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Kim HK, Jeon YJ, Um SW, Shin SH, Jeong BH, Lee K, Kim H, Lee HY, Kim TJ, Lee KS, Choi YL, Han J, Ahn YC, Pyo H, Noh JM, Choi JY, Cho JH, Choi YS, Zo JI, Shim YM, Hwang SS, Kim J. Role of invasive mediastinal nodal staging in survival outcomes of patients with non-small cell lung cancer and without radiologic lymph node metastasis: a retrospective cohort study. EClinicalMedicine 2024; 69:102478. [PMID: 38361994 PMCID: PMC10867420 DOI: 10.1016/j.eclinm.2024.102478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/19/2024] [Accepted: 01/25/2024] [Indexed: 02/17/2024] Open
Abstract
Background Lung cancer diagnostic guidelines advocate for invasive mediastinal nodal staging (IMNS), but the survival benefits of this approach in patients with non-small cell lung cancer (NSCLC) without radiologic evidence of lymph node metastasis (rN0) remain uncertain. We aimed to investigate the impact of IMNS in patients with rN0 NSCLC by comparing the long-term survival between patients who underwent IMNS and those who did not (non-IMNS). Methods In this retrospective cohort study, we included patients with NSCLC but without radiologic evidence of lymph node metastasis from the Registry for Thoracic Cancer Surgery and the clinical data warehouse at the Samsung Medical Centre, Republic of Korea between January 2, 2008 and December 31, 2016. We compared the 5-year overall survival (OS) rate as the primary outcome after propensity score matching between the IMNS and non-IMNS groups. The age, sex, performance statue, tumor size, centrality, solidity, lung function, FDG uptake in PET-CT, and histological examination of the tumor before surgery were matched. Findings A total of 4545 patients (887 in the IMNS group and 3658 in the non-IMNS group) who received curative treatment for NSCLC were included in this study. By the mediastinal node dissection, the overall incidence of unforeseen mediastinal node metastasis (N2) was 7.2% (317/4378 patients). Despite the IMNS, 67% of pathological N2 was missed (61/91 patients with unforeseen N2). Based on propensity score matching, 866 patients each for the IMNS and non-IMNS groups were assigned. There was no significant difference in 5-year OS and recurrence-free survival (RFS) between two groups: 5-year OS was 73.9% (95% confidence interval, CI: 71%-77%) for IMNS and 71.7% (95% CI: 68.6%-74.9%; p = 0.23), for non-IMNS (hazard ratio, HR 0.90, 95% CI: 0.77-1.07), while 5-year RFS was 64.7% (95% CI: 61.5%-68.2%) and 67.5% (95% CI: 64.3%-70.9%; p = 0.35 (HR 1.08, 95% CI: 0.92-1.27), respectively. Moreover, the timing and locations of recurrence were similar in both groups. Interpretation IMNS might not be required before surgery for patients with NSCLC without LN suspicious of metastasis. Further randomised trials are required to validate the findings of the present study. Funding None.
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Affiliation(s)
- Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yeong Jeong Jeon
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sang-Won Um
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sun Hye Shin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byeong-Ho Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyungjong Lee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hojoong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ho Yun Lee
- Department of Radiology and Centre for Imaging, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Tae Jung Kim
- Department of Radiology and Centre for Imaging, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyung Soo Lee
- Department of Radiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Yoon-La Choi
- Department of Pathology and Translational Genomics, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Joungho Han
- Department of Pathology and Translational Genomics, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hongryull Pyo
- Department of Radiation Oncology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae Myoung Noh
- Department of Radiation Oncology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jong Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yong Soo Choi
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae Ill Zo
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung-sik Hwang
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Jhingook Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Saha BK. Pneumomediastinum: A Rare Complication of Endobronchial Ultrasound Guided Fine Needle Aspiration. Prague Med Rep 2022; 123:43-47. [PMID: 35248164 DOI: 10.14712/23362936.2022.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is a commonly performed outpatient procedure used for the diagnosis, staging of lung cancer, and the evaluation of thoracic lymphadenopathy of unknown origin. With the advent of this minimally invasive technology, mediastinoscopy, once the gold standard, has fallen out of favour. Pneumomediastinum is a rare complication of EBUS-TBNA and can often be managed conservatively. We present a case of a 52-year-old female who developed pneumomediastinum following EBUS-TBNA and improved with expectant management in the emergency department. We discuss the proposed pathophysiology of this rare occurrence that usually follows a benign course. Severe complications, such as mediastinitis and tracheal tear, need to be excluded promptly.
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Affiliation(s)
- Biplab K Saha
- Department of Pulmonary and Critical Care Medicine, Ozarks Medical Center, West Plains, USA.
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Zhang Y, Simoff MJ, Ost D, Wagner OJ, Lavin J, Nauman B, Hsieh MC, Wu XC, Pettiford B, Shi L. Understanding the patient journey to diagnosis of lung cancer. BMC Cancer 2021; 21:402. [PMID: 33853552 PMCID: PMC8045203 DOI: 10.1186/s12885-021-08067-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/08/2021] [Indexed: 12/26/2022] Open
Abstract
Objective This research describes the clinical pathway and characteristics of two cohorts of patients. The first cohort consists of patients with a confirmed diagnosis of lung cancer while the second consists of patients with a solitary pulmonary nodule (SPN) and no evidence of lung cancer. Linked data from an electronic medical record and the Louisiana Tumor Registry were used in this investigation. Materials and methods REACHnet is one of 9 clinical research networks (CRNs) in PCORnet®, the National Patient-Centered Clinical Research Network and includes electronic health records for over 8 million patients from multiple partner health systems. Data from Ochsner Health System and Tulane Medical Center were linked to Louisiana Tumor Registry (LTR), a statewide population-based cancer registry, for analysis of patient’s clinical pathways between July 2013 and 2017. Patient characteristics and health services utilization rates by cancer stage were reported as frequency distributions. The Kaplan-Meier product limit method was used to estimate the time from index date to diagnosis by stage in lung cancer cohort. Results A total of 30,559 potentially eligible patients were identified and 2929 (9.58%) had primary lung cancer. Of these, 1496 (51.1%) were documented in LTR and their clinical pathway to diagnosis was further studied. Time to diagnosis varied significantly by cancer stage. A total of 24,140 patients with an SPN were identified in REACHnet and 15,978 (66.6%) had documented follow up care for 1 year. 1612 (10%) had no evidence of any work up for their SPN. The remaining 14,366 had some evidence of follow up, primarily office visits and additional chest imaging. Conclusion In both cohorts multiple biopsies were evident in the clinical pathway. Despite clinical workup, 70% of patients in the lung cancer cohort had stage III or IV disease. In the SPN cohort, only 66% were identified as receiving a diagnostic work-up. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08067-1.
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Affiliation(s)
- Yichen Zhang
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1900, New Orleans, LA, 70112, USA
| | - Michael J Simoff
- Bronchoscopy and Interventional Pulmonology, Lung Cancer Screening Program, Pulmonary & Critical Care Medicine, Henry Ford Hospital, Wayne State University School of Medicine, 2799 West Grand Boulevard, Detroit, MI, 48202, USA.
| | - David Ost
- Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | | | - James Lavin
- Intuitive, 1020 Kifer Road, Sunnyvale, CA, 94086, USA
| | - Beth Nauman
- Louisiana Public Health Institute, 1515 Poydras Street #1200, New Orleans, LA, 70112, USA
| | - Mei-Chin Hsieh
- Louisiana State University Health Science Center, 433 Bolivar St, New Orleans, LA, 70112, USA
| | - Xiao-Cheng Wu
- Louisiana State University Health Science Center, 433 Bolivar St, New Orleans, LA, 70112, USA
| | - Brian Pettiford
- Ochsner Health System, 1514 Jefferson Highway, Jefferson, LA, 70121, USA
| | - Lizheng Shi
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1900, New Orleans, LA, 70112, USA
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Chiu YW, Kao YH, Simoff MJ, Ost DE, Wagner O, Lavin J, Culbertson RA, Smith DG. Costs of Biopsy and Complications in Patients with Lung Cancer. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:191-200. [PMID: 33762834 PMCID: PMC7982449 DOI: 10.2147/ceor.s295494] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/04/2021] [Indexed: 12/26/2022] Open
Abstract
Purpose To describe the distribution of diagnostic procedures, rates of complications, and total cost of biopsies for patients with lung cancer. Patients and Methods Observational study using data from IBM Marketscan® Databases for continuously insured adult patients with a primary lung cancer diagnosis and treatment between July 2013 and June 2017. Costs of lung cancer diagnosis covered 6 months prior to index biopsy through treatment. Costs of chest CT scans, biopsy, and post-procedural complications were estimated from total payments. Costs of biopsies incidental to inpatient admissions were estimated by comparable outpatient biopsies. Results The database included 22,870 patients who had a total of 37,160 biopsies, of which 16,009 (43.1%) were percutaneous, 14,997 (40.4%) bronchoscopic, 4072 (11.0%) surgical and 2082 (5.6%) mediastinoscopic. Multiple biopsies were performed on 41.9% of patients. The most common complications among patients receiving only one type of biopsy were pneumothorax (1304 patients, 8.4%), bleeding (744 patients, 4.8%) and intubation (400 patients, 2.6%). However, most complications did not require interventions that would add to costs. Median total costs were highest for inpatient surgical biopsies ($29,988) and lowest for outpatient percutaneous biopsies ($1028). Repeat biopsies of the same type increased costs by 40–80%. Complications account for 13% of total costs. Conclusion Costs of biopsies to confirm lung cancer diagnosis vary substantially by type of biopsy and setting. Multiple biopsies, inpatient procedures and complications result in higher costs.
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Affiliation(s)
- Yu-Wen Chiu
- Health Policy & Systems Management, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Yu-Hsiang Kao
- Health Policy & Systems Management, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Michael J Simoff
- Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - David E Ost
- Department of Pulmonology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - James Lavin
- Intuitive Surgical, Sunnyvale, California, USA
| | - Richard A Culbertson
- Health Policy & Systems Management, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Dean G Smith
- Health Policy & Systems Management, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
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Kalsi HS, Thakrar R, Gosling AF, Shaefi S, Navani N. Interventional Pulmonology: A Brave New World. Thorac Surg Clin 2020; 30:321-338. [PMID: 32593365 DOI: 10.1016/j.thorsurg.2020.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Interventional pulmonology is a dynamic and evolving field in respiratory medicine. Advances have improved the ability to diagnose and manage diseases of the airways. A shift toward early detection of malignant disease has generated a focus on innovative diagnostic techniques. With patient populations living longer with malignant and benign diseases, the role for interventional bronchoscopy has grown. In cancer groups, novel immunotherapies have improved the prospects of clinical outcomes and reignited a focus on optimizing patient performance status to enable access to anticancer therapy. This review discusses current and emerging diagnostic modalities and therapeutic approaches available to manage airway diseases.
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Affiliation(s)
- Hardeep S Kalsi
- Division of Medicine, Lungs for Living Research Centre, UCL Respiratory, University College London, Rayne Building, 5 University Street, London, UK
| | - Ricky Thakrar
- Division of Medicine, Lungs for Living Research Centre, UCL Respiratory, University College London, Rayne Building, 5 University Street, London, UK
| | - Andre F Gosling
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, MA, USA
| | - Shahzad Shaefi
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, MA, USA
| | - Neal Navani
- Division of Medicine, Lungs for Living Research Centre, UCL Respiratory, University College London, Rayne Building, 5 University Street, London, UK.
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Zhang Y, Shi L, Simoff MJ, J Wagner O, Lavin J. Biopsy frequency and complications among lung cancer patients in the United States. Lung Cancer Manag 2020; 9:LMT40. [PMID: 33318758 PMCID: PMC7729592 DOI: 10.2217/lmt-2020-0022] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 07/30/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE This study aimed to describe the frequency and distribution of biopsy procedures for patients diagnosed and treated for primary lung cancer. STUDY DESIGN Retrospective cohort study within an administrative database. MATERIALS & METHODS This observational study used data from the IBM MarketScan® Databases between 2013 and 2015. RESULTS The total number of lung biopsies performed among eligible subjects was 32,814; an average of 1.7 biopsies per patient. Bronchoscopy and percutaneous approaches accounted for 95% of all procedures. Complication rates by procedure are remarkably similar irrespective of biopsy frequency. CONCLUSION Nearly half (46%) of patients in this population experienced multiple biopsies prior to diagnosis. Further, biopsy choice or sequence in patients receiving multiple procedures was unpredictable.
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Affiliation(s)
- Yichen Zhang
- Department of Health Policy & Management, Tulane University, School of Public Health & Tropical Medicine, 1440 Canal Street, Suite 1900, New Orleans, LA 70112, USA
| | - Lizheng Shi
- Department of Health Policy & Management, Tulane University, School of Public Health & Tropical Medicine, 1440 Canal Street, Suite 1900, New Orleans, LA 70112, USA
| | - Michael J Simoff
- Pulmonary & Critical Care Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | | | - James Lavin
- Intuitive, 1020 Kifer Road, Sunnyvale, CA 94086, USA
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7
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Yazgan S, Ucvet A, Gursoy S, Ceylan KC, Yıldırım Ş. Surgical Experience of Video-Assisted Mediastinoscopy for Nonlung Cancer Diseases. Thorac Cardiovasc Surg 2020; 69:189-193. [PMID: 32634834 DOI: 10.1055/s-0040-1713138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Video-assisted mediastinoscopy (VAM) is a valuable method in the investigation of diseases with mediastinal lymphadenopathy or those localized in the mediastinum. The aim of this study was to determine the diagnostic value of VAM in the investigation of mediastinal involvement of nonlung cancer diseases and to describe our institutional surgical experience. METHODS Clinical parameters such as age, sex, histological diagnosis, morbidity, and mortality of all patients who underwent VAM for the investigation of mediastinal involvement of diseases except lung cancer between January 2006 and July 2018 were retrospectively reviewed, and the diagnostic efficacy of VAM was determined statistically. RESULTS During the study period, 388 patients underwent VAM, and 536 lymph nodes were sampled for histopathological evaluation of mediastinum due to mediastinal lymphadenopathy or paratracheal lesions. The most common diagnoses were sarcoidosis (n = 178 [45.9%]), tuberculous lymphadenitis (n = 108 [27.8%]), lymphadenitis with anthracosis (n = 72 [18.6%]), and lymphoma (n = 15 [3.9%]). CONCLUSION The results of the study show that VAM should be used because of its high diagnostic benefit in mediastinal lymphadenopathies, which are difficult to diagnose, or mediastinal lesions located in the paratracheal region. Despite the increase in the number of new diagnostic modalities, VAM is still the most effective method and a gold standard.
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Affiliation(s)
- Serkan Yazgan
- Department of Thoracic Surgery, Dr Suat Seren Chest Diseases and Surgery Medical Practice Research Center, University of Health Sciences, Izmir, Turkey
| | - Ahmet Ucvet
- Department of Thoracic Surgery, Dr Suat Seren Chest Diseases and Surgery Medical Practice Research Center, University of Health Sciences, Izmir, Turkey
| | - Soner Gursoy
- Department of Thoracic Surgery, Dr Suat Seren Chest Diseases and Surgery Medical Practice Research Center, University of Health Sciences, Izmir, Turkey
| | - Kenan Can Ceylan
- Department of Thoracic Surgery, Dr Suat Seren Chest Diseases and Surgery Medical Practice Research Center, University of Health Sciences, Izmir, Turkey
| | - Şener Yıldırım
- Department of Thoracic Surgery, Dr Suat Seren Chest Diseases and Surgery Medical Practice Research Center, University of Health Sciences, Izmir, Turkey
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Saqib M, Maruf M, Bashir S, Mehmood S, Akhter N, Yusuf MA, Loya A. EUS-FNA, ancillary studies and their clinical utility in patients with mediastinal, pancreatic, and other abdominal lesions. Diagn Cytopathol 2020; 48:1058-1066. [PMID: 32515558 DOI: 10.1002/dc.24523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/21/2020] [Accepted: 05/19/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is an important modality to obtain tissue diagnosis from mediastinal, pancreatic, and intra-abdominal lesions in close proximity to the pulmonary and gastrointestinal tract. It is considered to be a relatively safe, rapid, and minimally invasive technique with low complication rates. AIMS To determine the diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and outcome of EUS-FNA, with histological correlation where applicable. METHODS Data of all 1059 consecutive patients who underwent EUS-FNA from 1 January 2005 to 31 December 2017 at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore was reviewed in this retrospective study. The major sites that were targeted for EUS-FNA were pancreatic (423), mediastinal (376), and other abdominal lesions (260). RESULTS The average number of passes per patient was 2.22. Rapid on-site evaluation (ROSE) was adequate in 969 patients (91.4%). Concordance between ROSE and final cytology was 99.5%. Follow-up was available in 810 patients (76.4%). The overall diagnostic yield was 94.3%. Ancillary studies, including immunohistochemical stains and flow cytometry, helped to increase the diagnostic yield from 78.1% to 94.3%. The overall sensitivity, specificity, PPV, NPV, and diagnostic accuracy for EUS-FNA were 94.8%, 98.6%, 99.9%, 65.5%, and 95.1%, respectively. Seven of 1059 patients (0.6%) developed complications. CONCLUSION EUS-FNA is a very sensitive and specific diagnostic tool with a minimal complication rate. Ancillary studies helped to increase the sensitivity, as well as the diagnostic yield.
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Affiliation(s)
- Muhammad Saqib
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Maheen Maruf
- Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Sehar Bashir
- Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Shafqat Mehmood
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Noreen Akhter
- Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Muhammed Aasim Yusuf
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Asif Loya
- Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
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Avasarala SK, Aravena C, Almeida FA. Convex probe endobronchial ultrasound: historical, contemporary, and cutting-edge applications. J Thorac Dis 2020; 12:1085-1099. [PMID: 32274177 PMCID: PMC7139045 DOI: 10.21037/jtd.2019.10.76] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The use of convex-probe endobronchial ultrasound (CP-EBUS) has revolutionized bronchoscopy. It has provided the option of a relatively safe, minimally invasive approach for the assessment of various intrathoracic diseases. In current practice, its most dramatic impact has been on the diagnosing and staging of lung cancer. It has served as an invaluable tool that has replaced mediastinoscopy in a variety of clinical scenarios. Many pulmonologists and thoracic surgeons consider CP-EBUS the most significant milestone in bronchoscopy after the development of the flexible bronchoscope itself. In this review, we summarize the historical aspects, current indications, technical approach, and future direction of CP-EBUS.
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Affiliation(s)
| | - Carlos Aravena
- Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
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10
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Sakairi Y, Nakajima T, Yoshino I. Role of endobronchial ultrasound-guided transbronchial needle aspiration in lung cancer management. Expert Rev Respir Med 2019; 13:863-870. [DOI: 10.1080/17476348.2019.1646642] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Yuichi Sakairi
- 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
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
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11
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Harris D, Saha S. Endobronchial ultrasound-guided biopsy for evaluation of suspected lung cancer. Asian Cardiovasc Thorac Ann 2019; 27:471-475. [DOI: 10.1177/0218492319853184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose Historically, mediastinoscopy has been the gold standard for lung cancer diagnosis and staging, but mediastinoscopy has many limitations including sensitivity, the limited number of lymph node levels that can be sampled, and safety. Endobronchial ultrasound-guided transbronchial needle aspiration is a relatively new and less-invasive technique being used for lung cancer screening. Many studies have reported that it has similar sensitivity and specificity compared to mediastinoscopy, with a significantly lower complication rate. We performed this review to determine our institution’s experience with endobronchial ultrasound-guided transbronchial needle aspiration in lung cancer diagnosis and staging. Methods We reviewed the last 150 patients with suspected lung cancer who underwent endobronchial ultrasound-guided transbronchial needle aspiration procedures in our institution from May 26, 2016 to August 31, 2017. Results Ninety-seven of the 150 patients had a confirmed diagnosis of malignancy. Forty patients had a diagnosis other than cancer, and 13 had incomplete information or were lost to follow-up. Endobronchial ultrasound-guided transbronchial needle aspiration was correct in diagnosing malignancy or excluding malignant lymph nodes in 92 of the 97 patients with malignancy. Overall, the sensitivity, specificity, positive-predictive value, and negative-predictive value was 94.0%, 100.0%, 100.0%, and 91.5%, respectively. Only 3 complications were reported: 2 patients suffered minor bleeding, and one suffered major bleeding that resulted in cardiac arrest. Conclusions Real-time endobronchial ultrasound-guided transbronchial needle aspiration has a similar sensitivity and specificity to mediastinoscopy in diagnosing malignancy, with fewer complications and more financial benefit.
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Affiliation(s)
- Dwight Harris
- University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Sibu Saha
- Department of Surgery, Division of Cardiothoracic Surgery, University of Kentucky, Lexington, Kentucky, USA
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Osarogiagbon RU, Lee YS, Faris NR, Ray MA, Ojeabulu PO, Smeltzer MP. Invasive mediastinal staging for resected non-small cell lung cancer in a population-based cohort. J Thorac Cardiovasc Surg 2019; 158:1220-1229.e2. [PMID: 31147169 DOI: 10.1016/j.jtcvs.2019.04.068] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 04/18/2019] [Accepted: 04/20/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Invasive mediastinal nodal staging is recommended before curative-intent resection in patients with non-small cell lung cancer deemed at risk for mediastinal lymph node involvement. We evaluated the use and survival effect of preoperative invasive mediastinal nodal staging in a population-based non-small cell lung cancer cohort. METHODS We analyzed all curative-intent resections for non-small cell lung cancer from 2009 to 2018 in 11 hospitals in 4 contiguous Dartmouth Hospital Referral Regions, comparing patients who did not have invasive mediastinal nodal staging with those who did. RESULTS Preoperative invasive nodal staging was used in 22% of 2916 patients, including mediastinoscopy only in 13%, minimally invasive procedures only in 6%, and both approaches in 3%. Sixty-three percent of patients at risk for nodal disease (tumor size ≥3.0 cm/T2-T4; N1-N3 by computed tomography or positron-emission tomography-computerized tomography criterion) did not undergo invasive staging; among those who did not have invasive testing, 47% had at least 1 of the 3 clinical indications. Mediastinoscopy yielded a median of 3 lymph nodes and 2 nodal stations; 17% of mediastinoscopies and 31% of endobronchial ultrasound procedures yielded no lymph node material. Patients not invasively staged were more likely to have no nodes (6% vs 2%; P < .0001) and no mediastinal nodes (20% vs 11%; P < .0001) examined at surgery. Invasive staging was associated with significantly better survival (P = .0157). CONCLUSIONS More than a decade after the 2001 American College of Surgeons Patient Care Evaluation report, preoperative invasive nodal staging remains underused and of variable quality, but was associated with survival benefit in high-risk patients.
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Affiliation(s)
| | - Yu-Sheng Lee
- Division of Epidemiology, Biostatistics, and Environmental Health, University of Memphis School of Public Health, Memphis, Tenn
| | - Nicholas R Faris
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tenn
| | - Meredith A Ray
- Division of Epidemiology, Biostatistics, and Environmental Health, University of Memphis School of Public Health, Memphis, Tenn
| | - Philip O Ojeabulu
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tenn
| | - Matthew P Smeltzer
- Division of Epidemiology, Biostatistics, and Environmental Health, University of Memphis School of Public Health, Memphis, Tenn
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13
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Grenda TR, Ballard TNS, Obi AT, Pozehl W, Seagull FJ, Chen R, Cohn AM, Daskin MS, Reddy RM. Computer Modeling to Evaluate the Impact of Technology Changes on Resident Procedural Volume. J Grad Med Educ 2016; 8:713-718. [PMID: 28018536 PMCID: PMC5180526 DOI: 10.4300/jgme-d-15-00503.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND As resident "index" procedures change in volume due to advances in technology or reliance on simulation, it may be difficult to ensure trainees meet case requirements. Training programs are in need of metrics to determine how many residents their institutional volume can support. OBJECTIVE As a case study of how such metrics can be applied, we evaluated a case distribution simulation model to examine program-level mediastinoscopy and endobronchial ultrasound (EBUS) volumes needed to train thoracic surgery residents. METHODS A computer model was created to simulate case distribution based on annual case volume, number of trainees, and rotation length. Single institutional case volume data (2011-2013) were applied, and 10 000 simulation years were run to predict the likelihood (95% confidence interval) of all residents (4 trainees) achieving board requirements for operative volume during a 2-year program. RESULTS The mean annual mediastinoscopy volume was 43. In a simulation of pre-2012 board requirements (thoracic pathway, 25; cardiac pathway, 10), there was a 6% probability of all 4 residents meeting requirements. Under post-2012 requirements (thoracic, 15; cardiac, 10), however, the likelihood increased to 88%. When EBUS volume (mean 19 cases per year) was concurrently evaluated in the post-2012 era (thoracic, 10; cardiac, 0), the likelihood of all 4 residents meeting case requirements was only 23%. CONCLUSIONS This model provides a metric to predict the probability of residents meeting case requirements in an era of changing volume by accounting for unpredictable and inequitable case distribution. It could be applied across operations, procedures, or disease diagnoses and may be particularly useful in developing resident curricula and schedules.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Rishindra M. Reddy
- Corresponding author: Rishindra M. Reddy, MD, FACS, University of Michigan, TC2120/5344, 1500 East Medical Center Drive, Ann Arbor, MI 48109, 734.763.7337, fax 734.615.2656,
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14
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Bellinger CR, Chatterjee AB, Adair N, Houle T, Khan I, Haponik E. Authors' Reply. Respiration 2015; 90:174. [PMID: 26160443 DOI: 10.1159/000435870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Christina R Bellinger
- Department of Pulmonary/Critical Care, Wake Forest Baptist Health, Winston-Salem, N.C., USA
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15
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Hanna WC. Old habits die hard. J Thorac Cardiovasc Surg 2014; 149:43-4. [PMID: 25304305 DOI: 10.1016/j.jtcvs.2014.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 09/11/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Waël C Hanna
- Division of Thoracic Surgery, McMaster University, St Joseph's Healthcare, Hamilton, Ontario, Canada.
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16
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Fernandez FG, Kozower BD, Crabtree TD, Force SD, Lau C, Pickens A, Krupnick AS, Veeramachaneni N, Patterson GA, Jones DR, Meyers BF. Utility of mediastinoscopy in clinical stage I lung cancers at risk for occult mediastinal nodal metastases. J Thorac Cardiovasc Surg 2014; 149:35-41, 42.e1. [PMID: 25439769 DOI: 10.1016/j.jtcvs.2014.08.075] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 08/15/2014] [Accepted: 08/20/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The prevalence of mediastinal lymph node metastases is unknown for patients with clinical N0 lung cancer who are thought to be at high risk for occult nodal metastases. Further, the utility of mediastinoscopy in these patients is unknown. We performed a prospective trial to evaluate the utility of routine cervical mediastinoscopy for patients who may be at high risk of occult nodal metastases. METHODS From January 1, 2008, July 31, 2013, 90 patients with lung cancer with clinical stage T2N0 or T1N0 with standardized uptake value greater than 10 by positron emission tomography/computed tomography underwent routine cervical mediastinoscopy before lung resection. Biopsy of a minimum of 3 nodal stations at mediastinoscopy and a minimum of 4 nodal stations with lung resection was advised. The prevalence of nodal metastases at mediastinoscopy and lung resection was recorded. RESULTS Some 64% of patients with lung cancer were male with a mean age of 67.3 years. A total of 81 patients had clinical T2N0 and 9 patients had T1N0 with standardized uptake value greater than 10. Mean tumor size was 4.3 ± 1.7 cm, and mean standardized uptake value was 13.5 ± 6.8. One patient (1.1%) had occult metastases detected at mediastinoscopy. A total of 86 patients underwent surgical resection; 4 patients (4.6%) were upstaged to pN2, and 18 patients (21%) were upstaged to pN1. Of 90 patients with clinically staged N0 lung cancer by positron emission tomography/computed tomography, 5.6% (5) were upstaged to pN2 and 20% (18) were upstaged to pN1 (total nodal upstaging = 25.6%). CONCLUSIONS Mediastinoscopy seems to have limited utility in these patients with T1 and T2 clinically staged N0 by positron emission tomography/computed tomography. Selective use of mediastinoscopy is recommended, along with thorough mediastinal lymph node evaluation in all patients at the time of lung cancer resection.
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Affiliation(s)
- Felix G Fernandez
- Section of General Thoracic Surgery, Emory University School of Medicine, Atlanta, Ga; Atlanta Veterans Affairs Medical Center, Decatur, Ga.
| | - Benjamin D Kozower
- Division of Cardiothoracic Surgery, University of Virginia School of Medicine, Charlottesville, Va
| | - Traves D Crabtree
- Section of General Thoracic Surgery, Washington University School of Medicine, St Louis, Mo
| | - Seth D Force
- Section of General Thoracic Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Christine Lau
- Division of Cardiothoracic Surgery, University of Virginia School of Medicine, Charlottesville, Va
| | - Allan Pickens
- Section of General Thoracic Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Alexander S Krupnick
- Section of General Thoracic Surgery, Washington University School of Medicine, St Louis, Mo
| | | | - G Alexander Patterson
- Section of General Thoracic Surgery, Washington University School of Medicine, St Louis, Mo
| | - David R Jones
- Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bryan F Meyers
- Section of General Thoracic Surgery, Washington University School of Medicine, St Louis, Mo
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