmatory test. RESULTS From January 2009 to December 2012, 106 patients met the inclusion criteria and underwent restaging CUSb-NA under mild sedation, in whom 286 (mean 2.7, range 2-5) lymph node stations were biopsied, 127 (mean 1.2, range 1-3) by EBUS-transbronchial needle aspiration (TBNA) and 159 (mean 1.5, range 1-4) by EUS-fine needle aspiration (FNA). The CUSb-NA revealed metastatic lymph node involvement in 37/106 patients (34.9%). In 69 (65.1%) patients with negative and uncertain CUSb-NA in 4 (3.8%) out of them, who underwent subsequent TEMLA metastatic nodes were found in 18 patients (17.0%) and there were single lymph nodes found only in one mediastinal station (minimal N2) in 10 (9.4%) out of them. False-positive results were found in 2 (1.9%) patients. In 9 (8.5%) patients CUSb-NA occurred to be false negative in Stations 2R and 4R (only accessible for EBUS), exclusively in small nodes and in 4 (3.8%) patients in Station 5-not accessible for CUSb-NA. The prevalence of mediastinal lymph node metastases in the present study was 51.9%. Diagnostic sensitivity, specificity, total accuracy, positive predictive value and negative predictive value (NPV) of the restaging CUSb-NA were 67.3% (95% CI [confidence interval]-53-79), 96.0% (95% CI-86-99), 81.0% (95% CI-73-87), 95.0% (95% CI-83-99) and 73.0% (95% CI-61-83), respectively. The sensitivity, accuracy and NPV of CUSb-NA were higher compared with EBUS-TBNA and EUS-FNA alone. No complications of CUSb-NA were observed. CONCLUSIONS The CUSb-NA is a reasonable and safe technique in mediastinal restaging in NSCLC patients after induction therapy. Following our data, in patients with negative result of CUSb-NA, a surgical restaging of the mediastinum should be considered.
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Affiliation(s)
| | - Marcin Zieliński
- Department of Thoracic Surgery, Pulmonary Hospital, Zakopane, Poland
| | - Jerzy Soja
- Department of Medicine, Jagiellonian University, Kraków, Poland
| | - Anna Filarecka
- Department of Pulmonology, Pulmonary Hospital, Zakopane, Poland
| | | | | | - Anna Obrochta
- Department of Pathology, Pulmonary Hospital, Zakopane, Poland
| | | | - Joanna Węgrzyn
- Department of Pathology, Pulmonary Hospital, Zakopane, Poland
| | - Adam Cmiel
- Department of Applied Mathematics, AGH University of Science and Technology, Kraków, Poland
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Yasufuku K. Current clinical applications of endobronchial ultrasound. Expert Rev Respir Med 2014; 4:491-8. [DOI: 10.1586/ers.10.39] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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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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80
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Zaric B, Eberhardt R, Herth F, Stojsic V, Carapic V, Popovic ZP, Perin B. Linear and radial endobronchial ultrasound in diagnosis and staging of lung cancer. Expert Rev Med Devices 2014; 10:685-95. [DOI: 10.1586/17434440.2013.827512] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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81
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Advanced imaging (positron emission tomography and magnetic resonance imaging) and image-guided biopsy in initial staging and monitoring of therapy of lung cancer. Cancer J 2013; 19:208-16. [PMID: 23708067 DOI: 10.1097/ppo.0b013e318295185f] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The results of the National Lung Screening Trial strongly support early detection and definitive treatment to reduce lung cancer mortality. Once lung cancer is discovered, accurate staging at baseline is imperative to maximize patient benefit and cost-effective use of health care resources. Although computed tomography (CT) remains a powerful tool for staging of lung cancer, advances in other imaging modalities, specifically positron emission tomography/CT and magnetic resonance imaging, can improve baseline staging over CT alone and can allow a more rapid and accurate assessment of response to treatment. Although noninvasive imaging is extremely useful, tissue diagnosis remains the criterion standard for staging lung cancer and monitoring treatment response. Accordingly, tissue sampling using advanced bronchoscopic imaging guidance, such as ultrasound or electromagnetic navigation, allows precise tissue location and sampling of mediastinal nodes or lung nodules in the least invasive manner. In the future, bronchoscopy may allow real-time microscopic analysis.
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Abstract
Accurate staging of lung cancer is crucial to ensure the validity of lung cancer clinical research efforts and constitutes the cornerstone of the management of affected patients. The last decade has witnessed unprecedented technological advances allowing for more accurate and less invasive staging. In general, these techniques should be viewed as complementary rather than competitive, and indications, contraindications, and limitations of all staging techniques should be fully understood by providers involved with lung cancer patients. Noninvasive imaging techniques include chest computed tomography (CT) and positron emission tomography (PET). Invasive techniques can be nonsurgical such as needle-based techniques (endobronchial or endoscopic ultrasound) or surgical (mediastinoscopy and variants). The necessary multidisciplinary approach to lung cancer patients dictates that all stakeholders be familiar with the benefits and limitations of these newer techniques.
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Affiliation(s)
- Fabien Maldonado
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
| | - James R Jett
- Division of Oncology, National Jewish Health, Denver, CO
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Figueiredo VR, Jacomelli M, Rodrigues AJ, Canzian M, Cardoso PFG, Jatene FB. Current status and clinical applicability of endobronchial ultrasound-guided transbronchial needle aspiration. J Bras Pneumol 2013; 39:226-37. [PMID: 23670509 PMCID: PMC4075814 DOI: 10.1590/s1806-37132013000200015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 01/10/2013] [Indexed: 05/27/2023] Open
Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has played a key role in the diagnosis of mediastinal, paratracheal, and peribronchial lesions, as well as in lymph node staging for lung cancer. Despite its minimally invasive character, EBUS-TBNA has demonstrated a diagnostic yield comparable with that of established surgical methods. It has therefore gained credibility and has become a routine procedure at various referral centers. A successful EBUS-TBNA procedure requires careful planning, which includes a thorough review of the radiological imaging and special care during specimen collection and preparation, as well as technical expertise, experience with the procedure itself, and knowledge of the potential complications inherent to the procedure. The most common indications for EBUS-TBNA include lymph node staging for lung cancer and the diagnostic investigation of mediastinal/hilar masses and lymph node enlargement. Recently, tumor biomarkers in malignant samples collected during the EBUS-TBNA procedure have begun to be identified, and this molecular analysis has proven to be absolutely feasible. The EBUS-TBNA procedure has yet to be included on the Brazilian Medical Association list of medical procedures approved for reimbursement. The EBUS-TBNA procedure has shown to be a safe and accurate tool for lung cancer staging/restaging, as well as for the diagnosis of mediastinal, paratracheal, and peribronchial lesions/lymph node enlargement
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Affiliation(s)
- Viviane Rossi Figueiredo
- Department of Bronchoscopy, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - InCor/HC-FMUSP, Heart Institute/University of São Paulo School of Medicine Hospital das Clínicas - São Paulo, Brazil.
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Navani N, Janes SM. Endobronchial ultrasound-guided transbronchial needle aspiration for lymphoma: the final frontier. Am J Respir Crit Care Med 2013; 188:1183-5. [PMID: 24236584 DOI: 10.1164/rccm.201309-1701ed] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- Neal Navani
- 1 Department of Thoracic Medicine University College London Hospital London, United Kingdom and Lungs for Living Research Centre University College London London, United Kingdom
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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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Huang JA, Browning R, Wang KP. Counterpoint: Should Endobronchial Ultrasound Guide Every Transbronchial Needle Aspiration of Lymph Nodes? No. Chest 2013; 144:734-737. [DOI: 10.1378/chest.13-0704] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Jaklitsch MT, Gu L, Demmy T, Harpole DH, D'Amico TA, McKenna RJ, Krasna MJ, Kohman LJ, Swanson SJ, DeCamp MM, Wang X, Barry S, Sugarbaker DJ. Prospective phase II trial of preresection thoracoscopic mediastinal restaging after neoadjuvant therapy for IIIA (N2) non-small cell lung cancer: results of CALGB Protocol 39803. J Thorac Cardiovasc Surg 2013; 146:9-16. [PMID: 23768804 PMCID: PMC3704168 DOI: 10.1016/j.jtcvs.2012.12.069] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 12/07/2012] [Accepted: 12/18/2012] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Accurate pathologic restaging of N2 stations after neoadjuvant therapy in stage IIIA (N2) non-small cell lung cancer is needed. METHODS A prospective multi-institutional trial was designed to judge the feasibility of videothoracoscopy to restage the ipsilateral nodes in mediastinoscopy-proven stage IIIA (N2) non-small cell lung cancer after 2 cycles of platinum-based chemotherapy and/or 40 Gy or more of radiotherapy. The goals included biopsy of 3 negative N2 node stations or to identify 1 positive N2 node or pleural carcinomatosis. RESULTS Ten institutions accrued 68 subjects. Of the 68 subjects, 46 (68%) underwent radiotherapy and 66 (97%) underwent chemotherapy. Videothoracoscopy successfully met the prestudy feasibility in 27 patients (40%): 3 negative stations confirmed at thoracotomy in 7, persistent stage N2 disease in 16, and pleural carcinomatosis in 4. In 20 procedures (29%), no N2 disease was found, 3 stations were not biopsied because of unanticipated nodal obliteration. Thus, 47 videothoracoscopy procedures (69%, 95% confidence interval, 57%-80%) restaged the mediastinum. Videothoracoscopy was unsuccessful in 21 patients (31%) because the procedure had to be aborted (n = 11) or because of false-negative stations (n = 10). Of the 21 failures, 15 were right-sided, and 10 had a positive 4R node. The sensitivity of videothoracoscopy was 67% (95% confidence interval, 47%-83%), and the negative predictive value was 73% (95% confidence interval, 56%-86%) if patients with obliterated nodal tissue were included. The sensitivity was 83% (95% confidence interval, 63%-95%) and the negative predictive value was 64% (95% confidence interval, 31%-89%) if those patients were excluded. The specificity was 100%. One death occurred after thoracotomy. CONCLUSIONS Videothoracoscopy restaging was "feasible" in this prospective multi-institutional trial and provided pathologic specimens of the ipsilateral nodes. Videothoracoscopy restaging was limited by radiation and the 4R nodal station.
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Affiliation(s)
- Michael T Jaklitsch
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass 02115, USA.
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Ripley RT, Rusch VW. Role of induction therapy: surgical resection of non-small cell lung cancer after induction therapy. Thorac Surg Clin 2013; 23:273-85. [PMID: 23931012 DOI: 10.1016/j.thorsurg.2013.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Patients with Stage III non-small cell lung cancer are best managed by multimodality therapy. Patients with N2 disease can be treated with induction therapy (usually chemotherapy) followed by surgical resection. Patients whose medical comorbidities preclude surgery should be treated with definitive chemoradiotherapy. T3 or T4 tumors involving the superior sulcus or spine are best managed with induction chemoradiotherapy and surgical resection.
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Affiliation(s)
- R Taylor Ripley
- Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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90
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Relevance of endoscopic ultrasonography and endobronchial ultrasonography to thoracic surgeons. Thorac Surg Clin 2013; 23:199-210. [PMID: 23566972 DOI: 10.1016/j.thorsurg.2013.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Although cervical mediastinoscopy has been considered the gold standard for mediastinal staging in non-small cell lung cancer, new minimally invasive endoscopic ultrasound technology, such as endobronchial ultrasound-guided transbronchial needle aspiration and endoscopic ultrasound fine-needle aspiration, have changed the practice of invasive staging. Based on the current evidence, minimally invasive endoscopic staging is the recommended choice in patients with high pretest probability of lymph node metastasis; however, all negative results should be verified by mediastinoscopy, especially in centers with low expertise. In patients with low pretest probability, mediastinoscopy may be omitted when adequate sampling is achieved with endoscopic modalities.
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91
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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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Dhillon SS, Dexter EU. Advances in bronchoscopy for lung cancer. J Carcinog 2012; 11:19. [PMID: 23346012 PMCID: PMC3548337 DOI: 10.4103/1477-3163.105337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Accepted: 12/13/2012] [Indexed: 12/14/2022] Open
Abstract
Bronchoscopic techniques have seen significant advances in the last decade. The development and refinement of different types of endobronchial ultrasound and navigation systems have led to improved diagnostic yield and lung cancer staging capabilities. The complication rate of these minimally invasive procedures is extremely low as compared to traditional transthoracic needle biopsy and surgical sampling. These advances augment the safe array of methods utilized in the work up and management algorithms of lung cancer.
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Affiliation(s)
- Samjot Singh Dhillon
- Department of Medicine Pulmonary Medicine and Thoracic Oncology, Roswell Park Cancer Institute, New York, USA ; Department of Medicine, State University of New York at Buffalo, New York, USA
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CZARNECKA KASIA, YASUFUKU KAZUHIRO. Interventional pulmonology: Focus on pulmonary diagnostics. Respirology 2012; 18:47-60. [DOI: 10.1111/j.1440-1843.2012.02211.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Advances in bronchoscopy have contributed valuable tools to the diagnosis and staging of lung cancer. Detection of lesions at the premalignant microscopic stage has become possible with autofluorescence bronchoscopy and narrow band imaging. Bronchoscopy also allows for sampling of visible intra-bronchial lesions and for transbronchial needle aspiration of lesions in pulmonary parenchyma. With endobronchial ultrasound guidance, real-time evaluation and biopsy of mediastinal and pulmonary lesions can be achieved, enabling accurate clinical and pathological T-staging and N-staging without the need for surgery. In combination with advanced imaging techniques, Navigational bronchoscopy allows for the targeting and biopsy of the most peripheral lesions that are located in the smallest airways. For patients in whom tumor genetics are important, bronchoscopic-guided transbronchial biopsy can provide sufficient material for molecular analysis. As minimally invasive technology continues to evolve and improve, bronchoscopic techniques are poised to continue to be essential for the diagnosis and staging of lung cancer.
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Affiliation(s)
- Waël C Hanna
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
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Hanna WC, Yasufuku K. Mediastinoscopy in the era of endobronchial ultrasound: when should it be performed? ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s13665-012-0032-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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97
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Yasufuku K, Feith JF. Cytological specimens obtained by endobronchial ultrasound-guided transbronchial needle aspiration: Sample handling and role of rapid on-site evaluation. Ann Pathol 2012; 32:e35-46, 421-32. [DOI: 10.1016/j.annpat.2012.09.212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 09/13/2012] [Indexed: 11/29/2022]
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Fleury-Feith J, Yasufuku K. Prélèvements cytologiques guidés par échoendoscopie bronchique : prise en charge du matériel recueilli et rôle de l’examen extemporané. Ann Pathol 2012. [DOI: 10.1016/j.annpat.2012.09.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Endobronchial Ultrasound-guided Transbronchial Miniforceps Biopsy of Mediastinal and Hilar Lymph Node Stations. J Bronchology Interv Pulmonol 2012; 16:168-71. [PMID: 23168545 DOI: 10.1097/lbr.0b013e3181af7a9f] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Linear array endobronchial ultrasound has significantly improved the diagnostic yield of transbronchial needle aspiration for the diagnosis of centrally located lesions within the thorax. Although transbronchial needle aspiration has become an accepted technique for diagnosing solid tumors within the chest, its yield for hematologic malignancies such as lymphoma and other benign conditions in which direct examination of tissue architecture are preferred is lower. Currently, surgical biopsies by mediastinoscopy or video-assisted thoracic surgery are often required to obtain adequate tissue specimens to make these diagnoses. In this retrospective study, we review our experience with patients who underwent endobronchial ultrasound-guided miniforceps biopsy of abnormalities at mediastinal and hilar lymph node stations.
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Wang Memoli JS, Silvestri GA. Endobronchial Ultrasound-Guided Biopsy of Mediastinal and Hilar Lymph Nodes: Response. Chest 2012. [DOI: 10.1378/chest.12-2328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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