1
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Ji XY, Li H, Chen HH, Lin J. Diagnostic performance of RASSF1A and SHOX2 methylation combined with EGFR mutations for differentiation between small pulmonary nodules. J Cancer Res Clin Oncol 2023:10.1007/s00432-023-04745-8. [PMID: 37097393 DOI: 10.1007/s00432-023-04745-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 04/03/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND AND AIM Aberrant methylation of Ras association domain family 1, isoform A (RASSF1A), and short-stature homeobox gene 2 (SHOX2) promoters has been validated as a pair of valuable biomarkers for diagnosing early lung adenocarcinomas (LUADs). Epidermal growth factor receptor (EGFR) is the key driver mutation in lung carcinogenesis. This study aimed to investigate the aberrant promoter methylation of RASSF1A and SHOX2, and the genetic mutation of EGFR in 258 specimens of early LUADs. METHODS We retrospectively selected 258 paraffin-embedded samples of pulmonary nodules measuring 2 cm or less in diameter and evaluated the diagnostic performance of individual biomarker assays and multiple panels between noninvasive (group 1) and invasive lesions (groups 2A and 2B). Then, we investigated the interaction between genetic and epigenetic alterations. RESULTS The degree of RASSF1A and SHOX2 promoter methylation and EGFR mutation was significantly higher in invasive lesions than in noninvasive lesions. The three biomarkers distinguished between noninvasive and invasive lesions with reliable sensitivity and specificity: 60.9% sensitivity [95% confidence interval (CI) 52.41-68.78] and 80.0% specificity (95% CI 72.14-86.07). The novel panel biomarkers could further discriminate among three invasive pathological subtypes (area under the curve value > 0.6). The distribution of RASSF1A methylation and EGFR mutation was considerably exclusive in early LUAD (P = 0.002). CONCLUSION DNA methylation of RASSF1A and SHOX2 is a pair of promising biomarkers, which may be used in combination with other driver alterations, such as EGFR mutation, to support the differential diagnosis of LUADs, especially for stage I.
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Affiliation(s)
- Xiang-Yu Ji
- Department of Pathology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
- Department of Pathology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, People's Republic of China
| | - Hong Li
- Department of Pathology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Hui-Hui Chen
- Department of Pathology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Jie Lin
- Department of Pathology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China.
- Department of Pathology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, People's Republic of China.
- National Virtual and Reality Experimental Education Center for Medical Morphology, Southern Medical University, Guangzhou, People's Republic of China.
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2
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Assisi D, Gallina FT, Forcella D, Tajè R, Melis E, Visca P, Pierconti F, Venti E, Facciolo F. Transesophageal Endoscopic Ultrasound Fine Needle Biopsy for the Diagnosis of Mediastinal Masses: A Retrospective Real-World Analysis. J Clin Med 2022; 11:jcm11185469. [PMID: 36143116 PMCID: PMC9506435 DOI: 10.3390/jcm11185469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Endoscopic ultrasound (EUS) plays an important role in the diagnosis and staging of thoracic disease. Our report studies the diagnostic performance and clinical impact of EUS fine needle aspiration (FNA) in a homogenous cohort of patients according to the distribution of the enlarged MLNs or pulmonary masses. Methods: We retrospectively reviewed the diagnostic performance of 211 EUS-FNA in 200 consecutive patients with enlarged or PET-positive MLNs and para-mediastinal masses who were referred to our oncological center between January 2019 and May 2020. Results: The overall sensitivity of EUS-FNA was 85% with a corresponding negative predictive value (NPV) of 56% and an accuracy of 87.5%. The sensitivity and accuracy in patients with abnormal MLNs were 81.1% and 84.4%, respectively. In those with para-mediastinal masses, sensitivity and accuracy were 96.4% and 96.8%. The accuracy for both masses and lymph nodes was 100%, and in the LAG (left adrenal gland), it was 66.6%. Conclusions: Our results show that, in patients with suspected mediastinal masses, EUS-FNA is an accurate technique to evaluate all reachable mediastinal nodal stations, including station 5.
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Affiliation(s)
- Daniela Assisi
- Digestive Endoscopy Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Filippo Tommaso Gallina
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
- Correspondence: ; Tel.: +39-0652665218
| | - Daniele Forcella
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Riccardo Tajè
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Enrico Melis
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Paolo Visca
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Federico Pierconti
- Anesthesiology and Intensive Care Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Emanuela Venti
- Anesthesiology and Intensive Care Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Francesco Facciolo
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
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3
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Visser MPJ, van Grimbergen I, Hölters J, Barendregt WB, Vermeer LC, Vreuls W, Janssen J. Performance insights of endobronchial ultrasonography (EBUS) and mediastinoscopy for mediastinal lymph node staging in lung cancer. Lung Cancer 2021; 156:122-128. [PMID: 33931293 DOI: 10.1016/j.lungcan.2021.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/28/2021] [Accepted: 04/02/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Endobronchial Ultrasonography (EBUS) and mediastinoscopy are used for mediastinal lymph node staging in patients with suspected non-small cell lung carcinoma (NSCLC). In our hospital, confirmatory mediastinoscopy has been largely abandoned, which may reduce the number of surgical interventions and health care costs. This study provides insight into EBUS and mediastinoscopy performance in patients with proven NSCLC from January 2007 until January 2019. METHODS This is a single-centre, retrospective study, evaluating unforeseen N2 rates, negative predictive value and survival, providing insight into the diagnostic yield of EBUS and mediastinoscopy. Surgical lung resection with lymph node dissection was used as reference. RESULTS A total of 418 patients with proven NSCLC after lung resection (mean age: 66 years; 61 % male) and 118 patients who underwent mediastinoscopy, have been included in the study. The overall prevalence of N2 metastases after lung resection was 10.5 %. The percentage of unforeseen N2 cases after negative EBUS was 14.5 %, and 14.3 % after negative mediastinoscopy. Over the past nine years, none of the confirmatory mediastinoscopies were tumor positive after negative EBUS results. The median survival in patients with surgically confirmed N2 metastases was 33 months, compared to 23 months in patients with EBUS/mediastinoscopy-proven N2 metastases. CONCLUSION Despite optimisation of mediastinal staging procedures, it remains difficult to identify all patients with N2 metastases in the workup of NSCLC. In our institute, confirmatory mediastinoscopy has no added value after tumor-negative EBUS procedures, and has been abandoned as standard procedure.
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Affiliation(s)
- M P J Visser
- Department of Pulmonary Medicine, Canisius-Wilhelmina Hospital, Weg Door Jonkerbos 100, 6532SZ, Nijmegen, the Netherlands.
| | - I van Grimbergen
- Department of Pulmonary Medicine, Canisius-Wilhelmina Hospital, Weg Door Jonkerbos 100, 6532SZ, Nijmegen, the Netherlands
| | - J Hölters
- Department of Pulmonary Medicine, Canisius-Wilhelmina Hospital, Weg Door Jonkerbos 100, 6532SZ, Nijmegen, the Netherlands
| | - W B Barendregt
- Department of Surgery, Canisius-Wilhelmina Hospital, Weg Door Jonkerbos 100, 6532SZ, Nijmegen, the Netherlands
| | - L C Vermeer
- Department of Pulmonary Medicine, Canisius-Wilhelmina Hospital, Weg Door Jonkerbos 100, 6532SZ, Nijmegen, the Netherlands
| | - W Vreuls
- Department of Pathology, Canisius-Wilhelmina Hospital, Weg Door Jonkerbos 100, 6532SZ, Nijmegen, the Netherlands
| | - J Janssen
- Department of Pulmonary Medicine, Canisius-Wilhelmina Hospital, Weg Door Jonkerbos 100, 6532SZ, Nijmegen, the Netherlands
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Chrysikos S, Karampitsakos T, Zervas E, Anyfanti M, Papaioannou O, Tzouvelekis A, Hillas G, Dimakou K. Thoracic endosonography (EBUS/EUS-b) in the diagnosis of different intrathoracic diseases: A 4-year experience at a single-centre in Greece. Int J Clin Pract 2021; 75:e13684. [PMID: 32813909 DOI: 10.1111/ijcp.13684] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 08/16/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND In the last decade, the advent of thoracic endosonography has revolutionised the field of diagnostic bronchoscopy. METHODS We conducted a single-centre prospective study in "Sotiria" Chest diseases hospital between January 2016 and December 2019. The study aimed to evaluate the efficacy and diagnostic value of combined EBUS/EUS-b in comparison with EBUS-TBNA and EUS-b FNA in different intrathoracic diseases. RESULTS A total of 266 patients were enrolled (70.7% males, 85.7% smokers, mean age ± SD: 62.8 ± 11.8). Diagnosis and staging of suspected lung cancer (LC) were the main indications for EBUS/EUS-b in 56.7% of patients, followed by lymphadenopathy of unknown origin in 27%, lymphadenopathy in previous malignancy in 10.9%, and staging of proven LC in 5.3%. EUS-b FNA alone or combined with EBUS-TBNA was performed in 14.7% of patients. A total of 512 lymph nodes was sampled (481 through EBUS-TBNA and 31 through EUS-b FNA). EBUS/EUS-b led to a definitive diagnosis in 68.4% of the patients. Most cases (50.4%) were malignancies, while 18% represented benign diseases (83.3% sarcoidosis). Sensitivity of combined EBUS/EUS-b was higher in comparison with sensitivity of both procedures alone (100% vs 89.4% vs 88.9%). Accordingly, the overall sensitivity of EBUS/EUS-b for the detection of malignancy and sarcoidosis was 93% and 95.2%, respectively. No severe complications were observed. CONCLUSION Thoracic endosonography is an efficient, safe, minimally invasive tool yielding high sensitivity and diagnostic accuracy in patients with suspected malignancy and mediastinal lymphadenopathy. Experienced pulmonologists in EBUS-TBNA should more routinely perform EUS-b FNA to avoid unnecessary surgical interventions.
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Affiliation(s)
- Serafeim Chrysikos
- 5th Respiratory Medicine Department, "Sotiria" Chest Diseases Hospital, Athens, Greece
| | | | - Eleftherios Zervas
- 7th Respiratory Medicine Department, "Sotiria" Chest Diseases Hospital, Athens, Greece
| | - Maria Anyfanti
- Intensive Care Unit, Georgios Gennimatas General Hospital, Athens, Greece
| | - Ourania Papaioannou
- 5th Respiratory Medicine Department, "Sotiria" Chest Diseases Hospital, Athens, Greece
| | - Argyrios Tzouvelekis
- 1st Academic Respiratory Medicine Department, "Sotiria" Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Hillas
- 5th Respiratory Medicine Department, "Sotiria" Chest Diseases Hospital, Athens, Greece
| | - Katerina Dimakou
- 5th Respiratory Medicine Department, "Sotiria" Chest Diseases Hospital, Athens, Greece
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Shi J, Chen X, Zhang L, Fang X, Liu Y, Zhu X, Zhang H, Fan L, Gu J, Zhang S, She B, Han H, Yi X. Performance Evaluation of SHOX2 and RASSF1A Methylation for the Aid in Diagnosis of Lung Cancer Based on the Analysis of FFPE Specimen. Front Oncol 2020; 10:565780. [PMID: 33425721 PMCID: PMC7793934 DOI: 10.3389/fonc.2020.565780] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 11/09/2020] [Indexed: 12/28/2022] Open
Abstract
Emerging molecular diagnostic methods are more sensitive and objective, which can overcome the intrinsic failings of morphological diagnosis. Here, a RT-PCR-based in vitro diagnostic test kit (LungMe®) was developed and characterized to simultaneously quantify the DNA methylation of SHOX2 and RASSF1A in FFPE tissue specimens. The clinical manifestations were evaluated in 251 FFPE samples with specificity and sensitivity of 90.4 and 89.8%, respectively. Furthermore, the quantitative analysis shows that the degree of SHOX2 methylation was correlated with the stages of lung cancer, but not in the case of RASSF1A. Our observation indicated that the DNA methylation of SHOX2 and RASSF1A may play different roles in cancer development. Comparison of the methylation levels of SHOX2 and RASSF1A between cancer and cancer-adjacent specimens (n = 30), showed they have “epigenetic field defect”. As additional clinical validation, the hypermethylation of SHOX2 and RASSF1A was detected not only in surgical operative specimens, but also in histopathological negative puncture biopsies. SHOX2 and RASSF1A methylation detection can be used to increase sensitivity and NPV, which provide us with a more accurate method of differential diagnosis and are likely to be rapidly applied in clinical examinations.
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Affiliation(s)
- Juanhong Shi
- Department of Pathology, Tongji Hospital, Tongji University, Shianghai, China
| | - Xue Chen
- Department of Pathology, Tongji Hospital, Tongji University, Shianghai, China
| | - Long Zhang
- Department of Pathology, Tongji Hospital, Tongji University, Shianghai, China
| | - Xia Fang
- Department of Pulmonary and Critical Care Medicine, Dongfang Hospital Affiliated to Tongji University, Shanghai, China
| | - Yuting Liu
- Department of Pathology, Tongji Hospital, Tongji University, Shianghai, China
| | - Xuyou Zhu
- Department of Pathology, Tongji Hospital, Tongji University, Shianghai, China
| | - Haoyang Zhang
- Department of Pathology, Tongji Hospital, Tongji University, Shianghai, China
| | - Lichao Fan
- Department of Pulmonary and Critical Care Medicine, Shanghai Pulmonary Hospital Affiliated to Tongji University, Shanghai, China
| | - Jun Gu
- Department of Pathology, Tongji Hospital, Tongji University, Shianghai, China
| | - Suxia Zhang
- Department of Pathology, Tongji Hospital, Tongji University, Shianghai, China
| | - Bin She
- Academic Development, Tellgen Corporation, Shanghai, China
| | - Hongxiu Han
- Department of Pathology, Tongji Hospital, Tongji University, Shianghai, China
| | - Xianghua Yi
- Department of Pathology, Tongji Hospital, Tongji University, Shianghai, China
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6
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Chi J, Lian SS, Yang Q, Luo GY, Xu GL. The utility of EBUS-TBNA in the diagnosis of suspected intrathoracic recurrence after esophageal cancer surgery. Jpn J Clin Oncol 2020; 50:602-608. [PMID: 31943047 DOI: 10.1093/jjco/hyz212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/18/2019] [Accepted: 12/23/2019] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Postoperative recurrences, especially anastomotic recurrence and regional lymph node recurrence were common in patients even with curative esophageal cancer surgery. Endobronchial ultrasound-guided transbronchial needle aspiration is an alternative to mediastinoscopy in patients with lung cancer and mediastinal lymphadenopathy. The aim of our study is to evaluate the utility of endobronchial ultrasound-guided transbronchial needle aspiration in postoperative patients suffered from esophageal malignancy. METHODS All endobronchial ultrasound-guided transbronchial needle aspiration cases performed between August 2015 and December 2018 in our center were all retrospective reviewed. The patients with enlarged mediastinal lymph node and/or unknown intrathoracic mass after esophageal cancer surgery were enrolled. Final diagnoses were determined by the result of endobronchial ultrasound-guided transbronchial needle aspiration, second surgery and/or clinical follow-up for at least 6 months. RESULTS Overall 29 patients were included in the analysis with 30 lesions sampled. No endobronchial ultrasound-guided transbronchial needle aspiration related complications were observed. In total, 22 of these (73.3%) had a diagnosis of tumor recurrence, whereas eight (26.7%) had a different diagnosis: two (6.7%) had a second primary malignancy and three (10.0%) had non-neoplastic diagnosis. Cases were false-negative in 3 (10.0%) out of 30 lesions. The overall sensitivity, negative predicted value and diagnostic accuracy were 88.9, 50.0 and 90.0%, respectively. CONCLUSIONS Given its safety, low invasiveness, high sensitivity and diagnostic accuracy, endobronchial ultrasound-guided transbronchial needle aspiration could be considered for mediastinal lymphadenopathy and intrathoracic masses of unknown origin in patients after radical esophageal cancer resection, and its strategic role in the management of these patients was confirmed.
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Affiliation(s)
- Jun Chi
- Department of Endoscopy, Sun Yat-Sen University Cancer Center Guangzhou, Guangdong, China.,State Key Laboratory of Oncology in South China, Sun Yat-sen University Guangzhou, Guangdong, China
| | - Shan-Shan Lian
- Department of Radiology, Sun Yat-Sen University Cancer Center Guangzhou, Guangdong, China, and.,State Key Laboratory of Oncology in South China, Sun Yat-sen University Guangzhou, Guangdong, China
| | - Qing Yang
- Department of Endoscopy, Sun Yat-Sen University Cancer Center Guangzhou, Guangdong, China.,State Key Laboratory of Oncology in South China, Sun Yat-sen University Guangzhou, Guangdong, China
| | - Guang-Yu Luo
- Department of Endoscopy, Sun Yat-Sen University Cancer Center Guangzhou, Guangdong, China.,State Key Laboratory of Oncology in South China, Sun Yat-sen University Guangzhou, Guangdong, China
| | - Guo-Liang Xu
- Department of Endoscopy, Sun Yat-Sen University Cancer Center Guangzhou, Guangdong, China.,State Key Laboratory of Oncology in South China, Sun Yat-sen University Guangzhou, Guangdong, China
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Cervical mediastinoscopy: Safety profile, feasibility and diagnostic accuracy in a decade in a single center. Pulmonology 2019; 25:119-120. [PMID: 30792171 DOI: 10.1016/j.pulmoe.2019.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 01/16/2019] [Accepted: 01/19/2019] [Indexed: 12/26/2022] Open
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Inage T, Nakajima T, Itoga S, Ishige T, Fujiwara T, Sakairi Y, Wada H, Suzuki H, Iwata T, Chiyo M, Yoshida S, Matsushita K, Yasufuku K, Yoshino I. Molecular Nodal Staging Using miRNA Expression in Lung Cancer Patients by Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration. Respiration 2018; 96:267-274. [PMID: 29898461 DOI: 10.1159/000489178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 04/06/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The limited negative predictive value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has often been discussed. OBJECTIVE The aim of this study was to identify a highly sensitive molecular biomarker for lymph node staging by EBUS-TBNA. METHODS Five microRNAs (miRNAs) (miR-200a, miR-200b, miR-200c, miR-141, and let-7e) were selected as biomarker candidates for the detection of nodal metastasis in a miRNA expression analysis. After having established a cutoff level of expression for each marker to differentiate malignant from benign lymph nodes among surgically dissected lymph nodes, the cutoff level was applied to snap-frozen EBUS-TBNA samples. Archived formalin-fixed paraffin- embedded (FFPE) samples rebiopsied by EBUS-TBNA after induction chemoradiotherapy were also analyzed. RESULTS The expression of all candidate miRNAs was significantly higher in metastatic lymph nodes than in benign ones (p < 0.05) among the surgical samples. miR-200c showed the highest diagnostic yield, with a sensitivity of 95.4% and a specificity of 100%. When the cutoff value for miR-200c was applied to the snap-frozen EBUS-TBNA samples, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 97.4, 81.8, 95.0, 90.0, and 94.0%, respectively. For restaging FFPE EBUS- TBNA samples, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 100, 60.0, 80.0, 100, and 84.6%, respectively. Among the restaged samples, 4 malignant lymph nodes were false negative by EBUS-TBNA, but they were accurately identified by miR-200c. CONCLUSIONS miR-200c can be used as a highly sensitive molecular staging biomarker that will enhance nodal staging of lung cancer.
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Affiliation(s)
- Terunaga Inage
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takahiro Nakajima
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Sakae Itoga
- Clinical Laboratory, Chiba University Hospital, Chiba, Japan
| | - Takayuki Ishige
- Clinical Laboratory, Chiba University Hospital, Chiba, Japan
| | - Taiki Fujiwara
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yuichi Sakairi
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hironobu Wada
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hidemi Suzuki
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takekazu Iwata
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Masako Chiyo
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Shigetoshi Yoshida
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Kazuyuki Matsushita
- Department of Molecular Diagnosis, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
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9
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Jain D, Allen TC, Aisner DL, Beasley MB, Cagle PT, Capelozzi VL, Hariri LP, Lantuejoul S, Miller R, Mino-Kenudson M, Monaco SE, Moreira A, Raparia K, Rekhtman N, Roden AC, Roy-Chowdhuri S, da Cunha Santos G, Thunnissen E, Troncone G, Vivero M. Rapid On-Site Evaluation of Endobronchial Ultrasound–Guided Transbronchial Needle Aspirations for the Diagnosis of Lung Cancer: A Perspective From Members of the Pulmonary Pathology Society. Arch Pathol Lab Med 2017. [DOI: 10.5858/arpa.2017-0114-sa] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
Endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA) has emerged as a very useful tool in the field of diagnostic respiratory cytology. Rapid on-site evaluation (ROSE) of EBUS-TBNA not only has the potential to improve diagnostic yield of the procedure but also to triage samples for predictive molecular testing to guide personalized treatments for lung cancer.
Objective.—
To provide an overview of the current status of the literature regarding ROSE of EBUS-TBNA in the diagnosis of lung cancer.
Data Sources.—
An electronic literature search in PubMed and Google databases was performed using the following key words: cytology, lung cancer, on-site evaluation, rapid on-site evaluation, and ROSE EBUS-TBNA. Only articles published in English were included in this review.
Conclusions.—
Rapid on-site evaluation can ensure that the targeted lesion is being sampled and can enable appropriate specimen triage. If available, it should be used with EBUS-TBNA in the diagnosis of lung cancer because it can minimize repeat procedures for additional desired testing (ie, molecular studies). Some studies have shown that ROSE does not adversely affect the number of aspirations, total procedure time of EBUS-TBNA, or the rate of postprocedure complications; it is also helpful in providing a preliminary diagnosis that can reduce the number of additional invasive procedures, such as mediastinoscopy. As EBUS technology continues to evolve, our knowledge of the role of ROSE in EBUS-TBNA for the diagnosis of lung cancer will also continue to grow and evolve.
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10
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Nardecchia E, Cattoni M, Dominioni L. Endobronchial ultrasound-transbronchial needle aspiration for mediastinal staging of non-small cell lung cancer: variability of results and perspectives. J Thorac Dis 2017; 9:S418-S424. [PMID: 28603655 DOI: 10.21037/jtd.2017.04.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The remarkable value of endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) for mediastinal staging of non-small cell lung cancer (NSCLC) is recognized worldwide. Reports from different centers however show considerable variation of EBUS-TBNA performance in terms of diagnostic yield, sensitivity and negative predictive value (NPV). Interpretation of EBUS-TBNA diagnostic efficacy requires clarifying whether the technique is used for purely diagnostic purpose or mediastinal staging, recognizing that different study groups may be inherently heterogeneous and that numerous factors may impact on the procedure outcomes. Review of these factors indicates that the prevalence of N2/N3 disease, the thoroughness of mediastinal sampling and >3 needle passes per target lymph node (LN) [in the absence of rapid on-site evaluation (ROSE)] influence the procedure outcomes, while many details in the sample preparation technique are unlikely to impact on the results and should be left to the proceduralists' preference. Generalized use of a standardized database for prospective collection of relevant EBUS-TBNA data would allow reporting institutional results by sub-groups of N2/N3 disease prevalence and thoroughness of staging, and would help establishing quality standards for the procedure.
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Affiliation(s)
- Elisa Nardecchia
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Maria Cattoni
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Lorenzo Dominioni
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
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11
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Jeebun V, Harrison RN. Understanding local performance data for EBUS-TBNA: insights from an unselected case series at a high volume UK center. J Thorac Dis 2017; 9:S350-S362. [PMID: 28603645 DOI: 10.21037/jtd.2017.05.18] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND We reviewed the diagnostic performance of endobronchial ultrasound transbronchial aspiration (EBUS-TBNA) on an unselected large cohort of patients who underwent the procedure in our institution in the past 3 years and to compare against published standards and existing literature. METHODS All consecutive patients who underwent EBUS from January 2013 to December 2015 were included in the retrospective analysis, with a minimum of 6 months of clinico-radiological follow up. For assessing EBUS-TBNA performance, patients were analysed in three subgroups based on the indication for the EBUS-TBNA: in investigation of isolated mediastinal and/or hilar lymphadenopathy (IMHL), in staging of suspected or confirmed non-small cell lung cancer (NSCLC) and in making a tissue diagnosis in suspected thoracic or extrathoracic cancer. For patients subjected to EBUS-TBNA for staging in suspected lung cancer, accuracy of EBUS was measured by its ability to determine the true N2 stage. RESULTS A total of 1,656 lymph nodes and 138 peribronchial/peritracheal masses were sampled in 940 patients over the study period. The prevalence of reactive lymphadenopathy was 34%. The overall sensitivity to detect pathological disease was 81.6% (95% CI: 74.2-87.6%) whilst NPV was 74.8% (95% CI: 65.2-82.8%). Amongst patients who underwent EBUS-TBNA for staging purposes, the sensitivity for N2 staging was 83.7% (95% CI: 76.2-89.6%) and NPV was 81.6% (95% CI: 73.2-88.2%). The prevalence of N2 disease was 58%. In the subgroup of patients who proceeded to surgical sampling, the sensitivity was higher with the N2/N3 disease prevalence of 67.4%. The sensitivity of EBUS-TBNA to make a tissue diagnosis of thoracic or extrathoracic cancer was 88% (95% CI: 85.1-90.5%) and a NPV of 62% (95% CI: 54.7-69.0%). The disease prevalence was 83.6%. CONCLUSIONS This retrospective study of a large volume of patients represents real life practice and provides an accurate representation of the typical cohort of patients referred in for EBUS-TBNA to the general respiratory physician in UK. Our study highlights the pitfalls in collecting and analyzing data but also demonstrates how they can be used to improve service performance.
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Affiliation(s)
- Vandana Jeebun
- Department of Respiratory Medicine, North Tees and Hartlepool NHS Foundation Trust, Cleveland, UK
| | - Richard Neil Harrison
- Department of Respiratory Medicine, North Tees and Hartlepool NHS Foundation Trust, Cleveland, UK
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Nasir BS, Yasufuku K, Liberman M. When Should Negative Endobronchial Ultrasonography Findings be Confirmed by a More Invasive Procedure? Ann Surg Oncol 2017; 25:68-75. [PMID: 28074327 DOI: 10.1245/s10434-016-5674-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Indexed: 12/25/2022]
Abstract
The treatment of non-small cell lung cancer is largely dependent on accurate staging in order to determine appropriate therapy. Despite advances in imaging, such as computed tomography and positron emission tomography, invasive mediastinal staging is frequently needed to rule out mediastinal involvement prior to curative-intent stereotactic ablative radiotherapy or surgical resection. Surgical mediastinal staging with mediastinoscopy, or anterior mediastinotomy, were traditionally considered the gold standard for invasive mediastinal staging. Endobronchial and endoscopic ultrasound have emerged as modern techniques that are being used as first-line options instead of surgical staging. As experience is gained with these newer techniques, the need for confirmatory surgical staging continues to diminish. This article addresses the situations in which negative results should be confirmed by a more invasive procedure.
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Affiliation(s)
- Basil S Nasir
- Division of Thoracic Surgery, Vancouver General Hospital, Vancouver, BC, Canada.
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, Toronto General Hospital, Toronto, ON, Canada
| | - Moishe Liberman
- Department of Thoracic Surgery, University of Montreal, Montreal, QC, Canada
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13
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Serra Fortuny M, Gallego M, Berna L, Montón C, Vigil L, Masdeu MJ, Fernández-Villar A, Botana MI, Cordovilla R, García-Luján R, Cases E, Monsó E. FDG-PET parameters predicting mediastinal malignancy in lung cancer. BMC Pulm Med 2016; 16:177. [PMID: 27931198 PMCID: PMC5146847 DOI: 10.1186/s12890-016-0338-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 11/24/2016] [Indexed: 12/25/2022] Open
Abstract
Background Staging of mediastinal lymph nodes in non-small cell lung cancer (NSCLC) is mandatory. The maximum Standard Uptake Value (SUVmax) obtained using F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) is the best non-invasive technique available for this evaluation, but its performance varies from center to center. The aim of the present study was to identify FDG-PET predictors of mediastinal malignancy that are able to minimize intercenter variability and improve the selection of subsequent staging procedures. Method A multicenter study of NSCLC patients staged through FDG-PET and endobronchial ultrasonography with needle aspiration (EBUS-NA) was performed using therapeutic surgery with systematic nodal dissection as gold standard. Intercenter variability and predictive power for mediastinal malignancy of different FDG-PET measures were assessed, as well as the role of these measures for selecting additional staging procedures. Results One hundred and twenty-one NSCLC patients, of whom 94 (72%) had ≥1 hypermetabolic spots in the mediastinum, were included in the study. Mean SUVmax of the primary tumor was 12.3 (SD 6.3), and median SUVmax of the highest hypermetabolic spots in the mediastinum was 3.9 (IQR 2.4-7). Variability of FDG-PET measures between hospitals was statistically significant (p = 0.016 and p < 0.001 respectively), but lost significance when SUVmax in the mediastinum was expressed as a ratio or a subtraction from the primary tumor (SUVmax mediastinum/tumor, p = 0.083; and SUVmax mediastinum - tumor, p = 0.428 respectively). SUVmax mediastinum/tumor showed higher accuracy in the ROC analysis (AUC 0.77 CI 0.68-0.85, p < 0.001), and showed predictive power for mediastinal malignancy when using a 0.4 cutoff (OR 6.62, 95%CI 2.98-14.69). Sensitivities and negative predictive values of clinical staging through EBUS-NA attained values ranging between 57% and 92% after FDG-PET, which improved with additional techniques when the tumor had a diameter >3 cm and/or a SUVmax mediastinum/tumor ratio >0.4. Conclusion The SUVmax mediastinum/tumor ratio is a good predictor of regional tumor extension in NSCLC. This measure is not influenced by intercenter variability and has an accuracy of over 70% for the identification of malignancy when using a 0.4 cutoff.
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Affiliation(s)
- M Serra Fortuny
- Hospital Universitari Parc Taulí, Sabadell, Spain. .,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain.
| | - M Gallego
- Hospital Universitari Parc Taulí, Sabadell, Spain.,Ciber de Enfermedades Respiratorias - Ciberes, Madrid, Spain
| | - Ll Berna
- Hospital Universitari Parc Taulí, Sabadell, Spain
| | - C Montón
- Hospital Universitari Parc Taulí, Sabadell, Spain.,Health Services Research on Chronic Diseases Network- REDISSEC, Madrid, Spain
| | - L Vigil
- Hospital Universitari Parc Taulí, Sabadell, Spain.,Ciber de Enfermedades Respiratorias - Ciberes, Madrid, Spain
| | - M J Masdeu
- Hospital Universitari Parc Taulí, Sabadell, Spain
| | | | - M I Botana
- Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - R Cordovilla
- Complejo Asistencial de Salamanca, Salamanca, Spain
| | - R García-Luján
- Ciber de Enfermedades Respiratorias - Ciberes, Madrid, Spain.,Hospital Universitario 12 de Octubre, Madrid, Spain
| | - E Cases
- Hospital Universitari La Fe, Valencia, Spain
| | - E Monsó
- Hospital Universitari Parc Taulí, Sabadell, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain.,Ciber de Enfermedades Respiratorias - Ciberes, Madrid, Spain
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14
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Jimenez MF, Novoa NM, Varela G. Surgery Versus Stereotactic Body Radiotherapy for Resectable Lung Cancer. CURRENT SURGERY REPORTS 2016. [DOI: 10.1007/s40137-016-0162-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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15
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Labarca G, Aravena C, Ortega F, Arenas A, Majid A, Folch E, Mehta HJ, Jantz MA, Fernandez-Bussy S. Minimally Invasive Methods for Staging in Lung Cancer: Systematic Review and Meta-Analysis. Pulm Med 2016; 2016:1024709. [PMID: 27818796 PMCID: PMC5081694 DOI: 10.1155/2016/1024709] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/29/2016] [Accepted: 08/31/2016] [Indexed: 12/25/2022] Open
Abstract
Introduction. Endobronchial ultrasound (EBUS) is a procedure that provides access to the mediastinal staging; however, EBUS cannot be used to stage all of the nodes in the mediastinum. In these cases, endoscopic ultrasound (EUS) is used for complete staging. Objective. To provide a synthesis of the evidence on the diagnostic performance of EBUS + EUS in patients undergoing mediastinal staging. Methods. Systematic review and meta-analysis to evaluate the diagnostic yield of EBUS + EUS compared with surgical staging. Two researchers performed the literature search, quality assessments, data extractions, and analyses. We produced a meta-analysis including sensitivity, specificity, and likelihood ratio analysis. Results. Twelve primary studies (1515 patients) were included; two were randomized controlled trials (RCTs) and ten were prospective trials. The pooled sensitivity for combined EBUS + EUS was 87% (CI 84-89%) and the specificity was 99% (CI 98-100%). For EBUS + EUS performed with a single bronchoscope group, the sensitivity improved to 88% (CI 83.1-91.4%) and specificity improved to 100% (CI 99-100%). Conclusion. EBUS + EUS is a highly accurate and safe procedure. The combined procedure should be considered in selected patients with lymphadenopathy noted at stations that are not traditionally accessible with conventional EBUS.
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Affiliation(s)
- Gonzalo Labarca
- Facultad de Medicina, Universidad San Sebastián, Lientur 1457, Concepción 4080871, Chile
- Division of Internal Medicine, Complejo Asistencial Victor Rios Ruiz, Los Angeles, Chile
| | - Carlos Aravena
- Division of Pulmonary Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Ortega
- Division of Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alex Arenas
- Division of Internal Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Adnan Majid
- Divisions of Thoracic Surgery and Interventional Pulmonary, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Erik Folch
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Hiren J. Mehta
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | - Michael A. Jantz
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, FL, USA
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Numan RC, Berge MT, Burgers JA, Klomp HM, van Sandick JW, Baas P, Wouters MW. Pre- and postoperative care for stage I-III NSCLC: Which quality of care indicators are evidence-based? Lung Cancer 2016; 101:120-128. [PMID: 27794400 DOI: 10.1016/j.lungcan.2016.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 05/16/2016] [Accepted: 05/29/2016] [Indexed: 10/21/2022]
Abstract
Identification of evidenced-based Quality of Care (QoC) indicators for lung cancer care is essential to quality improvement. The aim of this review was to identify evidence-based quality indicators for the pre- and postoperative care of stage I-III Non Small Cell Lung Cancer (NSCLC) provided by the lung physician. To obtain these indicators, a search in PubMed, Embase and the Cochrane library database was performed. English literature published between 1980 and 2012 was included and search terms regarding 'lung neoplasms', 'quality of care', 'pathology', 'diagnostic methods', 'preoperative and postoperative treatment' were used. The potential indicators were categorized as structure, process or outcome measures and the indicators supported by literature with high evidence level were selected. Five QoC indicators were identified. The use of the positron emission tomography-computed tomography (PET-CT) results in more accurate mediastinal staging compared to the CT scan. Endoscopic Ultrasound-Fine Needle Aspiration and Endobronchial Ultrasound-Fine Needle Aspiration are sensitive diagnostic tools for mediastinal staging and reduce futile thoracotomies. Pathological conformation of lung cancer can best be obtained by a combination of cytological and histological diagnostics used during bronchoscopy. For patients with clinical stage III NSCLC, preoperative multimodality treatment (i.e. preoperative chemoradiation) results in superior survival and increased mediastinal downstaging compared to single modality treatment (i.e. preoperative chemotherapy or radiotherapy). After surgery, the addition of chemotherapy results in a significant survival benefit for patients with pathological stage II and III NSCLC. These five QoC indicators can be used for benchmarking and ultimately quality improvement of lung cancer care.
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Affiliation(s)
- Rachel C Numan
- Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
| | - Martijn Ten Berge
- Department of Surgical Oncology, Leids Universitair Medisch Centrum, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Jacobus A Burgers
- Department of Thoracic Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Houke M Klomp
- Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Johanna W van Sandick
- Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Paul Baas
- Department of Thoracic Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Michel W Wouters
- Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
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17
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The impact on the prognosis of unsuspected N2 disease in non-small-cell lung cancer: indications for thorough mediastinal staging in the modern era. Surg Today 2016; 47:20-26. [DOI: 10.1007/s00595-016-1372-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 03/06/2016] [Indexed: 10/21/2022]
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Dziedzic D, Peryt A, Szolkowska M, Langfort R, Orlowski T. Endobronchial ultrasound-guided transbronchial needle aspiration in the staging of lung cancer patients. SAGE Open Med 2015; 3:2050312115610128. [PMID: 26770805 PMCID: PMC4679334 DOI: 10.1177/2050312115610128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 08/31/2015] [Indexed: 11/19/2022] Open
Abstract
Objective: Mediastinoscopy as diagnostic procedure for evaluation of mediastinum in patients with non-small-cell lung cancer has long been considered the reference standard. However, less invasive method has occurred. Endobronchial ultrasound–guided transbronchial needle aspiration came into widespread use and has resulted in controversy as to whether it is a good replacement for mediastinoscopy. We chose to demonstrate the usefulness of endobronchial ultrasound–guided transbronchial needle aspiration in evaluating the mediastinum in patients with non-small-cell lung cancer. Material and methods: Over a 48-month period, 1841 patients underwent endobronchial ultrasound–guided transbronchial needle aspiration at our healthcare centre. In all patients, 2964 biopsies from the lymph node group N2 and 783 from group N1 were taken. The mean short axis of the lymph nodes biopsied was 2.0 (range: 0.6–2.6). The mean number of lymph node stations biopsied per patient was 2.6. Patients with a negative result of endobronchial ultrasound–guided transbronchial needle aspiration underwent mediastinoscopy. All patients with a negative result in endobronchial ultrasound–guided transbronchial needle aspiration and mediastinoscopy underwent surgical resection with lymph node sampling. Results: The metastases to lymph nodes N2/N3 and N1 were found in 1111 (60.3%) and 199 (9.3%), respectively. Mediastinoscopy was performed in 730 patients with a positive result in 83 (11.4%) patients. In the group of operated patients, metastatic N1 disease was found in 264 (14.1%). In the group of the operated patients, mediastinal involvement of disease (N2) was found in 30 patients (4.5%). The sensitivity, negative predictive value and diagnostic accuracy for hilar lymph node staging for endobronchial ultrasound–guided transbronchial needle aspiration were 57%, 96% and 96%, respectively. The sensitivity, negative predictive value and diagnostic accuracy per patient for mediastinal lymph node staging for endobronchial ultrasound–guided transbronchial needle aspiration and mediastinoscopy were 91%, 85%, 93% and 73%, 95.5%, 97%, respectively. The specificity and positive predictive value of both tests were 100%. Conclusion: The clinical usefulness of endobronchial ultrasound–guided transbronchial needle aspiration is undeniable according to diagnostic performance data. Endobronchial ultrasound–guided transbronchial needle aspiration should be considered complementary to mediastinoscopy in the evaluation of patients with radiographically abnormal mediastinum.
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Affiliation(s)
- Dariusz Dziedzic
- Department of Thoracic Surgery, National Research Institute of Chest Diseases, Warsaw, Poland
| | - Adam Peryt
- Department of Thoracic Surgery, National Research Institute of Chest Diseases, Warsaw, Poland
| | - Malgorzata Szolkowska
- Department of Patomorphology, National Research Institute of Chest Diseases, Warsaw, Poland
| | - Renata Langfort
- Department of Patomorphology, National Research Institute of Chest Diseases, Warsaw, Poland
| | - Tadeusz Orlowski
- Department of Thoracic Surgery, National Research Institute of Chest Diseases, Warsaw, Poland
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19
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De Dominicis F, Fourdrain A, Iquille J, Toublanc B, François G, Basille D, Monconduit J, Merlusca G, Jounieaux V, Andrejak C, Berna P. [Results of endobronchial ultrasound-guided transbronchial needle aspiration in lung cancer: importance of the lymph node involvement prevalence]. REVUE DE PNEUMOLOGIE CLINIQUE 2015; 71:217-225. [PMID: 25727662 DOI: 10.1016/j.pneumo.2014.11.007] [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: 07/08/2014] [Revised: 11/09/2014] [Accepted: 11/18/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE We studied the non-surgical invasive staging by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and we detailed the differences of our series, in order to understand the criteria allowing to achieve a better performance. METHODS Retrospective observational study conducted between 2007 and 2011, including all patients with proven NSCLC who underwent EBUS-TBNA. RESULTS For the 92 EBUS-TBNA performed, we found a sensitivity of 78%, a specificity of 93%, a positive predictive value (PPV) of 98%, a negative predictive value (NPV) of 45%, an accuracy of 80% and a prevalence of lymph node involvement at 84%. A learning curve has been demonstrated and a significant difference was found based on the number of punctures by procedure (P=0.02) or on histological type (P=0.02). By analyzing the data of the literature, we have been able to demonstrate that the accuracy and the negative predictive value are correlated with the prevalence. If we take into account this correlation, we can consider the results of our study close to those of the literature. CONCLUSION We highlighted a number of criteria that will influence the diagnostic yield of EBUS-TBNA. While some have already been described, other criteria such as histological type or patient selection criteria are less discussed. The key point is the correlation between the prevalence and EBUS-TBNA results. Results of the assessment of lymph node involvement techniques should be interpreted according to the prevalence of lymph node involvement.
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Affiliation(s)
- F De Dominicis
- Service de chirurgie thoracique, université de Picardie, hôpital Sud, CHU d'Amiens, avenue René-Laennec, 80054 Amiens cedex 1, France
| | - A Fourdrain
- Service de chirurgie thoracique, université de Picardie, hôpital Sud, CHU d'Amiens, avenue René-Laennec, 80054 Amiens cedex 1, France
| | - J Iquille
- Service de chirurgie thoracique, université de Picardie, hôpital Sud, CHU d'Amiens, avenue René-Laennec, 80054 Amiens cedex 1, France
| | - B Toublanc
- Service de pneumologie et de réanimation respiratoire, université de Picardie, hôpital Sud, CHU d'Amiens, avenue René-Laennec, 80054 Amiens, France
| | - G François
- Service de pneumologie et de réanimation respiratoire, université de Picardie, hôpital Sud, CHU d'Amiens, avenue René-Laennec, 80054 Amiens, France
| | - D Basille
- Service de pneumologie et de réanimation respiratoire, université de Picardie, hôpital Sud, CHU d'Amiens, avenue René-Laennec, 80054 Amiens, France
| | - J Monconduit
- Service de chirurgie thoracique, université de Picardie, hôpital Sud, CHU d'Amiens, avenue René-Laennec, 80054 Amiens cedex 1, France
| | - G Merlusca
- Service de chirurgie thoracique, université de Picardie, hôpital Sud, CHU d'Amiens, avenue René-Laennec, 80054 Amiens cedex 1, France
| | - V Jounieaux
- Service de pneumologie et de réanimation respiratoire, université de Picardie, hôpital Sud, CHU d'Amiens, avenue René-Laennec, 80054 Amiens, France
| | - C Andrejak
- Service de pneumologie et de réanimation respiratoire, université de Picardie, hôpital Sud, CHU d'Amiens, avenue René-Laennec, 80054 Amiens, France
| | - P Berna
- Service de chirurgie thoracique, université de Picardie, hôpital Sud, CHU d'Amiens, avenue René-Laennec, 80054 Amiens cedex 1, France.
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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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(18)F-fluorodeoxyglucose positron emission tomography/computed tomography accuracy in the staging of non-small cell lung cancer: review and cost-effectiveness. Radiol Res Pract 2014; 2014:135934. [PMID: 25431665 PMCID: PMC4238277 DOI: 10.1155/2014/135934] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 09/26/2014] [Accepted: 10/01/2014] [Indexed: 12/21/2022] Open
Abstract
Aim of the performed clinical study was to compare the accuracy and cost-effectiveness of PET/CT in the staging of non-small cell lung cancer (NSCLC). Material and Methods. Cross-sectional and prospective study including 103 patients with histologically confirmed NSCLC. All patients were examined using PET/CT with intravenous contrast medium. Those with disease stage ≤IIB underwent surgery (n = 40). Disease stage was confirmed based on histology results, which were compared with those of PET/CT and positron emission tomography (PET) and computed tomography (CT) separately. 63 patients classified with ≥IIIA disease stage by PET/CT did not undergo surgery. The cost-effectiveness of PET/CT for disease classification was examined using a decision tree analysis. Results. Compared with histology, the accuracy of PET/CT for disease staging has a positive predictive value of 80%, a negative predictive value of 95%, a sensitivity of 94%, and a specificity of 82%. For PET alone, these values are 53%, 66%, 60%, and 50%, whereas for CT alone they are 68%, 86%, 76%, and 72%, respectively. Incremental cost-effectiveness of PET/CT over CT alone was €17,412 quality-adjusted life-year (QALY). Conclusion. In our clinical study, PET/CT using intravenous contrast medium was an accurate and cost-effective method for staging of patients with NSCLC.
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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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Mehta HJ, Tanner NT, Silvestri G, Simkovich SM, Shamblin C, Shaftman SR, Nietert PJ, Yang J. Outcome of patients with negative and unsatisfactory cytologic specimens obtained by endobronchial ultrasound-guided transbronchial fine-needle aspiration of mediastinal lymph nodes. Cancer Cytopathol 2014; 123:92-7. [PMID: 25186645 DOI: 10.1002/cncy.21482] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 07/25/2014] [Accepted: 08/13/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND Endobronchial ultrasound-guided transbronchial fine-needle aspiration (EBUS-FNA) has gained acceptance as the diagnostic procedure of choice with which to sample hilar and mediastinal lymph nodes (LNs) for diagnosing and staging patients with lung cancer. Studies have shown that EBUS has a high positive predictive value; however, its negative predictive value (NPV) varies significantly. The aim of the current study was to evaluate the clinical outcome surrounding negative and nondiagnostic EBUS-FNA of mediastinal LNs. METHODS A retrospective chart review of cases of EBUS-FNA performed between 2008 and the middle of 2011 was conducted. Mediastinal LNs with cytologic diagnoses of negative for malignant cells and unsatisfactory were selected for the study. Each LN was followed for up to 1 year with imaging or biopsy/surgical resection. A true-negative result was defined as a LN that did not enlarge on repeat imaging or was negative for malignancy on repeat biopsy or surgery during the follow-up period. RESULTS Among 1418 LNs sampled, 479 from 228 patients met the search criteria, including 394 LN (82.3%) with the cytologic diagnosis of negative for malignant cells and 85 (17.8%) with a diagnosis of unsatisfactory. A total of 104 patients (45.6%) were followed with imaging, and 124 patients (54.3%) underwent repeat biopsy/surgery. A total of 445 LNs met the definition of a true-negative finding, resulting in an overall NPV of 92.9% (95% confidence interval [95% CI], 90.6%-95.2%). The NPVs of a negative and unsatisfactory diagnosis were 93.9% (95% CI, 91.6%-96.3%) and 88.2% (95% CI, 81.4%-95.1%), respectively. CONCLUSIONS The vast majority of LNs with a cytologic diagnosis of negative and unsatisfactory were likely to be true-negative findings. In these patients, a more conservative approach to follow-up may be appropriate.
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Affiliation(s)
- Hiren J Mehta
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida
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[Advances in respiratory health 2010: Techniques and Transplantation Section]. Arch Bronconeumol 2014; 47 Suppl 1:36-40. [PMID: 21300217 DOI: 10.1016/s0300-2896(11)70010-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Five articles and an editorial on interventional pneumology were published in Archivos de Bronconeumología. Two of these articles deal with bronchoscopy, one with lung biopsy with cryoprobes, one with thermoplasty in asthma and the last with tracheobronchomalacia. We also review several publications in international journals, with special emphasis on endobronchial ultrasound. Four original articles on idiopathic pulmonary fibrosis were published in Archivos de Bronconeumología: one special article comparing two treatments and a Cochrane systematic review on the efficacy of non-steroidal drugs in this disease. Finally, we highlight studies in lung transplantation, consisting of 14 publications from different continents and with highly diverse contents: one editorial, one letter to the editor, one procedures manual and nine international publications on donor characteristics, various types of complications, experimental results in the field of preservation, and the casuistics obtained in distinct diseases in which transplantation is an option.
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Nasir BS, Bryant AS, Minnich DJ, Wei B, Dransfield MT, Cerfolio RJ. The efficacy of restaging endobronchial ultrasound in patients with non-small cell lung cancer after preoperative therapy. Ann Thorac Surg 2014; 98:1008-12. [PMID: 25069682 DOI: 10.1016/j.athoracsur.2014.04.091] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 04/19/2014] [Accepted: 04/21/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND Patient selection for surgery after neoadjuvant therapy for locally advanced non-small cell lung cancer depends on accurate restaging of mediastinal (N2) lymph nodes. Our objective is to assess the accuracy of endobronchial ultrasound (EBUS) for restaging N2 lymph nodes after neoadjuvant therapy. METHODS This is a retrospective review of patients with non-small cell lung cancer who underwent staging with repeat computed tomography and positron emission tomography and had restaging EBUS for sampling of N2 lymph nodes. Endobronchial ultrasound was performed for suspicious nodes in stations 2R, 2L, 4R, 4L, and 7. Selected patients who were N2-negative underwent thoracotomy with complete thoracic lymphadenectomy. RESULTS There were 32 patients with N2 disease who underwent preoperative chemotherapy or radiotherapy, or both, and subsequently had restaging EBUS. There were 3 patients who had recalcitrant N2 nodal disease detected by EBUS. There were 5 patients with pulmonary function or comorbidities that were prohibitive for surgery. Of the remaining 24 patients with negative EBUS, 3 underwent mediastinoscopy and 2 had recalcitrant N2 disease. The remaining 22 patients underwent thoracotomy. Recalcitrant N2 disease was noted in 1 patient at thoracotomy in the EBUS-assessable nodal stations. Thus EBUS was falsely negative in 3 patients. The sensitivity and negative predictive value of restaging EBUS were 50% and 88%, respectively. CONCLUSIONS Restaging EBUS is relatively accurate at predicting the absence of metastatic disease in N2 mediastinal lymph node in patients who underwent neoadjuvant therapy for non-small cell lung cancer.
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Affiliation(s)
- Basil S Nasir
- Division of Thoracic Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Ayesha S Bryant
- Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Douglas J Minnich
- Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ben Wei
- Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mark T Dransfield
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Robert J Cerfolio
- Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
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Sanz-Santos J, Serra M, Gallego M, Montón C, Cosio B, Sauleda J, Fernández-Villar A, García-Luján R, de Miguel E, Cordovilla R, Varela G, Cases E, Andreo F, Monsó E. Determinants of false-negative results in non-small-cell lung cancer staging by endobronchial ultrasound-guided needle aspiration. Eur J Cardiothorac Surg 2014; 47:642-7. [PMID: 25005839 DOI: 10.1093/ejcts/ezu253] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES False-negative results of endobronchial ultrasound-guided transbronchial needle aspiration in non-small-cell lung cancer staging have shown significant variability in previous studies. The aim of this study was to identify procedure- and tumour-related determinants of endobronchial ultrasound-guided transbronchial needle aspiration false-negative results. METHODS We conducted a prospective study that included non-small-cell lung cancer patients staged as N0/N1 by endobronchial ultrasound-guided transbronchial needle aspiration and undergoing therapeutic surgery. The frequency of false-negative results in the mediastinum was calculated. Procedure-related, first, and tumour-related, second, determinants of false-negative results in stations reachable and non-reachable by endobronchial ultrasound were determined by multivariate logistic regression. RESULTS False-negative endobronchial ultrasound-guided transbronchial needle aspiration results were identified in 23 of 165 enrolled patients (13.9%), mainly in stations reachable by endobronchial ultrasound (17 cases, 10.3%). False-negative results were related to the extensiveness of endobronchial ultrasound sampling: their prevalence was low (2.4%) when sampling of three mediastinal stations was satisfactory, but rose above 10% when this requirement was not fulfilled (P = 0.043). In the multivariate analysis, abnormal mediastinum on computer tomography/positron emission tomography [odds ratio (OR) 7.77, 95% confidence interval (CI) 2.19-27.51, P = 0.001] and extensiveness of satisfactory sampling of mediastinal stations (OR 0.37, 95% CI 0.16-0.89, P = 0.026) were statistically significant risk factors for false-negative results in stations reachable by endobronchial ultrasound. False-negative results in non-reachable nodes were associated with a left-sided location of the tumour (OR 10.11, 95% CI 1.17-87.52, P = 0.036). CONCLUSIONS The presence of false-negative ultrasound-guided transbronchial needle aspiration results were observed in nearly 15% of non-small-cell lung cancer patients but in only 3% when satisfactory samples were obtained from three mediastinal stations. False-negative results in stations reachable by endobronchial ultrasound were associated with the extensiveness of sampling, and in stations out of reach of endobronchial ultrasound with left-sided tumours. These results suggest that satisfactory sampling of at least three mediastinal stations by EBUS-TBNA may be a quality criterion to be recommended for EBUS-TBNA staging.
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Affiliation(s)
| | - Mireia Serra
- Hospital Universitari del Parc Taulí, Sabadell, Spain Departament de Medicina, Universitat Autónoma de Barcelona, Bellaterra, Spain
| | - Miguel Gallego
- Hospital Universitari del Parc Taulí, Sabadell, Spain Ciber de Enfermedades Respiratorias-Ciberes, Bunyola, Spain
| | | | - Borja Cosio
- Ciber de Enfermedades Respiratorias-Ciberes, Bunyola, Spain Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Jaume Sauleda
- Hospital Universitari Son Espases, Palma de Mallorca, Spain Ciber de Enfermedades Respiratorias-Ciberes, Bunyola, Spain Institut Universitari de Ciències de la Salut, Palma de Mallorca, Spain
| | | | - Ricardo García-Luján
- Ciber de Enfermedades Respiratorias-Ciberes, Bunyola, Spain Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Eduardo de Miguel
- Ciber de Enfermedades Respiratorias-Ciberes, Bunyola, Spain Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | | | - Felipe Andreo
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain Departament de Medicina, Universitat Autónoma de Barcelona, Bellaterra, Spain Ciber de Enfermedades Respiratorias-Ciberes, Bunyola, Spain
| | - Eduard Monsó
- Hospital Universitari del Parc Taulí, Sabadell, Spain Departament de Medicina, Universitat Autónoma de Barcelona, Bellaterra, Spain Ciber de Enfermedades Respiratorias-Ciberes, Bunyola, Spain
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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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Kinsey CM, Arenberg DA. Endobronchial ultrasound-guided transbronchial needle aspiration for non-small cell lung cancer staging. Am J Respir Crit Care Med 2014; 189:640-9. [PMID: 24484269 DOI: 10.1164/rccm.201311-2007ci] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an established technique for invasive mediastinal staging of non-small cell lung cancer (NSCLC). Needle-based techniques are now recommended as a first-line diagnostic modality for mediastinal staging. Accurate performance of systematic staging with EBUS-TBNA requires a detailed knowledge of mediastinal anatomy. This examination begins at the N3 lymph nodes, progressing through the N2 and N1 lymph node stations, unless a higher station lymph node is positive for malignant cells by rapid on-site cytologic examination. Objective methods of identifying EBUS-TBNA targets include sampling any lymph node station with a visible lymph node or with a lymph node greater than 5 mm in short axis. Three passes per station or the use of rapid on-site cytologic examination with identification of diagnostic material (tumor or lymphocytes) up to five passes are well-established techniques. Obtaining sufficient tissue for molecular profiling may require performing more than three passes. The operating characteristics of EBUS-TBNA are similar to mediastinoscopy. However, mediastinoscopy should be considered in the setting of a negative EBUS-TBNA and a high posterior probability of N2 or N3 involvement.
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Affiliation(s)
- C Matthew Kinsey
- 1 Department of Pulmonary and Critical Care, University of Vermont College of Medicine, Burlington, Vermont; and
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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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Marchevsky A, Marx A, Strobel P, Suster S, Venuta F, Marino M, Yousem S, Zakowski M. [Policies and reporting guidelines for small biopsy specimens of mediastinal masses]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2014; 17:104-9. [PMID: 24581160 PMCID: PMC6131233 DOI: 10.3779/j.issn.1009-3419.2014.02.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Alberto Marchevsky
- Department of Pathology and Laboratory Medicine, Cedars Sinai Medical Center, Los Angeles, California
| | - Alex Marx
- Department of Pathology, University Medical Center Mannheim, Mannheim, Germany
| | - Philipp Strobel
- Department of Pathology, University Medical Center Mannheim, Mannheim, Germany
| | - Saul Suster
- Department of Pathology 3nd Laboratory Medicine, Medical College of Wisconsin, Mil-waukee, Wisconsin
| | - Federico Venuta
- Department of Thoracic Surgery, University of Rome La Sapienza, Rome, Italy
| | - Mirella Marino
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Samuel Yousem
- Department of Pathology, UPMC-Presbyterian University Hospital, Pittsburgh, Pennsylvania
| | - Maureen Zakowski
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York
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Tsitsias T, Boulemden A, Ang K, Nakas A, Waller DA. The N2 paradox: similar outcomes of pre- and postoperatively identified single-zone N2a positive non-small-cell lung cancer. Eur J Cardiothorac Surg 2013; 45:882-7. [DOI: 10.1093/ejcts/ezt478] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Darwiche K, Zarogoulidis P, Baehner K, Welter S, Tetzner R, Wohlschlaeger J, Theegarten D, Nakajima T, Freitag L. Assessment of SHOX2 methylation in EBUS-TBNA specimen improves accuracy in lung cancer staging. Ann Oncol 2013; 24:2866-70. [PMID: 24026539 DOI: 10.1093/annonc/mdt365] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) is a well-established method to assess mediastinal lymph nodes for lung cancer. However, a proportion of patients require further investigation, due to the low negative predictive value (NPV). The objective of this study was to determine whether the assessment of short stature homeobox 2 (SHOX2) DNA methylation level in lymph node tissue obtained by EBUS-TBNA improves the accuracy of mediastinal staging. PATIENTS AND METHODS EBUS-TBNA was carried out for suspicious lymph nodes of 154 patients. Negative or ambiguous histological results were confirmed by surgical means and clinical follow-up over 6 months. EBUS-TBNA was assessed on 80 positive and 85 negative classified lymph nodes and compared with the result of the SHOX2 DNA methylation real-time PCR analysis. Relative methylation measured by delta-delta cycle threshold (ΔΔCt) was used to classify the samples. Clinical performance of the EBUS-TBNA procedure with and without the additional SHOX2 assessment was calculated against the final classification according to the gold standard. RESULTS Based on data from 105 patients, an average 80-fold increase in the SHOX2 methylation level was measured for positive compared with negative lymph nodes. SHOX2 results with a ΔΔCt value of <6.5 indicate positive lymph nodes. Applying this molecular analysis to EBUS-TBNA cases, not diagnosed by pathologic assessment, the sensitivity of staging was improved by 17%-99%. The NPV increased from 80% to 99%. CONCLUSIONS The combination of EBUS-TBNA and SHOX2 methylation level strongly improves the assessment of the nodal status by identifying additional malignant lesions and confirming benign nodes and therefore avoiding invasive follow-up procedures.
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Affiliation(s)
- K Darwiche
- Department of Interventional Pneumology, Ruhrlandklinik, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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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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Tian Q, Chen LA, Wang RT, Yang Z, An Y. The reasons of false negative results of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of intrapulmonary and mediastinal malignancy. Thorac Cancer 2013; 4:186-190. [PMID: 28920208 DOI: 10.1111/1759-7714.12010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 11/06/2012] [Indexed: 11/30/2022] Open
Affiliation(s)
- Qing Tian
- Department of Respiratory Diseases; PLA General Hospital; Beijing; China
| | - Liang-An Chen
- Department of Respiratory Diseases; PLA General Hospital; Beijing; China
| | - Ren-Tao Wang
- Department of Respiratory Diseases; PLA General Hospital; Beijing; China
| | - Zhen Yang
- Department of Respiratory Diseases; PLA General Hospital; Beijing; China
| | - Yang An
- Department of Respiratory Diseases; PLA General Hospital; Beijing; China
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Endobronchial ultrasound transbronchial needle aspiration in mediastinal and hilar lymphadenopathies. South Med J 2013; 105:645-9. [PMID: 23211498 DOI: 10.1097/smj.0b013e3182749150] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Endobronchial ultrasound (EBUS)-transbronchial needle aspiration (TBNA) is a relatively noninvasive technique that allows sampling of mediastinal and hilar lymph nodes or masses under real-time and direct visualization, overcoming some of the problems associated with mediastinoscopy and blind TBNA. The goal of this study was to evaluate the yield of this technique in patients with and without malignant disease in a newly started EBUS program involving physicians not previously fully trained in interventional pulmonology. METHODS Between March 2010 and July 2011, 43 patients with enlarged lymph nodes (>1 cm on short axis) on chest computed tomography who underwent EBUS-TBNA were included in the study. Nondiagnostic results were confirmed with mediastinoscopy. The sensitivity, specificity, positive predictive value and negative predictive value of the technique were assessed. RESULTS Among the 43 patients who underwent EBUS-TBNA, a correct diagnosis was made in 39 of the 43 patients (91%). The sensitivity, specificity, positive predictive value, and negative predictive values were 89%, 100%, 100%, and 67%, respectively. The success rate, complication rate, and 30-day mortality were 91%, 0%, and 0%, respectively. CONCLUSIONS EBUS-TBNA is a safe and effective approach with high diagnostic yield and minimal complications for diagnosing and staging of mediastinal/hilar lymph nodes. Satisfactory results can be obtained immediately by pulmonologists experienced in conventional bronchoscopy with the provision of additional training on the technique.
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Bolton WD, Johnson R, Banks E, Hutcheson S, Wall W, Stephenson J. Utility and accuracy of endobronchial ultrasound as a diagnostic and staging tool for the evaluation of mediastinal adenopathy. Surg Endosc 2012; 27:1119-23. [DOI: 10.1007/s00464-012-2613-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 09/09/2012] [Indexed: 11/28/2022]
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Buchbender C, Herbrik M, Treffert J, Forsting M, Bockisch A, Antoch G, Heusner TA. Virtual 18F-FDG PET/CT bronchoscopy for lymph node staging in non-small-cell lung cancer patients: present and future applications. Expert Rev Med Devices 2012; 9:241-7. [PMID: 22702254 DOI: 10.1586/erd.12.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Virtual (18)F-fluorodeoxyglucose (FDG) PET/computed tomography (CT) bronchoscopies provide virtually realistic, 3D endoscopic views of the airways combining anatomical and functional data at a high resolution. Today, even very small airways can be imaged by virtual bronchoscopy. (18)F-FDG PET/CT bronchoscopy images are generated from standard whole-body (18)F-FDG PET/CT scan source data without any additional radiation exposure. The purpose of this review was to give an overview over the studies that are currently available, to provide the technical background of (18)F-FDG PET/CT bronchoscopy and to explain the diagnostic accuracy of (18)F-FDG PET/CT bronchoscopy. Moreover, this manuscript highlights potential future applications of this promising new imaging technique.
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Affiliation(s)
- Christian Buchbender
- University of Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany
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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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Cerfolio RJ, Bryant AS, Minnich DJ. Complete Thoracic Mediastinal Lymphadenectomy Leads to a Higher Rate of Pathologically Proven N2 Disease in Patients With Non-Small Cell Lung Cancer. Ann Thorac Surg 2012; 94:902-6. [DOI: 10.1016/j.athoracsur.2012.05.034] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 05/07/2012] [Accepted: 05/11/2012] [Indexed: 10/28/2022]
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Kokkonouzis I, Strimpakos AS, Lampaditis I, Tsimpoukis S, Syrigos KN. The role of endobronchial ultrasound in lung cancer diagnosis and staging: a comprehensive review. Clin Lung Cancer 2012; 13:408-15. [PMID: 22694791 DOI: 10.1016/j.cllc.2012.05.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2011] [Revised: 04/27/2012] [Accepted: 05/01/2012] [Indexed: 10/28/2022]
Abstract
Endobronchial ultrasound (EBUS) technology is a relatively new bronchoscopic method of visualizing the tracheobronchial tree, the surrounding pulmonary parenchyma, and the mediastinal structures, with a particular role in lung cancer diagnosis, staging, and treatment. There are 2 types of probes used in EBUS: the peripheral or radial probe (RP) and the linear or convex probe (CP) EBUS, which have technical differences and distinct diagnostic abilities. Both are used for EBUS-guided biopsies and transbronchial needle aspirations (TBNA), which increases the diagnostic yield over conventional bronchoscopic techniques, thus providing advanced information on staging, diagnosis, and treatment. Complications of EBUS are rare, and they are usually related to the underlying biopsy procedure and the operator's experience. EBUS examination duration is usually short, and it can be performed as an outpatient procedure. Interestingly, EBUS combinations with other current and evolving techniques, eg, electromagnetic navigation, are feasible and have a role in therapeutic interventions and molecular diagnostics. In conclusion, EBUS is a safe and accurate technique that is comparable with current criterion standard procedures, eg, mediastinoscopy. More training is required for the vast majority of respiratory physicians, and precise diagnostic algorithms are needed so that more patients benefit from this development.
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Affiliation(s)
- Ioannis Kokkonouzis
- Oncology Unit, 3rd Department of Medicine, Sotiria General Hospital, Athens School of Medicine, Athens, Greece
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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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Utility of endobronchial ultrasound–guided mediastinal lymph node biopsy in patients with non–small cell lung cancer. J Thorac Cardiovasc Surg 2012; 143:585-90. [DOI: 10.1016/j.jtcvs.2011.11.022] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 10/28/2011] [Accepted: 11/09/2011] [Indexed: 11/19/2022]
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Jhun BW, Park HY, Jeon K, Koh WJ, Suh GY, Chung MP, Kim H, Kwon OJ, Han J, Um SW. Nodal stations and diagnostic performances of endobronchial ultrasound-guided transbronchial needle aspiration in patients with non-small cell lung cancer. J Korean Med Sci 2012; 27:46-51. [PMID: 22219613 PMCID: PMC3247774 DOI: 10.3346/jkms.2012.27.1.46] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 11/07/2011] [Indexed: 11/20/2022] Open
Abstract
There are no accurate data on the relationship between nodal station and diagnostic performance of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). We evaluated the impact of nodal station and size on the diagnostic performance of EBUS-TBNA in patients with non-small cell lung cancer (NSCLC). Consecutive patients who underwent EBUS-TBNA of mediastinal or hilar lymph nodes for staging or diagnosis of NSCLC were included in this retrospective study. Between May 2009 and February 2010, EBUS-TBNA was performed in 373 mediastinal and hilar lymph nodes in 151 patients. The overall diagnostic sensitivity, specificity, accuracy and negative predictive value (NPV) of EBUS-TBNA were 91.6%, 98.6%, 93.8%, and 84.3%, respectively. NPV of the left side nodal group was significantly lower than those of the other groups (P = 0.047) and sensitivity of the left side nodal group tended to decrease (P = 0.096) compared with those of the other groups. Diagnostic sensitivity and NPV of 4L lymph node were 83.3% and 66.7%, respectively. However, diagnostic performances of EBUS-TBNA did not differ according to nodal size. Bronchoscopists should consider the impact of nodal stations on diagnostic performances of EBUS-TBNA.
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Affiliation(s)
- Byung Woo Jhun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyeongman Jeon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won-Jung Koh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gee Young Suh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Man Pyo Chung
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hojoong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - O Jung Kwon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joungho Han
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Won Um
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Sánchez de Cos Escuín J, Hernández Hernández J, Jiménez López M, Padrones Sánchez S, Rosell Gratacós A, Rami Porta R. Réplica. Arch Bronconeumol 2012. [DOI: 10.1016/j.arbres.2011.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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46
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Annual review of advances in non-small cell lung cancer research: a report for the year 2010. J Thorac Oncol 2011; 6:1443-50. [PMID: 21709589 DOI: 10.1097/jto.0b013e3182246413] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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47
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Wang J, Welch K, Wang L, Kong FMS. Negative predictive value of positron emission tomography and computed tomography for stage T1-2N0 non-small-cell lung cancer: a meta-analysis. Clin Lung Cancer 2011; 13:81-9. [PMID: 22056226 DOI: 10.1016/j.cllc.2011.08.002] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 08/03/2011] [Accepted: 08/09/2011] [Indexed: 01/08/2023]
Abstract
BACKGROUND Nodal staging of non-small-cell lung cancer (NSCLC) is crucial in evaluation of prognosis and determination of therapeutic strategy. This study aimed to determine the negative predictive value (NPV) of combined positron emission tomography and computed tomography (PET-CT) in patients with stage I (T1-2N0) NSCLC and to investigate the possible risk factors for occult nodal disease. METHODS Studies investigating the performance of PET in conjunction with CT in the nodal staging of stage I NSCLC were identified in the MEDLINE database. The initiative of standards for reporting of diagnostic accuracy (STARD) was used to ensure study quality. Pathologic assessments through mediastinoscopy or thoracotomy were required as the reference standard for evaluation of PET-CT accuracy. Stata-based meta-analysis was applied to calculate the individual and pooled NPVs. RESULTS Ten studies with a total of 1122 patients with stage I (T1-2N0) NSCLC were eligible for analysis. The NPVs of combined PET and CT for mediastinal metastases were 0.94 in T1 disease and 0.89 in T2 disease. Including both T1 disease and T2 disease, the NPVs were 0.93 for mediastinal metastases and 0.87 for overall nodal metastases. Adenocarcinoma histology type (risk ratio [RR], 2.72) and high fluorine-18 (18F) fluorodeoxyglucose (FDG) uptake in the primary lesion were associated with greater risk of occult nodal metastases. CONCLUSIONS Although overall occult nodal metastases in clinical stage T1-2N0 NSCLC is not infrequent, combined PET and CT provide a favorable NPV for mediastinal metastases in T1N0 NSCLC, suggesting a low yield from routine invasive staging procedures for this subgroup of patients.
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Affiliation(s)
- Jingbo Wang
- Department of Radiation Oncology, Cancer Hospital & Institute, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), Beijing, PR China
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Gamliel Z. Surgical staging for non-small cell lung cancer. Surg Oncol Clin N Am 2011; 20:691-700. [PMID: 21986266 DOI: 10.1016/j.soc.2011.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The treatment of non-small cell lung cancer is stage specific. Aggressive staging is associated with improved stage-specific prognosis. Available methods of surgical staging include scalene node biopsy, mediastinoscopy, anterior mediastinotomy, and thoracoscopy. In this article the various surgical staging methods are described and their respective roles are discussed.
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Affiliation(s)
- Ziv Gamliel
- Division of Thoracic Surgery, St Joseph Medical Center, 7501 Osler Drive, Towson, MD 21204, USA.
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Herbrik M, Treffert J, Geiger B, Riegger C, Hartung V, Rosenbaum-Krumme SJ, Forsting M, Antoch G, Heusner TA. Diagnostic Accuracy of Virtual 18F-FDG PET/CT Bronchoscopy for the Detection of Lymph Node Metastases in Non–Small Cell Lung Cancer Patients. J Nucl Med 2011; 52:1520-5. [DOI: 10.2967/jnumed.111.092593] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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