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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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2
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Gallina FT, Assisi D, Forcella D, Pierconti F, Visca P, Melis E, Facciolo F. Five years of thoracic endoscopy unit activity on lung cancer staging: how teamwork can improve the outcomes. MEDIASTINUM (HONG KONG, CHINA) 2022; 5:13. [PMID: 35118319 PMCID: PMC8794365 DOI: 10.21037/med-20-53] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 03/30/2021] [Indexed: 01/18/2023]
Abstract
Background Regarding the staging of mediastinal lymph nodes before lung cancer surgery, Endobronchial Ultrasound Transbronchial Needle Aspirations (EBUS-TBNA) have proven to be highly sensitive and specific as well as safe. Endoscopic Ultrasound Fine Needle Aspirations (EUS-FNA) plays an important role in the diagnosis and staging of thoracic diseases, including lung cancer. In this study we analysed all patients underwent endoscopic procedures in our endoscopic mediastinal ultrasound unit. Methods Between January 2013 and February 2018, we performed a total of 929 endoscopic procedures, 432 EBUS-TBNA and 497 EUS-FNA. Biopsy was performed at the following mediastinal sites: station 7 in 642 cases, at stations 8 and 9 in 211 cases; at station 3P and 4L in 27 and 114 cases respectively; with EUS we were able to perform biopsy at station 5 in 52 cases. Results A total of 841 patients showed a diagnosis of cancer: non-small cell lung cancer (NSCLC) in 645 patients, SCLC in 190 patients, neuroendocrine tumour in 5 patients and one patient with mesothelioma. 88 patients were negative for cancer. In terms of sensitivity, specificity and accuracy, the association between EUS-FNAb and EBUS-TBNAb showed a better quality on diagnosis compared to single procedures. EUS-FNA and EBUS-TBNA are safe, feasible, and highly sensitive techniques. Conclusions An endoscopic mediastinal ultrasound unit allows to perform a higher number of endoscopic procedures and improved the sensitivity and the accuracy of the minimally invasive hilar-mediastinal staging.
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Affiliation(s)
| | - Daniela Assisi
- Digestive Endoscopy Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Daniele Forcella
- Thoracic Surgery, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Federico Pierconti
- Anesthesiology and Intensive Care Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Paolo Visca
- Pathology Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Enrico Melis
- Thoracic Surgery, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Francesco Facciolo
- Thoracic Surgery, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
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Tejedor-Tejada J, Chavarría C, Burgueño-Gómez B, Fanjul I, García-Alonso FJ, Torres MÁ, Madrigal B, Pérez-Miranda M, De la Serna-Higuera C. Role of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis and classification of lymphomas. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 113:404-410. [PMID: 33222483 DOI: 10.17235/reed.2020.7191/2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a safe and effective technique in the diagnosis of mediastinal and abdominal masses. However, the usefulness of EUS-FNA in the diagnosis and classification of lymphomas is controversial. The aim of this study was to determine the yield of EUS-FNA in the diagnosis and classification of lymphomas. METHODS a retrospective case series was performed in a tertiary referral center. All consecutive patients referred for EUS-FNA with a suspected diagnosis of lymphoma from March 2013 to June 2019 were included. RESULTS thirty-five patients (54.3 % women, median age 72 years) were included. The most frequent location of the node was the abdomen (67.9 %). Nodes were punctured using a 22-gauge (85.7 %) and 19-gauge needle (14.3 %) with a slow-pull technique. The number of passes performed were three or more in 82.9 % of patients. The samples were processed by the cellblock method. Adequate samples for immunohistochemical and molecular biological study were obtained in 33 (94.3 %) patients. EUS-FNA correctly diagnosed lymphoma in 30 out of 35 patients (85.7 %), and subclassification was determined in 23 patients (65.7 %). The most frequent diagnosis was non-Hodgkin lymphoma (85.7 %). There was one moderate adverse event (bleeding), which was resolved during the procedure. CONCLUSIONS EUS-FNA may be a valuable technique in the evaluation of suspected lymphomas with an adequate diagnostic yield and a very low rate of adverse events.
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Affiliation(s)
- Javier Tejedor-Tejada
- Endoscopy Unit. Department of Gastroenterology, Hospital Universitario Río Hortega, España
| | - Carlos Chavarría
- Endoscopy Unit. Department of Gastroenterology, Hospital Universitario Río Hortega, España
| | - Beatriz Burgueño-Gómez
- Endoscopy Unit. Department of Gastroenterology, Hospital Universitario Río Hortega, España
| | - Ignacio Fanjul
- Endoscopy Unit. Department of Gastroenterology, Hospital Universitario Río Hortega, España
| | | | | | | | - Manuel Pérez-Miranda
- Endoscopy Unit. Department of Gastroenterology, Hospital Universitario Río Hortega, España
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Gallina FT, Ferraresi V, Annovazzi A, Vari S, Visca P, Forcella D, Assisi D, Melis E, Facciolo F. Mediastinal lymph node metastasis as a single expression of disease relapse in Ewing's sarcoma: multidisciplinary approach of two consecutive cases. Intractable Rare Dis Res 2021; 10:214-219. [PMID: 34466345 PMCID: PMC8397818 DOI: 10.5582/irdr.2021.01063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/15/2021] [Accepted: 07/27/2021] [Indexed: 11/05/2022] Open
Abstract
Ewing's sarcoma of the bone is a rare, highly aggressive tumor that typically affects children and young adults. Progress in the treatment of Ewing's sarcoma has improved survival from about 10%, before the introduction of chemotherapy, to about 75% today for patients with localized tumors. On the contrary, metastatic disease still has a poor prognosis, and a multidisciplinary approach is essential to improve the outcome. Molecular techniques and new imaging modalities are affecting the diagnosis and classification of patients with Ewing's sarcoma. The most frequent sites of metastases in Ewing's sarcoma include lungs, bones and bone marrow. Lymph nodes are a rare site of metastatic spread, particularly in the mediastinum. In this report, we present two consecutive cases of patients with Ewing's Sarcoma, diagnosed, and treated at our institute. We focused particularly on the rarity of the atypical presentation of the disease and on the synergistic strategy to adopt as a model of networking in treating patients with rare diseases.
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Affiliation(s)
- Filippo Tommaso Gallina
- Department of Thoracic Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
- Address correspondence to:Filippo Tommaso Gallina, Thoracic Surgery, National Cancer Institute "Regina Elena" Rome Via Elio Chianesi 53, 00144 Rome, Italy.
| | - Virginia Ferraresi
- Department of Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alessio Annovazzi
- Nuclear Medicine Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Sabrina Vari
- Department of Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Paolo Visca
- Pathology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Daniele Forcella
- Department of Thoracic Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Daniela Assisi
- Digestive Endoscopy Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Enrico Melis
- Department of Thoracic Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesco Facciolo
- Department of Thoracic Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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Chen L, Li Y, Gao X, Lin S, He L, Luo G, Li J, Huang C, Wang G, Yang Q, Shan H. High Diagnostic Accuracy and Safety of Endoscopic Ultrasound-Guided Fine-Needle Aspiration in Malignant Lymph Nodes: A Systematic Review and Meta-Analysis. Dig Dis Sci 2021; 66:2763-2775. [PMID: 32979158 DOI: 10.1007/s10620-020-06554-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 08/10/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is increasingly being used for diagnosing lymphadenopathy. We aim to systematically review the accuracy of EUS-FNA in differentiating benign and malignant mediastinal and abdominal lymph nodes (LNs). METHODS A comprehensive literature search was performed on multiple electronic databases through February 2020. A random or fixed effect model generated the pooled sensitivity, specificity, likelihood ratio (LR), and diagnostic odds ratio (DOR) of EUS-FNA. Subgroup analyses and meta-regression were used to explore sources of heterogeneity. RESULTS Twenty-six studies involving 2753 patients with 2833 LNs were included. In the differential diagnosis of benign and malignant LNs, EUS-FNA had a pooled sensitivity, specificity, positive LR, and negative LR of 87% (95% confidence interval [CI] 86-90%), 100% (95% CI 99-100%), 68.98 (95% CI 42.10-113.02), and 0.14 (95% CI 0.11-0.17), respectively. The pooled rate of adverse events associated with EUS-FNA was 1.57% (95% CI 1.06-2.24%). The summary receiver operating characteristic (SROC) yielded an area under the curve (AUC) of 0.9912. EUS-FNA performed in mediastinal LNs gained a sensitivity of 85% (95% CI 81-88%), while in abdominal LNs, it reached 87% (95% CI 82-91%). The sensitivity of the subgroup with rapid on-site evaluation (ROSE) was 91% (95% CI 89-93%), while non-ROSE was 85% (95% CI 82-87%). CONCLUSIONS EUS-FNA is a sensitive, highly specific, and safe method for distinguishing benign and malignant mediastinal or abdominal LNs. However, the sensitivity of EUS-FNA still varies significantly among different centers.
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Affiliation(s)
- Linbin Chen
- Department of Endoscopy, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Yin Li
- Department of Endoscopy, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Xiaoyan Gao
- Department of Endoscopy, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Shiyong Lin
- Department of Endoscopy, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Longjun He
- Department of Endoscopy, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Guangyu Luo
- Department of Endoscopy, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Jianjun Li
- Department of Endoscopy, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Chunyu Huang
- Department of Endoscopy, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Guobao Wang
- Department of Endoscopy, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Qing Yang
- Department of Endoscopy, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Hongbo Shan
- Department of Endoscopy, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China. .,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.
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Diagnosis of Pancreatic Solid Lesions, Subepithelial Lesions, and Lymph Nodes Using Endoscopic Ultrasound. J Clin Med 2021; 10:jcm10051076. [PMID: 33807558 PMCID: PMC7961381 DOI: 10.3390/jcm10051076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 02/28/2021] [Accepted: 03/02/2021] [Indexed: 12/12/2022] Open
Abstract
Currently, endoscopic ultrasound (EUS) has become widely accepted and has considerable advantages over computed tomography (CT) and other imaging modalities, given that it enables echostructure assessment in lesions with <1 cm diameter and permits high resolution imaging. EUS-guided tissue acquisition (EUS-TA) provides consistent results under ultrasound guidance and has been considered more effective compared to CT- or ultrasound-guided lesion biopsy. Moreover, complication rates, including pancreatitis and bleeding, have been extremely low, with <1% morbidity and mortality rates, thereby suggesting the exceptional overall safety of EUS-TA. The aggressive use of EUS for various lesions has been key in facilitating early diagnosis and therapy. This review summarizes the diagnostic ability of EUS for pancreatic solid lesions, subepithelial lesions, and lymph nodes where it is mainly used. EUS has played an important role in diagnosing these lesions and planning treatment strategies. Future developments in EUS imaging technology, such as producing images close to histopathological findings, are expected to further improve its diagnostic ability. Moreover, tissue acquisition via EUS is expected to be used for precision medicine, which facilitates the selection of an appropriate therapeutic agent by increasing the amount of tissue collected and improving genetic analysis.
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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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Chrysikos S, Gkiozos I, Dimakou K, Zervas E, Karampitsakos T, Anyfanti M, Tzouvelekis A, Samitas K, Gaga M, Koulouris N, Vasileiadis I, Syrigos K. Clinical utility of thoracic endosonography (EBUS/EUS-b) in mediastinal staging of patients with non-small cell lung cancer: comparison with integrated PET/CT-a real-life prospective study in Greece. J Thorac Dis 2020; 12:5657-5666. [PMID: 33209398 PMCID: PMC7656385 DOI: 10.21037/jtd-20-1735] [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] [Indexed: 12/25/2022]
Abstract
Background Accurate mediastinal staging in patients with non-small cell lung cancer (NSCLC) is crucial for the determination of optimal treatment management. Methods This was a real-life prospective study enrolling 140 patients between December 2016 and August 2018. We aimed to determine the clinical utility of EBUS/EUS-b in mediastinal staging of patients with NSCLC in comparison with integrated PET/CT. Furthermore, SUVmax cut-off value with the highest specificity/accuracy was evaluated. Subgroup analysis according to histological type was performed. Results One hundred and thirty patients were eligible for analysis (mean age ± SD: 67.6±7.6, males 97). Three hundred different lymph node stations were sampled (272 through EBUS-TBNA and 28 through EUS-b FNA). Mean SUVmax of all malignant lymph nodes was 7.46 (SD =5.54). Sensitivity, specificity, PPV and NPV of EBUS/EUS-b for the identification of mediastinal malignant lymph nodes was 93.8%, 100%, 100%, and 93.4%, respectively. Accordingly, PET/CT yielded 92.2% sensitivity, 43.9% specificity, 64.8% PPV and 83.3% NPV. For adenocarcinoma (n=76) NPV were 86.2% with EBUS/EUS-b and 75% with PET/CT. NPV for squamous cell (n=46) was 100% with EBUS/EUS-b and 90.9% with PET/CT. EBUS/EUS-b staging yielded excellent agreement with final staging (97.5%, Tau 0.94, P<0.001). ROC curve analysis identified the value 4.95 as the optimal SUVmax cut-off value with the best specificity (87.4%) and accuracy (79%) (AUC 0.69; 95% CI: 0.73-0.84, P<0.001). Conclusions Thoracic endosonography is an excellent, minimally invasive tool yielding high sensitivity and diagnostic accuracy in mediastinal staging of patients with NSCLC. Implementation of both EBUS/EUS-b and PET/CT is necessary before any surgical intervention.
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Affiliation(s)
- Serafeim Chrysikos
- 5 Respiratory Medicine Department, "Sotiria" Chest Diseases Hospital, Athens, Greece
| | - Ioannis Gkiozos
- 3 Internal Medicine Department, "Sotiria" Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Katerina Dimakou
- 5 Respiratory Medicine Department, "Sotiria" Chest Diseases Hospital, Athens, Greece
| | - Eleftherios Zervas
- 7 Respiratory Medicine Department, Athens "Sotiria" Chest Diseases Hospital, Athens, Greece
| | | | - Maria Anyfanti
- 7 Respiratory Medicine Department, Athens "Sotiria" Chest Diseases Hospital, Athens, Greece
| | - Argyrios Tzouvelekis
- 1 Academic Respiratory Medicine Department, "Sotiria" Chest diseases hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Samitas
- 7 Respiratory Medicine Department, Athens "Sotiria" Chest Diseases Hospital, Athens, Greece
| | - Mina Gaga
- 7 Respiratory Medicine Department, Athens "Sotiria" Chest Diseases Hospital, Athens, Greece
| | - Nikolaos Koulouris
- 1 Academic Respiratory Medicine Department, "Sotiria" Chest diseases hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Vasileiadis
- Intensive Care Unit, First Department of Respiratory Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Syrigos
- 3 Internal Medicine Department, "Sotiria" Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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9
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Balwan A, Bixby B, Grotepas C, Witt BL, Iravani A, Ansari S, Reddy CB. Core needle biopsy with endobronchial ultrasonography: single center experience with 100 cases. J Am Soc Cytopathol 2020; 9:249-253. [PMID: 32451285 DOI: 10.1016/j.jasc.2020.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Adequate sampling by endobronchial ultrasound (EBUS)-transbronchial needle aspiration to meet the demands of precision medicine or histologic evaluation is challenging. There is increasing demand for core biopsy specimens with advances in therapy. Franseen enodoscopic ultrasound needles have shown promising results in gastroenterology application for obtaining core biopsies and same design has recently been extended for pulmonary use. We evaluated Franseen needles with EBUS to assess its utility, safety and ability to provide core biopsy specimens. MATERIALS AND METHODS Retrospective analysis of our database at the University of Utah of patients undergoing EBUS with a Franseen needle was performed to ascertain the performance characteristics of this needle in the first 100 patients after its implementation. Medical records were also reviewed to identify any immediate procedure-related complications. RESULTS One hundred seventy locations were sampled in 100 patients. A total of 152 lymph nodes and 18 masses were sampled. Core biopsies, as per pathology report, were seen in 87% of patients. A clinically concordant pathological diagnosis was established in 97% of patients. Diagnostic yield for granulomatous lymphadenopathy was 95.6% (22 of 23). No patient-related adverse events were noted. CONCLUSION The Franseen needle evaluated in this study can safely procure core tissue samples during EBUS bronchoscopy that are adequate for histopathological diagnosis in benign and malignant lesions. Its ability to provide adequate tissue in patients with granulomatous inflammation is encouraging.
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Affiliation(s)
- Akshu Balwan
- Division of Respiratory Critical Care and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, Utah.
| | - Billie Bixby
- Division of Respiratory Critical Care and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, Utah
| | - Cassi Grotepas
- Department of Pathology, University of Utah, Salt Lake City, Utah
| | - Benjamin L Witt
- Department of Pathology, University of Utah, Salt Lake City, Utah
| | - Aidin Iravani
- Division of Respiratory Critical Care and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, Utah
| | - Sikandar Ansari
- Division of Respiratory Critical Care and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, Utah
| | - Chakravarthy B Reddy
- Division of Respiratory Critical Care and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, Utah
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10
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The diagnostic accuracy of endobronchial ultrasound and spiral chest computed tomography scan in the prediction of infiltrating and non-infiltrating lymph nodes in patients undergoing endobronchial ultrasound. Pol J Radiol 2019; 84:e565-e569. [PMID: 32082455 PMCID: PMC7016360 DOI: 10.5114/pjr.2019.91402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 11/18/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose Endobronchial ultrasound (EBUS) and spiral chest computed tomography (CT) scan are important methods in the prediction of infiltrating and non-infiltrating lymph nodes, and the determination of their diagnostic accuracy would result in a reduction of the burden of problems and an improvement in prognosis. The purpose in this study was to determine the diagnostic accuracy of endobronchial ultrasound and spiral chest CT scan in the prediction of infiltrating and non-infiltrating lymph nodes in patients undergoing endobronchial ultrasound. Material and methods In this observational prospective study, 40 consecutive patients with infiltrating and non-infiltrating lymph nodes in Masih-Daneshvari Hospital in 2017 and 2018 were enrolled, and the sensitivity, specificity, and accuracy of EBUS and CT-scan versus fine needle aspiration pathology results were determined in them. Results The results in this study demonstrated that the congruence between EBUS and CT scan was 80.5% (p = 0.0001). The sensitivity, specificity, and accuracy for CT scan were 100%, 22.6%, and 40%, respectively, and the sensitivity, specificity, and accuracy for EBUS were 100%, 16.1%, and 35%, respectively. Conclusion According to the obtained results, it may be concluded that CT scan and EBUS results have good congruence and high sensitivity to differentiate infiltrating and non-infiltrating lymph nodes. Hence, these methods are useful for screening methods, but due to their low specificity and accuracy the use of them for a confirmative approach is not beneficial. However, regarding the accessibility and less invasive nature, use of chest CT scan is more rational and is recommended in these patients.
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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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Is SUVmax Helpful in the Differential Diagnosis of Enlarged Mediastinal Lymph Nodes? A Pilot Study. CONTRAST MEDIA & MOLECULAR IMAGING 2018; 2018:3417190. [PMID: 30510493 PMCID: PMC6230427 DOI: 10.1155/2018/3417190] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/02/2018] [Accepted: 09/20/2018] [Indexed: 12/16/2022]
Abstract
Objective To explore the diagnostic value of maximum standard uptake value (SUVmax) from 18F-FDG PET/CT images in enlarged mediastinal lymph nodes of unknown etiology. Methods We performed a retrospective study of patients with enlarged mediastinal lymph nodes on 18F-FDG PET/CT scans. SUVmax and the short axis and long axis of lymph nodes were recorded. These parameters were compared among the five commonest causes of mediastinal lymphadenopathy: lymphoma, metastatic disease, sarcoidosis, tuberculosis, and lymphadenitis. Histopathologic diagnosis was recorded as the final golden standard. Results A total of 94 patients (62 men and 32 women; age range 7-85 y) were included with final diagnoses of 42 patients with benign pathology and 52 patients with malignancies. The sensitivity, specificity, and the accuracy of PET/CT in diagnosis of the benign and malignant mediastinal lymph nodes were 94.2%, 73.8%, and 85.1%, respectively. The SUVmax of benign and malignant groups were 13.10 ± 5.21 and 12.59 ± 5.50, respectively, which had no statistical difference (P > 0.05). However, the long axis and the short axis of lymph nodes in the benign and malignant groups were 2.86 ± 1.02 cm, 1.77 ± 0.60 cm and 6.04 ± 3.83 cm, 3.95 ± 2.08 cm, respectively (P < 0.05). The diagnostic values of PET/CT were higher than those of the long or short axis. However, the specificity of PET/CT was lower (73.8%) than that from the long or short axis (90.5% and 92.9%, respectively), although no statistical difference existed. Among the five common causes of mediastinal lymphadenopathy, significant differences could be seen in SUVmax and in the long axis and the short axis of lymph nodes (P < 0.05). Conclusions SUVmax, a commonly used semiquantitative measurement, was not helpful for differentiation between benign and malignant lesions in patients with enlarged mediastinal lymph nodes in this study. Many benign lesions, such as sarcoidosis and tuberculosis, had high FDG uptake, possibly a trend that the size of the lymph nodes seems to have some diagnostic value.
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Žemaitis M, Musteikienė G, Miliauskas S, Pranys D, Sakalauskas R. Diagnostic Yield of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration Cytological Smears and Cell Blocks: A Single-Institution Experience. MEDICINA (KAUNAS, LITHUANIA) 2018; 54:E19. [PMID: 30344250 PMCID: PMC6037240 DOI: 10.3390/medicina54020019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/03/2018] [Accepted: 04/04/2018] [Indexed: 01/15/2023]
Abstract
Background and Objective: Endobronchial ultrasound (EBUS) is a minimally invasive endobronchial technique, which uses ultrasound along with a bronchoscope to visualize the airway wall and structures that are adjacent to it. Indications for endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) are samplings of mediastinal, hilar lymph nodes, and tumors adjacent to airway walls. EBUS-TBNA has been used in our clinic since 2009. The aim of the study is to evaluate the sensitivity, specificity, positive and negative predictive value, and diagnostic accuracy of cytological and histological specimens, and the safety of EBUS-TBNA in an unselected patient population that has been referred to our hospital. Materials and Methods: We have retrospectively analyzed the medical documentation of 215 patients who had EBUS-TBNA performed in our clinic from April 2009 to February 2014. Results: There were 215 patients who underwent EBUS-TBNA. A total of 296 lymph nodes were sampled. EBUS-TBNA was diagnostic in 176 (81.9%) cases of cytological, 147 (68.4%) cases of histological, and 191 (88.9%) cases of the combined evaluation. In the lung cancer patients, EBUS-TBNA cytology had a sensitivity of 72.9% and histology of 72.9%, and in the sarcoidosis group, it had a cytology of 55.8% and histology of 64.5%. As all positive cytology and histology specimens were assumed to be true positive, specificity and positive predictive value (PPV) were 100%. The sensitivity and diagnostic accuracy was significantly higher when cytology and histology specimens were combined, compared with cytology or histology results evaluated separately (p < 0.05) (for lung cancer 84.1% and for sarcoidosis 78.8%). The sensitivity and diagnostic accuracy of EBUS-TBNA procedures increased significantly over time, with increased experience. There were no complications with EBUS-TBNA in our clinical practice. Conclusions: EBUS-TBNA had a high diagnostic yield and was safe in the diagnosis of lung cancer and sarcoidosis. It was most informative when cytology and histology were combined. The informative value of EBUS-TBNA histology increased with our experience.
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Affiliation(s)
- Marius Žemaitis
- Department of Pulmonology, Medical Academy, Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, 44307 Kaunas, Lithuania.
| | - Greta Musteikienė
- Department of Pulmonology, Medical Academy, Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, 44307 Kaunas, Lithuania.
| | - Skaidrius Miliauskas
- Department of Pulmonology, Medical Academy, Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, 44307 Kaunas, Lithuania.
| | - Darius Pranys
- Department of Pathological Anatomy, Medical Academy, Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, 44307 Kaunas, Lithuania.
| | - Raimundas Sakalauskas
- Department of Pulmonology, Medical Academy, Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, 44307 Kaunas, Lithuania.
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Santini M, Fiorelli A. Surgery: Recommendations for Surgeons. CURRENT CLINICAL PATHOLOGY 2018:43-64. [DOI: 10.1007/978-3-319-90368-2_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Bhatia S, Puri R. Role of endoscopic ultrasound in non-small cell lung cancer. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2016. [DOI: 10.18528/gii160014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Sumit Bhatia
- Institute of Digestive and Hepatobiliary Sciences, Medanta - The Medicity, Gurgaon, India
| | - Rajesh Puri
- Institute of Digestive and Hepatobiliary Sciences, Medanta - The Medicity, Gurgaon, India
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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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Jenssen C, Annema JT, Clementsen P, Cui XW, Borst MM, Dietrich CF. Ultrasound techniques in the evaluation of the mediastinum, part 2: mediastinal lymph node anatomy and diagnostic reach of ultrasound techniques, clinical work up of neoplastic and inflammatory mediastinal lymphadenopathy using ultrasound techniques and how to learn mediastinal endosonography. J Thorac Dis 2015; 7:E439-58. [PMID: 26623120 DOI: 10.3978/j.issn.2072-1439.2015.10.08] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Ultrasound imaging has gained importance in pulmonary medicine over the last decades including conventional transcutaneous ultrasound (TUS), endoscopic ultrasound (EUS), and endobronchial ultrasound (EBUS). Mediastinal lymph node (MLN) staging affects the management of patients with both operable and inoperable lung cancer (e.g., surgery vs. combined chemoradiation therapy). Tissue sampling is often indicated for accurate nodal staging. Recent international lung cancer staging guidelines clearly state that endosonography should be the initial tissue sampling test over surgical staging. Mediastinal nodes can be sampled from the airways [endobronchial ultrasound combined with transbronchial needle aspiration (EBUS-TBNA)] or the esophagus [endoscopic ultrasound fine needle aspiration (EUS-FNA)]. EBUS and EUS have a complementary diagnostic yield and in combination virtually all MLNs can be biopsied. Additionally endosonography has an excellent yield in assessing granulomas in patients suspected of sarcoidosis. The aim of this review in two integrative parts is to discuss the current role and future perspectives of all ultrasound techniques available for the evaluation of mediastinal lymphadenopathy and mediastinal staging of lung cancer. A specific emphasis will be on learning mediastinal endosonography. Part 1 deals with an introduction into ultrasound techniques, MLN anatomy and diagnostic reach of ultrasound techniques and part 2 with the clinical work up of neoplastic and inflammatory mediastinal lymphadenopathy using ultrasound techniques and how to learn mediastinal endosonography.
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Affiliation(s)
- Christian Jenssen
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Jouke Tabe Annema
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Paul Clementsen
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Xin-Wu Cui
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Mathias Maximilian Borst
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
| | - Christoph Frank Dietrich
- 1 Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany ; 2 Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands ; 3 Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark ; 4 Centre for Clinical Education, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Hellerup, Denmark ; 5 Medical Department 2, 6 Medical Department 1, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Würzburg, Germany
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Dietrich CF, Jenssen C, Arcidiacono PG, Cui XW, Giovannini M, Hocke M, Iglesias-Garcia J, Saftoiu A, Sun S, Chiorean L. Endoscopic ultrasound: Elastographic lymph node evaluation. Endosc Ultrasound 2015; 4:176-90. [PMID: 26374575 PMCID: PMC4568629 DOI: 10.4103/2303-9027.162995] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Different imaging techniques can bring different information which will contribute to the final diagnosis and further management of the patients. Even from the time of Hippocrates, palpation has been used in order to detect and characterize a body mass. The so-called virtual palpation has now become a reality due to elastography, which is a recently developed technique. Elastography has already been proving its added value as a complementary imaging method, helpful to better characterize and differentiate between benign and malignant masses. The current applications of elastography in lymph nodes (LNs) assessment by endoscopic ultrasonography will be further discussed in this paper, with a review of the literature and future perspectives.
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Affiliation(s)
- Christoph F Dietrich
- Department of Medicine, Caritas-Krankenhaus, Uhlandstr, Bad Mergentheim, Germany
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Aziz F. Endobronchial ultrasound-guided transbronchial needle aspiration for staging of lung cancer: a concise review. Transl Lung Cancer Res 2015; 1:208-13. [PMID: 25806182 DOI: 10.3978/j.issn.2218-6751.2012.09.08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 09/17/2012] [Indexed: 11/14/2022]
Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) offers a minimally invasive alternative to mediastinoscopy with additional access to the hilar nodes, a better safety profile, and it removes the costs and hazards of theatre time and general anesthesia with comparable sensitivity, although the negative predictive value of mediastinoscopy (and sample size) is greater. EBUS- TBNA also obtains larger samples than conventional TBNA, has superior performance and theoretically is safer, allowing real-time sampling under direct vision. It can also have predictive value both in sonographic appearance of the nodes and histological characteristics. EBUS-TBNA is therefore indicated for NSCLC staging, diagnosis of lung cancer when there is no endobronchial lesion, and diagnosis of both benign (especially tuberculosis and sarcoidosis) and malignant mediastinal lesions. The procedure is different than for flexible bronchoscopy, takes longer, and requires more training. EBUS-TBNA is more expensive than conventional TBNA but can save costs by reducing the number of more costly mediastinoscopies. In the future, endobronchial ultrasound may have applications in airways disease and pulmonary vascular disease.
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Affiliation(s)
- Fahad Aziz
- Department of Internal Medicine, Section on Hospital Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1021, USA
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Wani S, Wallace MB, Cohen J, Pike IM, Adler DG, Kochman ML, Lieb JG, Park WG, Rizk MK, Sawhney MS, Shaheen NJ, Tokar JL. Quality indicators for EUS. Am J Gastroenterol 2015; 110:102-13. [PMID: 25448871 DOI: 10.1038/ajg.2014.387] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Wani S, Wallace MB, Cohen J, Pike IM, Adler DG, Kochman ML, Lieb JG, Park WG, Rizk MK, Sawhney MS, Shaheen NJ, Tokar JL. Quality indicators for EUS. Gastrointest Endosc 2015; 81:67-80. [PMID: 25480097 DOI: 10.1016/j.gie.2014.07.054] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 07/24/2014] [Indexed: 02/08/2023]
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Colella S, Vilmann P, Konge L, Clementsen PF. Endoscopic ultrasound in the diagnosis and staging of lung cancer. Endosc Ultrasound 2014; 3:205-12. [PMID: 25485267 PMCID: PMC4247527 DOI: 10.4103/2303-9027.144510] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 01/03/2014] [Indexed: 12/25/2022] Open
Abstract
We reviewed the role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and esophageal ultrasound guided fine needle aspiration (EUS-FNA) in the pretherapeutic assessment of patients with proven or suspected lung cancer. EUS-FNA and EBUS-TBNA have been shown to have a good diagnostic accuracy in the diagnosis and staging of lung cancer. In the future, these techniques in combination with positron emission tomography/computed tomographic may replace surgical staging in patients with suspected and proven lung cancer, but until then surgical staging remains the gold standard for adequate preoperative evaluation.
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Affiliation(s)
- Sara Colella
- Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark
| | - Peter Vilmann
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Herlev, Denmark
| | - Lars Konge
- Centre for Clinical Education, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
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Hashemi SMS, Dahele M, Daniels JMA, Smit EF. Complications of endoscopic ultrasound-guided needle aspiration. Acta Oncol 2014; 53:1265-8. [PMID: 24666266 DOI: 10.3109/0284186x.2014.887855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Liberman M, Sampalis J, Duranceau A, Thiffault V, Hadjeres R, Ferraro P. Endosonographic Mediastinal Lymph Node Staging of Lung Cancer. Chest 2014; 146:389-397. [DOI: 10.1378/chest.13-2349] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Dal T, Sazak H, Tunç M, Sahin S, Yılmaz A. A comparison of ketamine-midazolam and ketamine-propofol combinations used for sedation in the endobronchial ultrasound-guided transbronchial needle aspiration: a prospective, single-blind, randomized study. J Thorac Dis 2014; 6:742-51. [PMID: 24976998 DOI: 10.3978/j.issn.2072-1439.2014.04.10] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 03/28/2014] [Indexed: 11/14/2022]
Abstract
OBJECTIVE We aimed to compare the effectiveness and safety of ketamine-midazolam and ketamine-propofol combinations for procedural sedation in endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA). METHODS Sixty patients who were undergoing EBUS-TBNA were included in this study. Patients were randomly divided into two groups. Group 1 was given 0.25 mg/kg intravenous (iv) ketamine, 2 min later than 0.05 mg/kg iv midazolam. Group 2 received 0.125 mg/kg ketamine-propofol mixture (ketofol), 2 min subsequent to injection of 0.25 mg/kg each. Sedation was maintained with additional doses of ketamine 0.25 mg/kg, and ketofol 0.125 mg/kg each in Group 1 and Group 2, respectively. Blood pressure, heart rate (HR), peripheral oxygen saturation, respiratory rate (RR), Ramsay Sedation Score (RSS), and severity of cough were recorded prior to and after administration of sedation agent in the beginning of fiberoptic bronchoscopy (FOB) and every 5 min of the procedure. The consumption of the agents, the satisfactions of the bronchoscopist and the patients, and the recovery time were also recorded. RESULTS HR in the 10(th) min and RSS value in the 35(th) min of induction in Group 1 were higher than the other group (P<0.05). The recovery time in Group 1 was statistically longer than Group 2 (P<0.05). There was no statistically significant difference between groups with respect to other parameters (P>0.05). CONCLUSIONS It was concluded that both ketamine-midazolam and ketamine-propofol combinations for sedation during EBUS-TBNA were similarly effective and safe without remarkable side effects.
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Affiliation(s)
- Tülay Dal
- 1 Department of Anesthesiology and Reanimation, Dr Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey ; 2 Department of Anesthesiology and Reanimation, Ataturk Chest Disease and Thoracic Surgery Education and Research Hospital, Ankara, Turkey ; 3 Gazi University, Faculty of Dentistry, Department of Anesthesiology, Ankara, Turkey ; 4 Department of Chest Diseases and Tuberculosis, Ataturk Chest Disease and Thoracic Surgery Education and Research Hospital, Ankara, Turkey
| | - Hilal Sazak
- 1 Department of Anesthesiology and Reanimation, Dr Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey ; 2 Department of Anesthesiology and Reanimation, Ataturk Chest Disease and Thoracic Surgery Education and Research Hospital, Ankara, Turkey ; 3 Gazi University, Faculty of Dentistry, Department of Anesthesiology, Ankara, Turkey ; 4 Department of Chest Diseases and Tuberculosis, Ataturk Chest Disease and Thoracic Surgery Education and Research Hospital, Ankara, Turkey
| | - Mehtap Tunç
- 1 Department of Anesthesiology and Reanimation, Dr Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey ; 2 Department of Anesthesiology and Reanimation, Ataturk Chest Disease and Thoracic Surgery Education and Research Hospital, Ankara, Turkey ; 3 Gazi University, Faculty of Dentistry, Department of Anesthesiology, Ankara, Turkey ; 4 Department of Chest Diseases and Tuberculosis, Ataturk Chest Disease and Thoracic Surgery Education and Research Hospital, Ankara, Turkey
| | - Saziye Sahin
- 1 Department of Anesthesiology and Reanimation, Dr Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey ; 2 Department of Anesthesiology and Reanimation, Ataturk Chest Disease and Thoracic Surgery Education and Research Hospital, Ankara, Turkey ; 3 Gazi University, Faculty of Dentistry, Department of Anesthesiology, Ankara, Turkey ; 4 Department of Chest Diseases and Tuberculosis, Ataturk Chest Disease and Thoracic Surgery Education and Research Hospital, Ankara, Turkey
| | - Aydın Yılmaz
- 1 Department of Anesthesiology and Reanimation, Dr Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey ; 2 Department of Anesthesiology and Reanimation, Ataturk Chest Disease and Thoracic Surgery Education and Research Hospital, Ankara, Turkey ; 3 Gazi University, Faculty of Dentistry, Department of Anesthesiology, Ankara, Turkey ; 4 Department of Chest Diseases and Tuberculosis, Ataturk Chest Disease and Thoracic Surgery Education and Research Hospital, Ankara, Turkey
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Fusaroli P, Ceroni L, Caletti G. Forward-view Endoscopic Ultrasound: A Systematic Review of Diagnostic and Therapeutic Applications. Endosc Ultrasound 2014; 2:64-70. [PMID: 24949367 PMCID: PMC4062242 DOI: 10.4103/2303-9027.117689] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 02/27/2013] [Indexed: 12/16/2022] Open
Abstract
Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) and therapeutic procedures have been performed by a curved linear array (CLA) echoendoscope since the early 1990's. This particular echoendoscope, allowing real time visualization of aspiration needles and of other devices, has substantially remained unchanged since its introduction to the market. In a context of rapidly expanding indications for EUS-guided procedures, a dedicated forward view (FV) echoendoscope has been developed and tested under different clinical conditions. The FV echoendoscope is equipped with front endoscopic and EUS view, allowing deployment of needles and other devices through the working channel in straight direction. Several new diagnostic and therapeutic applications may thereby potentially be feasible with the FV echoendoscope and the established ones may prove easier to accomplish. The published literature with the FV echoendoscope has been systematically reviewed and the results are presented analytically and discussed in detail. EUS-FNA and therapeutic procedures, including pancreatic pseudocyst drainage, treatment of gastric fundal varices, celiac plexus neurolysis, and duct drainage were reported. The FV echoendoscope showed some unique advantages, opening new possibilities such as EUS-FNA in difficult gastrointestinal tracts and combined endoscopic/EUS treatment with frontal approach. However, no statistically significant evidence of superiority of the FV echoendoscope vs. the CLA echoendoscope was found in pancreatic pseudocyst drainage. No complications specifically attributable to the use of the FV echoendoscope were reported.
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Affiliation(s)
| | - Liza Ceroni
- GI Unit, University of Bologna/Hospital of Imola, Italy
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Szlubowski A, Zieliński M, Soja J, Filarecka A, Orzechowski S, Pankowski J, Obrochta A, Jakubiak M, Węgrzyn J, Cmiel A. Accurate and safe mediastinal restaging by combined endobronchial and endoscopic ultrasound-guided needle aspiration performed by single ultrasound bronchoscope. Eur J Cardiothorac Surg 2014; 46:262-6. [PMID: 24420366 DOI: 10.1093/ejcts/ezt570] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES The aim of this prospective trial was to assess the diagnostic utility of combined endobronchial (EBUS) and endoscopic (EUS) ultrasound-guided needle aspiration by use of a single ultrasound bronchoscope (CUSb-NA) in non-small-cell lung cancer (NSCLC) restaging in patients after induction therapy. METHODS In a consecutive group of NSCLC patients with pathologically confirmed N2 disease (clinical stage IIIa and IIIb) who underwent induction chemotherapy, CUSb-NA was performed. All of the patients with negative or suspected for metastases (uncertain) diagnosed by endoscopy underwent subsequently transcervical extended mediastinal lymphadenectomy (TEMLA) as a confirmatory test. RESULTS From January 2009 to December 2012, 106 patients met the inclusion criteria and underwent restaging CUSb-NA under mild sedation, in whom 286 (mean 2.7, range 2-5) lymph node stations were biopsied, 127 (mean 1.2, range 1-3) by EBUS-transbronchial needle aspiration (TBNA) and 159 (mean 1.5, range 1-4) by EUS-fine needle aspiration (FNA). The CUSb-NA revealed metastatic lymph node involvement in 37/106 patients (34.9%). In 69 (65.1%) patients with negative and uncertain CUSb-NA in 4 (3.8%) out of them, who underwent subsequent TEMLA metastatic nodes were found in 18 patients (17.0%) and there were single lymph nodes found only in one mediastinal station (minimal N2) in 10 (9.4%) out of them. False-positive results were found in 2 (1.9%) patients. In 9 (8.5%) patients CUSb-NA occurred to be false negative in Stations 2R and 4R (only accessible for EBUS), exclusively in small nodes and in 4 (3.8%) patients in Station 5-not accessible for CUSb-NA. The prevalence of mediastinal lymph node metastases in the present study was 51.9%. Diagnostic sensitivity, specificity, total accuracy, positive predictive value and negative predictive value (NPV) of the restaging CUSb-NA were 67.3% (95% CI [confidence interval]-53-79), 96.0% (95% CI-86-99), 81.0% (95% CI-73-87), 95.0% (95% CI-83-99) and 73.0% (95% CI-61-83), respectively. The sensitivity, accuracy and NPV of CUSb-NA were higher compared with EBUS-TBNA and EUS-FNA alone. No complications of CUSb-NA were observed. CONCLUSIONS The CUSb-NA is a reasonable and safe technique in mediastinal restaging in NSCLC patients after induction therapy. Following our data, in patients with negative result of CUSb-NA, a surgical restaging of the mediastinum should be considered.
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Affiliation(s)
| | - Marcin Zieliński
- Department of Thoracic Surgery, Pulmonary Hospital, Zakopane, Poland
| | - Jerzy Soja
- Department of Medicine, Jagiellonian University, Kraków, Poland
| | - Anna Filarecka
- Department of Pulmonology, Pulmonary Hospital, Zakopane, Poland
| | | | | | - Anna Obrochta
- Department of Pathology, Pulmonary Hospital, Zakopane, Poland
| | | | - Joanna Węgrzyn
- Department of Pathology, Pulmonary Hospital, Zakopane, Poland
| | - Adam Cmiel
- Department of Applied Mathematics, AGH University of Science and Technology, Kraków, Poland
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Advanced imaging (positron emission tomography and magnetic resonance imaging) and image-guided biopsy in initial staging and monitoring of therapy of lung cancer. Cancer J 2013; 19:208-16. [PMID: 23708067 DOI: 10.1097/ppo.0b013e318295185f] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The results of the National Lung Screening Trial strongly support early detection and definitive treatment to reduce lung cancer mortality. Once lung cancer is discovered, accurate staging at baseline is imperative to maximize patient benefit and cost-effective use of health care resources. Although computed tomography (CT) remains a powerful tool for staging of lung cancer, advances in other imaging modalities, specifically positron emission tomography/CT and magnetic resonance imaging, can improve baseline staging over CT alone and can allow a more rapid and accurate assessment of response to treatment. Although noninvasive imaging is extremely useful, tissue diagnosis remains the criterion standard for staging lung cancer and monitoring treatment response. Accordingly, tissue sampling using advanced bronchoscopic imaging guidance, such as ultrasound or electromagnetic navigation, allows precise tissue location and sampling of mediastinal nodes or lung nodules in the least invasive manner. In the future, bronchoscopy may allow real-time microscopic analysis.
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Sayar A, Çitak N, Büyükkale S, Metin M, Kök A, Yurt S, Çelikten A, Gürses A. Impact of extended cervical mediastinoscopy in staging of left lung carcinoma. Thorac Cancer 2013; 4:361-368. [DOI: 10.1111/1759-7714.12026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
- Adnan Sayar
- Yedikule Thoracic Surgery and Chest Disease Education and Research Hospital; Istanbul Turkey
| | - Necati Çitak
- Yedikule Thoracic Surgery and Chest Disease Education and Research Hospital; Istanbul Turkey
| | - Songül Büyükkale
- Yedikule Thoracic Surgery and Chest Disease Education and Research Hospital; Istanbul Turkey
| | - Muzaffer Metin
- Yedikule Thoracic Surgery and Chest Disease Education and Research Hospital; Istanbul Turkey
| | - Abdulaziz Kök
- Yedikule Thoracic Surgery and Chest Disease Education and Research Hospital; Istanbul Turkey
| | - Sibel Yurt
- Yedikule Thoracic Surgery and Chest Disease Education and Research Hospital; Istanbul Turkey
| | - Alper Çelikten
- Yedikule Thoracic Surgery and Chest Disease Education and Research Hospital; Istanbul Turkey
| | - Atilla Gürses
- Yedikule Thoracic Surgery and Chest Disease Education and Research Hospital; Istanbul Turkey
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Zhu T, Zhang X, Xu J, Tian J, Li H, Liu D, Chen R, Li Q, Bai C. Endobronchial ultrasound guided-transbronchial needle aspiration vs. conventional transbronchial needle aspiration in the diagnosis of mediastinal masses: A meta-analysis. Mol Clin Oncol 2013; 2:151-155. [PMID: 24649325 DOI: 10.3892/mco.2013.206] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 10/17/2013] [Indexed: 12/25/2022] Open
Abstract
Whether an endobronchial ultrasound (EBUS) is required for transbronchial needle aspiration (TBNA) in the diagnosis of mediastinal masses is currently a disputed subject. Previous studies have demonstrated that EBUS-TBNA performs better compared to conventional TBNA as it is capable of sampling in real-time compared with conventional TBNA. However, some clinicians consider conventional TBNA to be sufficient for diagnosis. In this meta-analysis, we evaluated these two methods according to diagnostic yield. A search was conducted through PubMed, Embase and the proceedings of major conferences, for studies comparing TBNA with EBUS-TBNA in the diagnosis of mediastinal masses. The identified studies were evaluated for publication bias and heterogeneity. The primary outcome was diagnostic yield. Pooled odds ratio (OR) estimated with 95% confidence intervals (CIs) was calculated using the fixed-effects model. Five studies, including a total of 407 patients, were included in the meta-analysis. The EBUS-TBNA arm was associated with a significantly higher OR compared to that of the TBNA arm in terms of diagnostic yield (OR=2.72, 95% CI: 1.72-4.30, P<0.001). There was no evidence of heterogeneity (I2=0%, P=0.540) or publication bias (Egger's test, P=0.568; Begg-Mazumdar test, P=0.806). In conclusion, EBUS-TBNA and conventional TBNA are safe and provide good diagnostic yield in the diagnosis of hilar and mediastinal masses and lymphadenopathies; however, EBUS-TBNA performs better compared to conventional TBNA, with a shorter aspiration time and higher sensitivity.
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Affiliation(s)
- Tianyi Zhu
- Department of Respiratory Medicine, Changhai Hospital, Second Military Medical University, Shanghai
| | - Xinji Zhang
- Departments of Health Statistics, Second Military Medical University, Shanghai
| | - Junnan Xu
- Pathophysiology, Second Military Medical University, Shanghai
| | - Jun Tian
- Department of Immunology, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Hui Li
- Departments of Health Statistics, Second Military Medical University, Shanghai
| | - Dan Liu
- Department of Respiratory Medicine, Changhai Hospital, Second Military Medical University, Shanghai
| | - Ruohua Chen
- Department of Respiratory Medicine, Changhai Hospital, Second Military Medical University, Shanghai
| | - Qiang Li
- Department of Respiratory Medicine, Changhai Hospital, Second Military Medical University, Shanghai
| | - Chong Bai
- Department of Respiratory Medicine, Changhai Hospital, Second Military Medical University, Shanghai
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Abstract
Non-small-cell lung cancer is one of the leading causes of deaths from cancer worldwide. Therefore, improvements in diagnostics and treatments are urgently needed. In this review, we will discuss the evolution of lung cancer staging towards more non-invasive, endoscopy-based, and image-based methods, and the development of stage-adapted treatment. A special focus will be placed on the role of novel surgical approaches and modern radiotherapy strategies for early stages of disease, the effect of multimodal treatment in locally advanced disease, and ongoing developments in the treatment of patients with metastatic disease. In particular, we will include an emphasis on targeted therapies, which are based on the assumption that a treatable driver mutation or gene rearrangement is present within the tumour. Finally, the position of lung cancer treatment on the pathway to personalised therapy will be discussed.
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Affiliation(s)
- Martin Reck
- LungenClinic Grosshansdorf, Airway Research Center North, Grosshansdorf, Germany.
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32
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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: 961] [Impact Index Per Article: 87.4] [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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Omland SH, Henrik H, Olsen EK, Birthe T, Guldhammer SB. Subtyping of nonsmall cell lung cancer on cytology specimens: reproducibility of cytopathologic diagnoses on sparse material. Diagn Cytopathol 2013; 42:105-10. [PMID: 23687077 DOI: 10.1002/dc.22995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 01/07/2013] [Accepted: 02/14/2013] [Indexed: 11/08/2022]
Abstract
Cytologic examination of fine-needle aspiration (material is increasingly used in diagnosing lung cancer. High interobserver agreement in distinguishing small-cell lung cancer from nonsmall-cell lung cancer (NSCLC) on cytologic material has been demonstrated. Because of new treatment-modalities, subclassification of NSCLC into squamous cell carcinoma (SQC) and non-SQC has clinical impact. Subclassification based on morphology alone may be difficult, but applying immunohistochemistry (IHC) to clot-material has proved helpful. When insufficient material is available to make a clot from the aspirate, cytoscrape (CS) can convert cytologic material into tissue fragments useful for IHC. The purpose of this study was to test the reproducibility of pulmonary malignant diagnoses, in particular distinction between subgroups of NSCLC, based on smeared material and IHC on CS. A consecutive series of May-Grunwald-Giemsa (MGG) stained smears and CS with IHC on material from 79 patients suspected of having lung cancer was included. The material was circulated twice to four pathologists. The diagnoses were categorized in five groups: SQC, adenocarcinoma of the lung, non-SQC, benign lesion and other forms of malignancy, including metastases. Reproducibility was analyzed using Kappa statistics. Interobserver reproducibility of the diagnoses in round 1 was good to very good (kappa 0.57-0.71) and very good in round 2 (0.63-0.80). Reproducibility of subclassification of NSCLC based on MGG stained smear and IHC on CS, was very good among experienced pathologists. With only sparse material available, CS should be used to achieve reproducible diagnoses, including subtyping of NSCLC.
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Affiliation(s)
- Silje Haukali Omland
- Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Denmark
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35
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Relevance of endoscopic ultrasonography and endobronchial ultrasonography to thoracic surgeons. Thorac Surg Clin 2013; 23:199-210. [PMID: 23566972 DOI: 10.1016/j.thorsurg.2013.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Although cervical mediastinoscopy has been considered the gold standard for mediastinal staging in non-small cell lung cancer, new minimally invasive endoscopic ultrasound technology, such as endobronchial ultrasound-guided transbronchial needle aspiration and endoscopic ultrasound fine-needle aspiration, have changed the practice of invasive staging. Based on the current evidence, minimally invasive endoscopic staging is the recommended choice in patients with high pretest probability of lymph node metastasis; however, all negative results should be verified by mediastinoscopy, especially in centers with low expertise. In patients with low pretest probability, mediastinoscopy may be omitted when adequate sampling is achieved with endoscopic modalities.
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36
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Hanna WC, Yasufuku K. Mediastinoscopy in the era of endobronchial ultrasound: when should it be performed? ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s13665-012-0032-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Tharian B, Tsiopoulos F, George N, Pietro SD, Attili F, Larghi A. Endoscopic ultrasound fine needle aspiration: Technique and applications in clinical practice. World J Gastrointest Endosc 2012; 4:532-44. [PMID: 23293723 PMCID: PMC3536850 DOI: 10.4253/wjge.v4.i12.532] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 11/09/2012] [Accepted: 12/01/2012] [Indexed: 02/05/2023] Open
Abstract
Since its initial report in 1992, endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has now been incorporated into the diagnostic and staging algorithm for the evaluation of benign and malignant diseases of the gastrointestinal tract and of adjacent organs. Its introduction constitutes a major breakthrough in the endoscopic field and has gradually transformed EUS from a pure imaging modality into a more interventional. In addition, the possibility of collecting samples, providing a definitive cytological and/or histological evidence of the presence of malignancy, has strongly contributed to changing EUS from a subjective, highly operator dependant procedure into a more objective one. This article will review the instrumentation, technique and the most important clinical applications of EUS-FNA.
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Affiliation(s)
- Benjamin Tharian
- Benjamin Tharian, Fotios Tsiopoulos, Nayana George, Salvatore Di Pietro, Fabia Attili, Alberto Larghi, Digestive Endoscopy Unit, Catholic University, 00168 Rome, Italy
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Darlington P, Haugom-Olsen H, von Sivers K, Wahlström J, Runold M, Svjatoha V, Porwit A, Eklund A, Grunewald J. T-cell phenotypes in bronchoalveolar lavage fluid, blood and lymph nodes in pulmonary sarcoidosis--indication for an airborne antigen as the triggering factor in sarcoidosis. J Intern Med 2012; 272:465-71. [PMID: 22469005 DOI: 10.1111/j.1365-2796.2012.02543.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND An increased percentage of CD4+ T cells is usually observed in bronchoalveolar lavage fluid (BALF) from patients with sarcoidosis. In HLA-DRB1*03-positive patients, such T cells express the T-cell receptor (TCR) AV2S3+ gene segment. It is not known whether cells found in BALF reflect those in enlarged regional lymph nodes (LNs). Therefore, the aim of this study was to compare T-cell phenotypes in BALF, blood and mediastinal LNs. METHODS Fifteen patients underwent clinical investigation including bronchoscopy with bronchoalveolar lavage. Blood samples were drawn, and endoscopic ultrasound-guided fine-needle aspiration of enlarged mediastinal LNs was performed via the oesophagus. T cells from all three compartments were analysed by flow cytometry for markers of activity, differentiation and T regulatory function. RESULTS The CD4/CD8 ratio was significantly higher in BALF compared with regional LNs and was also significantly higher in LNs than in blood. The CD4+ T cells were recently activated and more differentiated in BALF than in blood and LNs. There was an accumulation of T regulatory cells (FOXP3+) in LNs and a correlation between high levels of FOXP3+ cells in BALF and in LNs. In HLA-DRB1*03-positive patients, TCR AV2S3+ CD4+ T cells were predominantly localized within BALF. CONCLUSIONS The CD4+ T-cell phenotype in BALF indicates an active ongoing specific immune response primarily localized to the alveolar space.
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Affiliation(s)
- P Darlington
- Department of Medicine, Respiratory Medicine Unit, Södersjukhuset, Sweden.
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[Role of endoscopic ultrasound (EUS) and endobronchial ultrasound (EBUS) for the evaluation of mediastinal adenopathy]. Bull Cancer 2012; 99:761-70. [PMID: 22713588 DOI: 10.1684/bdc.2012.1606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Mediastinal lymphadenopathy may be detected by CT-scan or positron emission tomography. Malignant (e.g, lung cancer, metastatic cancer, lymphoma), infectious (e.g, tuberculosis, histoplasmosis), and systemic processes (e.g, sarcoidosis) can cause mediastinal adenopathy. In the posterior and inferior mediastinum, endoscopic ultrasound visualizes and directs transesophageal fine needle aspiration of adenopathy. In the anterior mediastinum, endobronchial ultrasound visualizes and directs transbronchial fine needle aspiration of adenopathy. We discuss the role of EUS and EBUS in the evaluation of mediastinal adenopathy according to their anatomical localization.
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40
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Szlubowski A, Soja J, Kocon P, Talar P, Czajkowski W, Rudnicka-Sosin L, Cmiel A, Kuzdzal J. A comparison of the combined ultrasound of the mediastinum by use of a single ultrasound bronchoscope versus ultrasound bronchoscope plus ultrasound gastroscope in lung cancer staging: a prospective trial. Interact Cardiovasc Thorac Surg 2012; 15:442-6; discussion 446. [PMID: 22623626 DOI: 10.1093/icvts/ivs161] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The aim of the study was to compare diagnostic utility of combined (i.e. transbronchial and transoesophageal) ultrasound imaging with needle biopsy of the mediastinum in lung cancer (LC) staging, (a) by use of a single ultrasound bronchoscope (CUSb) and (b) by using two scopes (CUS). METHODS In consecutive LC patients, clinical stage IA-IIIB the CUS or CUSb was performed under mild sedation and, if negative, underwent lung resection with confirmatory systematic lymph node dissection. RESULTS From 214 LC patients, 110 underwent CUS and 104 underwent CUSb (618 biopsies); both revealed metastases in 50% of cases. There was 'minimal N2' in 11 of 14 false negative patients. Diagnostic sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of CUS was 91.7%, 98%, 94.6%, 98.2% and 90.7% respectively and of CUSb was 85%, 93.2%, 88.5%, 94.4%, 82%, respectively with no significant difference in yield of CUS vs CUSb (P = 0.255 and P = 0.192). The mean time of CUS (25 ± 4.4 min) was significantly longer as compared to CUSb (14.9 ± 2.3 min) (P < 0.001). No severe complications of either method were observed. CONCLUSIONS The combined ultrasound imaging of the mediastinum by use of CUSb is significantly less time-consuming and equally as effective and safe as the use of CUS for LC staging.
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Kużdżał J, Szlubowski A. Ultrasound-Guided Transbronchial and Transesophageal Needle Biopsy in the Mediastinal Staging of Lung Cancer. Thorac Surg Clin 2012; 22:191-203. [DOI: 10.1016/j.thorsurg.2011.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Lankarani A, Wallace MB. Endoscopic ultrasonography/fine-needle aspiration and endobronchial ultrasonography/fine-needle aspiration for lung cancer staging. Gastrointest Endosc Clin N Am 2012; 22:207-19, viii. [PMID: 22632944 DOI: 10.1016/j.giec.2012.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This article reviews different techniques available for diagnosis and staging of patients with non-small cell lung cancer (NSCLC). The advantages and disadvantages of each staging method are highlighted. The role of the gastroenterologist in NSCLC staging is explored. A new algorithm is proposed for the staging of NSCLC that incorporates endoscopic and endobronchial ultrasonography for mediastinal staging in patients with intrathoracic disease.
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Affiliation(s)
- Ali Lankarani
- Department of Gastroenterology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL 32224, USA
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Ray CE, English B, Funaki BS, Burke CT, Fidelman N, Ginsburg ME, Kinney TB, Kostelic JK, Kouri BE, Lorenz JM, Nair AV, Nemcek AA, Owens CA, Saleh AG, Vatakencherry G, Mohammed TLH. ACR Appropriateness Criteria® Radiologic Management of Thoracic Nodules and Masses. J Am Coll Radiol 2012; 9:13-9. [DOI: 10.1016/j.jacr.2011.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 09/19/2011] [Indexed: 12/21/2022]
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Transesophageal ultrasound-guided fine-needle aspiration for the mediastinal restaging of non-small cell lung cancer. J Thorac Oncol 2011; 6:1510-5. [PMID: 21642873 DOI: 10.1097/jto.0b013e31821e1a64] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Selected patients with stage III (N2/N3) non-small cell lung cancer (NSCLC) who are downstaged to N0 by chemoradiation therapy might benefit from subsequent surgical resection of the tumor. How mediastinal lymph nodes can be best reevaluated is subject of debate. Transesophageal ultrasound-guided fine-needle aspiration (EUS-FNA) is a minimally invasive technique to sample mediastinal nodes. We assessed sensitivity and false-negative rate of EUS-FNA for the mediastinal restaging of patients with stage III NSCLC. METHODS Fifty-eight consecutive patients with stage III NSCLC and tissue-proven lymph node metastases N2/N3) who underwent EUS-FNA for restaging purposes after chemoradiation therapy were retrospectively analyzed. Surgical-pathological staging was used as the reference standard for nodal metastases. RESULTS EUS-FNA found persistent nodal metastases (N2/N3) in 15 patients (26%). Of the 43 patients without persistent mediastinal metastases at EUS, 33 patients subsequently underwent surgical verification of the mediastinal nodes in whom persistent metastases (yN2/N3) were found in 19 patients (58%), and loco-regional downstaging (yN0) was achieved in the other 14 (42%). The prevalence of persistent nodal metastases in the 48 patients who could be analyzed was 71%. Sensitivity and the false-negative rate of EUS-FNA for mediastinal restaging were 44 and 58%, respectively. DISCUSSION For mediastinal restaging of stage III NSCLC, EUS-FNA is a minimally invasive and safe method to confirm persistent nodal metastases, but this technique has a low negative predictive value and is therefore not useful for the exclusion of mediastinal metastases. Surgical restaging is indicated in the absence of mediastinal metastases at EUS-FNA.
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Xu W, Shi J, Zeng X, Li X, Xie WF, Guo J, Lin Y. EUS elastography for the differentiation of benign and malignant lymph nodes: a meta-analysis. Gastrointest Endosc 2011; 74:1001-9; quiz 1115.e1-4. [PMID: 22032315 DOI: 10.1016/j.gie.2011.07.026] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2011] [Accepted: 07/05/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND EUS elastography is a new technique for differentiating benign and malignant lymph nodes (LNs) by describing the mechanical property of the target tissue. OBJECTIVE To assess the accuracy of EUS elastography by pooling data of existing trials. DESIGN Seven studies involving 368 patients with 431 LNs were included. Meta-analysis was performed. Pooling was conducted in a fixed-effect model or a random-effect model. PATIENTS This study involved 368 patients. INTERVENTION EUS elastography. MAIN OUTCOME MEASUREMENTS Meta-analysis and meta-regression analysis. RESULTS The pooled sensitivity of EUS elastography for the differential diagnosis of benign and malignant LNs was 88% (95% confidence interval [CI] 0.83-0.92), and the specificity was 85% (95% CI, 0.79-0.89). The area under the curve under summary receiver operating characteristic (SROC) was 0.9456. The pooled positive likelihood ratio was 5.68 (95% CI, 2.86-11.28), and the negative likelihood ratio was 0.15 (95% CI, 0.10-0.21). The subgroup analysis by excluding the outliers provided a sensitivity of 85% (95% CI, 0.79-0.90) and a specificity of 91% (95% CI, 0.85-0.95) for the differential diagnosis of benign and malignant LNs. The area under the curve under SROC was 0.9421. LIMITATIONS A small number of studies met inclusion criteria. CONCLUSION EUS elastography is a promising, noninvasive method for differential diagnosis of malignant LNs and may prove to be a valuable supplemental method to EUS-guided FNA.
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Affiliation(s)
- Wei Xu
- Department of Gastroenterology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
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Hikichi T, Irisawa A, Takagi T, Shibukawa G, Wakatsuki T, Imamura H, Takahashi Y, Sato A, Sato M, Ikeda T, Suzuki R, Watanabe K, Nakamura J, Ohira H, Obara K. An electronic radial scanning echoendoscope is superior to a mechanical radial scanning echoendoscope in ultrasound image quality for gastrointestinal tract and pancreaticobiliary lesions. Fukushima J Med Sci 2011; 56:99-106. [PMID: 21502709 DOI: 10.5387/fms.56.99] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To objectively compare the electronic radial scanning echoendoscope (ER-ES) with the mechanical radial scanning echoendoscope (MR-ES) in the quality of endoscopic ultrasonography (EUS) images of gastrointestinal tract and pancreaticobiliary lesions. METHODS Studied were 56 patients: 20 with gastric cancer, 20 with gallbladder lesions, and 16 with intraductal papillary-mucinous neoplasms of the pancreas (IPMN). They were subjected to EUS, half of them using the ER-ES, and the other half using the MR-ES. EUS images thus obtained were evaluated concerning four items in patients with gastric cancer and those with gallbladder lesions, and three items in patients with IPMN. Six endosonographers blindly assessed two EUS images per patient on a visual analogue scale. In each of the three groups of patients, the evaluators' median scores for the ER-ES and MR-ES for each item were compared. RESULTS The median scores for the ER-ES were significantly higher than those for the MR-ES in all items in patients with gastric cancer and those with IPMN, and in one item in patients with gallbladder lesions. CONCLUSION The ER-ES is certainly superior to the MR-ES in the quality of EUS images of gastrointestinal tract and pancreaticobiliary lesions.
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Affiliation(s)
- Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan.
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Tournoy KG, Carprieaux M, Deschepper E, van Meerbeeck JP, Praet M. Are EUS-FNA and EBUS-TBNA specimens reliable for subtyping non-small cell lung cancer? Lung Cancer 2011; 76:46-50. [PMID: 21945658 DOI: 10.1016/j.lungcan.2011.09.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 09/01/2011] [Accepted: 09/03/2011] [Indexed: 11/28/2022]
Abstract
With endosonography, the diagnosis and staging of non-small cell lung cancer (NSCLC) increasingly relies on small samples. The discrimination between squamous and non-squamous subtypes is now important for therapy tailoring. We analyzed the agreement between fine needle aspirates obtained by endosonography and matched biopsy samples for subtyping NSCLC. Patients with a positive endoscopic fine needle aspirate and a matched biopsy were identified. The level of diagnostic agreement was estimated with biopsy samples as golden standard. In 951 patients investigated with endosonography, we identified 92 with NSCLC on the positive fine needle aspirate and on the matched biopsy. Squamous cell carcinoma was diagnosed in 34 (37%) and 44 (48%) of fine needle aspirate and biopsy samples; while non-squamous carcinoma was diagnosed in 58 (63%) and 48 (52%) respectively. The agreement between needle aspirate and biopsy for the subtyping of NSCLC was 76% (kappa=0.52). In cases with cell block preparation, the agreement for subtyping was 96% (kappa=0.91) vs 69% (kappa=0.39) in cases without cell blocks. Therefore, the diagnostic agreement between endosonographic fine needle aspirates and biopsy specimens for subtyping NSCLC is moderate with a disagreement in 1 out of 4 patients. However, cell block preparation increased the agreement and thus the reliability of the fine needle specimens obtained during endosonography, for subtyping NSCLC considerably. In conclusion, for patients with NSCLC in whom subtyping is relevant, a diagnostic technique yielding larger samples (FNA with cell block preparation or biopsies) should be preferred.
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Affiliation(s)
- K G Tournoy
- Department of Respiratory Medicine and Thoracic Oncology, Ghent University Hospital, Belgium.
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Buxbaum JL, Eloubeidi MA. Transgastric endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) in patients with esophageal narrowing using the ultrasonic bronchovideoscope. Dis Esophagus 2011; 24:458-61. [PMID: 21385282 DOI: 10.1111/j.1442-2050.2011.01179.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Endobronchial ultrasound-guided fine needle aspiration (EBUS-FNA) is emerging as a critical technology in the evaluation of mediastinal lesions and is increasingly regarded as complementary to endoscopic ultrasound (EUS) in this arena. This complementary role may extend into the abdomen in cases where esophageal strictures prevent the passage of the echoendoscope. The objective of the study was to characterize the uses of EBUS-FNA in the evaluation of gastrointestinal lesions in patients with esophageal narrowing. The study design was a single-center case series. The setting was in a tertiary referral center. Four patients underwent EBUS-FNA to evaluate gastrointestinal lesions; esophageal strictures prevented EUS passage in three, the fourth patient did not tolerate transbronchial EBUS but had abdominal lesions within reach of the EBUS scope. EBUS was used to evaluate the liver, adrenal gland, a retroperitoneal mass, and a celiac axis lymph node. EBUS-FNA has greater potential to evaluate abdominal lesions than has been previously recognized. The EBUS scope represents a safe and readily available technology to evaluate patients with esophageal strictures. Interventional endoscopists should be exposed to this modality.
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Affiliation(s)
- J L Buxbaum
- Division of Gastroenterology, Department of Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California, USA
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Kazarian M, Laird-Offringa IA. Small-cell lung cancer-associated autoantibodies: potential applications to cancer diagnosis, early detection, and therapy. Mol Cancer 2011; 10:33. [PMID: 21450098 PMCID: PMC3080347 DOI: 10.1186/1476-4598-10-33] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 03/30/2011] [Indexed: 12/26/2022] Open
Abstract
Small-cell lung cancer (SCLC) is the most aggressive lung cancer subtype and lacks effective early detection methods and therapies. A number of rare paraneoplastic neurologic autoimmune diseases are strongly associated with SCLC. Most patients with such paraneoplastic syndromes harbor high titers of antibodies against neuronal proteins that are abnormally expressed in SCLC tumors. These autoantibodies may cross-react with the nervous system, possibly contributing to autoimmune disease development. Importantly, similar antibodies are present in many SCLC patients without autoimmune disease, albeit at lower titers. The timing of autoantibody development relative to cancer and the nature of the immune trigger remain to be elucidated. Here we review what is currently known about SCLC-associated autoantibodies, and describe a recently developed mouse model system of SCLC that appears to lend itself well to the study of the SCLC-associated immune response. We also discuss potential clinical applications for these autoantibodies, such as SCLC diagnosis, early detection, and therapy.
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Affiliation(s)
- Meleeneh Kazarian
- Department of Surgery, Norris Cancer Center, Keck School of Medicine, University of Southern California, 1441 Eastlake Ave, NOR 6420, Los Angeles, CA 90089-9176, USA
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van Eijk R, Licht J, Schrumpf M, Talebian Yazdi M, Ruano D, Forte GI, Nederlof PM, Veselic M, Rabe KF, Annema JT, Smit V, Morreau H, van Wezel T. Rapid KRAS, EGFR, BRAF and PIK3CA mutation analysis of fine needle aspirates from non-small-cell lung cancer using allele-specific qPCR. PLoS One 2011; 6:e17791. [PMID: 21408138 PMCID: PMC3050927 DOI: 10.1371/journal.pone.0017791] [Citation(s) in RCA: 139] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 02/11/2011] [Indexed: 12/30/2022] Open
Abstract
Endobronchial Ultrasound Guided Transbronchial Needle Aspiration (EBUS-TBNA) and Trans-esophageal Ultrasound Scanning with Fine Needle Aspiration (EUS-FNA) are important, novel techniques for the diagnosis and staging of non-small cell lung cancer (NSCLC) that have been incorporated into lung cancer staging guidelines. To guide and optimize treatment decisions, especially for NSCLC patients in stage III and IV, EGFR and KRAS mutation status is often required. The concordance rate of the mutation analysis between these cytological aspirates and histological samples obtained by surgical staging is unknown. Therefore, we studied the extent to which allele-specific quantitative real-time PCR with hydrolysis probes could be reliably performed on EBUS and EUS fine needle aspirates by comparing the results with histological material from the same patient. We analyzed a series of 43 NSCLC patients for whom cytological and histological material was available. We demonstrated that these standard molecular techniques can be accurately applied on fine needle cytological aspirates from NSCLC patients. Importantly, we show that all mutations detected in the histological material of primary tumor were also identified in the cytological samples. We conclude that molecular profiling can be reliably performed on fine needle cytology aspirates from NSCLC patients.
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Affiliation(s)
- Ronald van Eijk
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jappe Licht
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Melanie Schrumpf
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Dina Ruano
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Giusi I. Forte
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Petra M. Nederlof
- Department of Pathology, Netherlands Cancer Institute NKI-AVL, Amsterdam, The Netherlands
| | - Maud Veselic
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Klaus F. Rabe
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jouke T. Annema
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | - Vincent Smit
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hans Morreau
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tom van Wezel
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
- * E-mail:
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