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Ugurlu E, Metin M, Cetin N, Kilicarslan E, Degirmencioglu S, Sengoz T, Akbudak IH, Gokoz Dogu G, Aydogmus U. Evaluation of hypermetabolic mediastinal-hilar lymph nodes determined by PET/CT with EBUS-TBNA and calculation of SUVmax cutoff values in differentiation of malignancy. Medicine (Baltimore) 2023; 102:e34928. [PMID: 37657039 PMCID: PMC10476785 DOI: 10.1097/md.0000000000034928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 08/03/2023] [Indexed: 09/03/2023] Open
Abstract
Computed tomography (CT) and positron emission tomography (PET) are the most commonly used methods for diagnosis and staging in both malignant and benign diseases of the lung parenchyma and mediastinum. Endobronchial ultrasonography (EBUS) guided transbronchial needle aspiration biopsy (TBNA) has become widespread in recent years because it allows minimally invasive tissue sampling. PET-CT has high sensitivity in the diagnosis of malignancy but has low specificity. The false positive rate is high with the SUVmax 2.5 cutoff value, which is widely used in studies about malignancy. In our study, we evaluated lymph nodes with high F18-fluorodeoxyglucose (FDG) uptake on PET/CT and sampled by EBUS-TBNA. We aimed to calculate the new SUVmax cutoff values in the differentiation of malignancy. Our study included 103 patients who were examined for any reason and who underwent biopsy with EBUS-TBNA due to mediastinal or hilar lymph node enlargement on PET-CT. The relationship between PET-CT findings and EBUS findings, EBUS-TBNA results was evaluated. Biopsies were taken from 140 lymph nodes in 103 patients included in our study, and 39 (27.8%) were diagnosed as malignant. In our study, when the SUVmax cutoff value in PET-CT is taken as 2.54, the sensitivity is 98%, but the specificity remains at the level of 12%. When the SUVmax cutoff value in PET-CT was taken as 4.58, the sensitivity was 92% and the specificity was 49%. When this value was accepted as 5.25, and 6.09 the sensitivity was respectively 90% and 85%, the specificity was respectively 52% and 60%. In evaluations, we conducted in order to determine different SUVmax cutoff values that can be used for higher sensitivity and specificity in malignancy studies, the cutoff values were 4.58, 5.25, and 6.09. It is thought that these cutoff values will be useful both for diagnosing malignancy and for distinguishing benign pathologies.
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Affiliation(s)
- Erhan Ugurlu
- Department of Pulmonary Diseases, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Melis Metin
- Department of Pulmonary Diseases, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Nazli Cetin
- Department of Pulmonary Diseases, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Emel Kilicarslan
- Department of Pathology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Serkan Degirmencioglu
- Department of Medical Oncology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Tarik Sengoz
- Department of Nuclear Medicine, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Ilknur Hatice Akbudak
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Gamze Gokoz Dogu
- Department of Medical Oncology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Umit Aydogmus
- Department of Thoracic Surgery, Faculty of Medicine, Pamukkale University, Denizli, Turkey
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Bulut S, Celik D, Karamanlı H, Aktas Z, Özmen Ö, Ertürk H, Gürçay N, Biber Ç. The Differentiation of Metastatic Mediastinal Lymph Nodes From Benign Hypermetabolic Lesions. Cureus 2022; 14:e24884. [PMID: 35698679 PMCID: PMC9184177 DOI: 10.7759/cureus.24884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2022] [Indexed: 11/24/2022] Open
Abstract
Background Anthracosis may cause a positron emission tomography/computed tomography (PET/CT) false positivity in mediastinal and hilar lymph nodes. We aimed to evaluate the radiological features and the maximum standardized uptake values (SUVmax) of the mediastinal lymph nodes with anthracosis or squamous cell lung cancer metastasized. Methodology Patients diagnosed with anthracosis or squamous cell lung cancer with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) between January 1, 2015, and November 15, 2020, in a tertiary hospital were enrolled. The squamous cell subtype of lung cancer was selected due to its association with tobacco use, biomass, and air pollution. Anthracosis may occur due to the same etiologic reasons. Results A total of 190 patients met the study enrollment criteria, of which 86 were diagnosed with anthracosis and 33 with squamous cell lung cancer lymph metastasis. Median values for short axis, long axis, SUVmax, shape features, and presence of calcification were found significantly different between the groups. In receiver operating characteristic (ROC) analysis, the SUVmax cut-off value was calculated as 6.61. With this cutoff value, the negative predictive value (NPV) was 92.5% and the positive predictive value (PPV) was 54% for differentiating anthracosis and malignant lymph nodes metastasis. Conclusions We conclude that the evaluation of the shape and metabolic activities of the anthracotic lymph nodes detected by PET/CT together with EBUS-TBNA granted a more accurate staging of the patients and more cancer patients will benefit from surgical treatment.
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Khalid U, Akram MJ, Abu Bakar M, Butt FM, Ashraf MB. Elucidating the Etiologies of 18F-fluorodeoxyglucose-Avid Mediastinal Lymph Nodes Among Cancer Patients in a Tuberculosis-Endemic Region Using Endobronchial Ultrasound. Cureus 2021; 13:e19339. [PMID: 34909300 PMCID: PMC8651531 DOI: 10.7759/cureus.19339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2021] [Indexed: 12/25/2022] Open
Abstract
Background Non-malignant conditions, including infections (such as tuberculosis [TB]), can mimic malignancy with regards to their uptake of 18F-fluorodeoxyglucose (18F-FDG) tracer utilized for positron emission tomography-computed tomography (PET-CT) scan, as part of the diagnostic and staging workup of cancer patients. This poses a diagnostic challenge, for which tissue sampling is decisive. In this study, we aimed to determine the underlying etiologies of 18F-FDG-avid mediastinal lymph nodes among cancer patients in a TB-endemic demographic using endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and the respective sensitivity and specificity of PET-CT and EBUS in diagnosing malignancy. Methodology In this retrospective cross-sectional study, we analyzed the data of all cancer patients with 18F-FDG-avid mediastinal lymphadenopathy on diagnostic PET imaging, who later underwent EBUS-TBNA between July 2013 and December 2018 at our center. Logistic regression analysis was used to determine the relative risk of lymph node characteristics with malignant TBNA cytology, based on which a risk stratification model was formulated. Results A total of 178 patients were included in this study, comprising predominantly males (60.7%). The primary malignancy was lung cancer in 33 (18.5%) patients, while 145 (81.5%) had non-lung cancer. A total of 214 18F-FDG lymph nodes were sampled, out of which TBNA revealed malignant cytology in only 44 (20.6%). The final diagnosis was malignancy, TB, and sarcoidosis in 42 (23.6%), 16 (9%), and 12 (6.7%) patients, respectively. Among the remaining, 98 (55%) patients were determined to have only reactive lymphadenopathy, of which 24 (24.5%) had nodal anthracosis, while TBNA was inadequate for the diagnosis in 10 (5.6%) patients. An increased risk of malignancy was associated with the size of lymph node [odds ratio (OR): 1.58 (confidence interval (CI): 1.19, 2.11; p = 0.001], the standard uptake value (SUV) of the lymph node on PET-CT [OR: 1.30 (CI: 1.15, 1.45); p = 0.001], and with primary lung malignancy [OR: 4.44 (CI: 1.96, 10.06); p = 0.001]. At an SUV cut-off value of 6.0, PET-CT had the sensitivity, specificity, positive predictive value, and negative predictive value of 73%, 70%, 49.3%, and 91.8%, respectively, for diagnosing malignancy, while the same for EBUS was estimated to be 93.3%, 100%, 100%, and 97%, respectively. Conclusions In addition to TB, benign etiologies including nodal anthracosis and sarcoidosis predominate as causes of 18F-FDG-avid mediastinal lymphadenopathy in cancer patients of a TB-endemic demographic. The predictable risk of malignancy on PET imaging increases with nodal size, SUV, and lung primary malignancy; however, EBUS clearly demonstrates a higher sensitivity.
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Affiliation(s)
- Usman Khalid
- Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Muhammad J Akram
- Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Muhammad Abu Bakar
- Cancer Registry, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Faheem M Butt
- Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Mohammad B Ashraf
- Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
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Zarogoulidis P, Petridis D, Sapalidis K, Tsakiridis K, Baka S, Vagionas A, Hohenforst-Schmidt W, Freitag L, Huang H, Bai C, Drougas D, Theofilatou V, Romanidis K, Perdikouri EI, Petanidis S, Zaric B, Kovacevic T, Stojsic V, Sarcev T, Bursac D, Kukic B, Perin B, Courcoutsakis N, Athanasiou E, Hatzibougias D, Drevelegas K, Boukovinas I, Kosmidou M, Kosmidis C. Lung cancer biopsies: Comparison between simple 22G, 22G upgraded and 21G needle for EBUS-TBNA. J Cancer 2020; 11:6454-6459. [PMID: 33033529 PMCID: PMC7532516 DOI: 10.7150/jca.48691] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/25/2020] [Indexed: 02/07/2023] Open
Abstract
Introduction: Novel technologies are currently used for lung cancer diagnosis. EBUS-TBNA 22G is considered one of the most important tools. However; there are still issues with the sample size.Patients and Methods: 223 patients underwent EBUS-TBNA with a 21G Olympus needle, 22GUS Mediglobe and 22GUB Mediglobe. In order to evaluate the efficiency of 22GUB novel needle design. In order to evaluate the sample size of each needle, we constructed cell blocks and measured the different number of slices from each biopsy site. Results: The 22GUB novel needle had similar and larger number of slices from each biopsy site compared to 21G needle. Discussion: Firstly as a novel methodology we used the number of slices from the constructed cell blocks in order to evaluate the sample size. Secondly, we should seek novel needle designs and not only concentrate on the volume of the sample size.
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Affiliation(s)
- Paul Zarogoulidis
- 3rd University General Hospital, "AHEPA" University Hospital, Thessaloniki, Greece
| | - Dimitris Petridis
- Department of Food Technology, School of Food Technology and Nutrition, Alexander Technological Educational Institute, Thessaloniki, Greece
| | | | - Kosmas Tsakiridis
- Thoracic Surgery Department, "Interbalkan" European Medical Center, Thessaloniki, Greece
| | - Sofia Baka
- Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece
| | | | - Wolfgang Hohenforst-Schmidt
- Sana Clinic Group Franken, Department of Cardiology/Pulmonology/Intensive Care/Nephrology, "Hof" Clinics, University of Erlangen, Hof, Germany
| | - Lutz Freitag
- Department of Pulmonology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich Switzerland
| | - Haidong Huang
- Department of Respiratory Medicine, Changhai Hospital of Second Military Medical University, Shanghai, China
| | - Chong Bai
- Department of Respiratory Medicine, Changhai Hospital of Second Military Medical University, Shanghai, China
| | - Dimitris Drougas
- Scientigraphy Department, "Bioclinic" Private Laboratory, Thessaloniki, Greece
| | | | - Konstantinos Romanidis
- Second Department of Surgery, General University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Savas Petanidis
- Department of Pulmonology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Bojan Zaric
- Faculty of Medicine, University of Novi Sad, Institute for Pulmonary Diseases of Vojvodina, Novi Sad, Serbia
| | - Tomi Kovacevic
- Faculty of Medicine, University of Novi Sad, Institute for Pulmonary Diseases of Vojvodina, Novi Sad, Serbia
| | - Vladimir Stojsic
- Faculty of Medicine, University of Novi Sad, Institute for Pulmonary Diseases of Vojvodina, Novi Sad, Serbia
| | - Tatjana Sarcev
- Faculty of Medicine, University of Novi Sad, Institute for Pulmonary Diseases of Vojvodina, Novi Sad, Serbia
| | - Daliborka Bursac
- Faculty of Medicine, University of Novi Sad, Institute for Pulmonary Diseases of Vojvodina, Novi Sad, Serbia
| | - Biljana Kukic
- Faculty of Medicine, University of Novi Sad, Institute for Pulmonary Diseases of Vojvodina, Novi Sad, Serbia
| | - Branislav Perin
- Faculty of Medicine, University of Novi Sad, Institute for Pulmonary Diseases of Vojvodina, Novi Sad, Serbia
| | | | | | | | | | | | - Maria Kosmidou
- Internal Medicine Department, University of Ioannina, Ioannina, Greece
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Zhang L, Wu F, Zhu R, Wu D, Ding Y, Zhang Z, Gao Y, Wan Y. Application of computed tomography, positron emission tomography-computed tomography, magnetic resonance imaging, endobronchial ultrasound, and mediastinoscopy in the diagnosis of mediastinal lymph node staging of non-small-cell lung cancer: A protocol for a systematic review. Medicine (Baltimore) 2020; 99:e19314. [PMID: 32118758 PMCID: PMC7478550 DOI: 10.1097/md.0000000000019314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Ruling out distant metastases, non-small cell lung cancer (NSCLC)treatment depends on the results of mediastinal node staging (N staging). Several diagnostic methods play central roles in mediastinal N staging. This study is intended to evaluate the existing diagnostic methods and report quality, and to search for the best method for staging mediastinal lymph nodes. METHODS We searched PubMed, Embase, and the Cochrane Library to identify relevant studies, including randomized controlled trials and retrospective studies. These studies report the application of computed tomography, positron emission tomography-computed tomography, magnetic resonance imaging, endobronchial ultrasound, and mediastinoscopy in the diagnosis of mediastinal lymph node staging of NSCLC. The quality of the literature was assessed using the Quality Assessment of Diagnostic Accuracy Study 2. The true positive, false positive, true negative, and false negative of each study was extracted. The corresponding sensitivity, specificity, and other indicators were calculated and the Summary Receiver Operating curve was established. Then, head-to-head and indirect comparison meta-analyses will be conducted. RESULTS The results of this study will be published in a peer-reviewed journal. CONCLUSION This study will provide basis for mediastinal lymph node staging of non-small cell lung cancer. PROSPERO REGISTRATION NUMBER CRD42019145667.
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Affiliation(s)
- Longguo Zhang
- The Second Clinical Medical School of Lanzhou University
| | - Fanqi Wu
- Department of Respiratory, Lanzhou University Second Hospital
| | - Rui Zhu
- The Second Clinical Medical School of Lanzhou University
| | - Di Wu
- The Second Clinical Medical School of Lanzhou University
| | - Yao Ding
- The First Clinical Medical College
| | - Zhongmei Zhang
- The Second Clinical Medical School of Lanzhou University
| | - Ya Gao
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Yixin Wan
- Department of Respiratory, Lanzhou University Second Hospital
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The need of a clinically oriented reporting of 18F-FDG PET/CT in non-small cell lung cancer (NSCLC). Clin Transl Imaging 2020. [DOI: 10.1007/s40336-019-00354-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sapalidis K, Romanidis K, Oikonomou P, Zarogoulidis P, Katsaounis A, Amaniti A, Michalopoulos N, Koulouris C, Tsakiridis K, Giannakidis D, Kesisoglou I, Ioannidis A, Nikolaos-Katsios I, Vagionas A, Hohenforst-Schmidt W, Huang H, Bai C, Goganau AM, Kosmidis C. Convex endobronchial ultrasound: same coin, two faces. Challenging biopsy and staging for non-small-cell lung cancer. Lung Cancer Manag 2020; 8:LMT20. [PMID: 31983928 PMCID: PMC6978727 DOI: 10.2217/lmt-2019-0008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Lung cancer is still diagnosed at a late stage due to lack of early disease symptoms. Despite the development of new diagnostic endoscopic tools, such as radial/convex endobronchial ultrasounds (EBUS) and electromagnetic navigation, most patients are still diagnosed at advanced stage disease. Most of the patients refer to their doctor only if they cough blood or their cough changes character. There are challenging cases in the diagnosis and staging of a patient, such as the one that we will present. We present a case of lung cancer that was diagnosed through a biopsy from the main lesion, with access from the esophagus, through transbronchial needle aspiration with EBUS, under general anesthesia and intubation. Staging with transbronchial needle aspiration with EBUS was also performed at the same session.
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Affiliation(s)
- Konstantinos Sapalidis
- 3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Romanidis
- Second Department of Surgery, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Panagoula Oikonomou
- Second Department of Surgery, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Paul Zarogoulidis
- 3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Pulmonary Department, Creta InterClinic Private Hospital, Iraklio, Crete, Greece
| | - Athanasios Katsaounis
- 3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aikaterini Amaniti
- Anesthesiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Michalopoulos
- 3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Charilaos Koulouris
- 3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kosmas Tsakiridis
- Thoracic Surgery Department, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Dimitrios Giannakidis
- 3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Isaak Kesisoglou
- 3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aris Ioannidis
- 3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Iason Nikolaos-Katsios
- 3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Wolfgang Hohenforst-Schmidt
- Sana Clinic Group Franken, Department of Cardiology/Pulmonology/Intensive Care/Nephrology, 'Hof' Clinics, University of Erlangen, Hof, Germany
| | - Haidong Huang
- The Diagnostic & Therapeutic Center of Respiratory Diseases, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Chong Bai
- 3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexandru Marian Goganau
- General Surgery Clinic 1, University of Medicine andPharmacy of Craiova, Craiova County Emergency Hospital, Craiova, Romania
| | - Christoforos Kosmidis
- 3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Sawabata N. Mediastinal lymph node staging for lung cancer. MEDIASTINUM (HONG KONG, CHINA) 2019; 3:33. [PMID: 35118261 PMCID: PMC8794439 DOI: 10.21037/med.2019.07.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 07/22/2019] [Indexed: 12/13/2022]
Abstract
Mediastinal lymph node staging is crucial in deciding the treatment strategy for lung carcinoma. The diagnosis rate of computed tomography is not high; however, it is a standard examination. Although the contrast computed tomography is necessary for an accurate diagnosis, images from the positron emission tomography are excellent, and these two technologies are independent and complementary. Positron emission tomography has a disadvantage of false positives and false negatives, but it should also be used in cases where lymph node diameters are 1 cm or more. However, image-based diagnostic methods are not an alternative to histological examination. The results of a transbronchial needle biopsy are extremely dependent on the inspection method, the diagnostic ability of the physician, and the staging of the case. The transesophageal ultrasound endoscope is useful for reaching parts inaccessible by a mediastinoscope. Although its employment requires technical training, it is becoming popular as a minimally invasive method of obtaining cell and the tissue samples. A thoracoscopic biopsy is considered as a last resort for mediastinal lymph node diagnosis. Carefully-chosen invasive procedures are necessary to diagnose swollen lymph nodes. Although mediastinoscopy is still considered as the gold standard, most procedures will be replaced by a comparatively minimally invasive method in the future.
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Affiliation(s)
- Noriyoshi Sawabata
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Nara, Japan
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