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Iyer H, Anand A, Sryma PB, Gupta K, Naranje P, Damle N, Mittal S, Madan NK, Mohan A, Hadda V, Tiwari P, Guleria R, Madan K. Mediastinal lymphadenopathy: a practical approach. Expert Rev Respir Med 2021; 15:1317-1334. [PMID: 33888038 DOI: 10.1080/17476348.2021.1920404] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: Mediastinal lymphadenopathy is secondary to various benign and malignant etiologies. There is a variation in the underlying cause in different demographic settings. The initial clue to the presence of enlarged mediastinal lymph nodes is through thoracic imaging modalities. Malignancy (Lung cancer, lymphoma, and extrathoracic cancer) and granulomatous conditions (sarcoidosis and tuberculosis) are the most common causes. For a confident diagnosis, the clinician must choose from several available options and integrate the clinical, radiological, and pathology findings. An accurate diagnosis is necessary for optimal management.Areas covered: We performed a search of the PUBMED database to identify relevant articles on the causes, imaging modalities, and interventional modalities to diagnose these conditions. We discuss a practical approach toward the evaluation of a patient with mediastinal lymphadenopathy.Expert opinion: Mediastinal lymphadenopathy is a commonly encountered clinical problem. Treating physicians need to be aware of the clinico-radiological manifestations of the common diagnostic entities. Selecting an appropriate tissue diagnosis modality is crucial, with an intent to use the least invasive technique with good diagnostic yield. Endosonographic modalities (EBUS-TBNA, EUS-FNA, and EUS-B-FNA) have emerged as the cornerstone to most patients' diagnosis. An accurate diagnosis translates into favorable treatment outcomes.
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Affiliation(s)
- Hariharan Iyer
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Abhishek Anand
- Department of Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - P B Sryma
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Kartik Gupta
- Department of Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Priyanka Naranje
- Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Nishikant Damle
- Department of Nuclear Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Vijay Hadda
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Pawan Tiwari
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Liran L, Rottem K, Gregorio FZ, Avi A, Neville B. A novel, stepwise approach combining conventional and endobronchial ultrasound needle aspiration for mediastinal lymph node sampling. Endosc Ultrasound 2019; 8:31-35. [PMID: 28879863 PMCID: PMC6400088 DOI: 10.4103/eus.eus_29_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background and Objectives: Since the introduction of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), most pulmonary centers use this technique exclusively for mediastinal lymph node (LN) sampling. Conventional “blind” TBNA (cTBNA), however, is cheaper, more accessible, provides more tissue, and requires less training. We evaluated whether sampling of mediastinal LN using EBUS-TBNA or cTBNA according to a predefined set of criteria provides acceptable diagnostic yield. Materials and Methods: Sampling method was determined prospectively according to a predefined set of criteria based on LN station, LN size, and presumed diagnosis. Sensitivity, specificity, positive, and negative predictive value were evaluated for each modality. Results: One hundred and eighty-six biopsies were carried out over a 3-year period (86 cTBNA, 100 EBUS-TBNA). Seventy-seven percent of LN biopsied by EBUS-TBNA were <20 mm, while 83% of cTBNA biopsies were ≥20 mm. Most common sites of cTBNA sampling were station 7, 4R, and 11R as opposed to 7, 11R, 4R, and 4 L in the case of EBUS-TBNA. Most common EBUS-TBNA diagnosis was malignancy versus sarcoidosis in cTBNA. EBUS-TBNA and cTBNA both had a true positive yield of 65%, but EBUS-TBNA had a higher true negative rate (21% vs. 2% for cTBNA) and a lower false negative rate (7% vs. 28%). Sensitivity, specificity, positive predictive value, and negative predictive value for EBUS-TBNA were 90%, 100%, 100%, and 75%, respectively, and for cTBNA were 68%, 100%, 100%, and 7%, respectively. Conclusion: A stepwise approach based on LN size, station, and presumed diagnosis may be a reasonable, cost-effective approach in choosing between cTBNA and EBUS-TBNA.
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Affiliation(s)
- Levy Liran
- Institute of Pulmonary Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Kuint Rottem
- Institute of Pulmonary Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Fridlender Zvi Gregorio
- Institute of Pulmonary Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Abutbul Avi
- Institute of Pulmonary Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Berkman Neville
- Institute of Pulmonary Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Influence of the Learning Effect on the Diagnostic Yield of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration of Mediastinal and Hilar Lymph Nodes. J Bronchology Interv Pulmonol 2017; 24:193-199. [PMID: 28696965 DOI: 10.1097/lbr.0000000000000372] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The diagnostic yield of conventional transbronchial needle aspiration (TBNA) is characterized by a learning effect. The aim of this retrospective study was to verify whether a learning curve similarly affected the yield of endobronchial ultrasound-guided (EBUS)-TBNA. To this end, we evaluated the sensitivity and diagnostic accuracy of EBUS-TBNA during the first 3 years of activity. METHODS EBUS-TBNA was performed by 2 operators with no previous experience in this technique. Cytologic samples were obtained from mediastinal and hilar lymph nodes enlarged at a chest computed tomography scan and/or with increased fluorodeoxyglucose uptake at computed tomography/positron emission tomography scan in patients with suspected lung cancer. The cytologic diagnosis of EBUS-TBNA samples has been compared with the final diagnosis obtained from further diagnostic procedures, surgery, or clinical-radiologic follow-up. RESULTS From October 2012 to October 2015, we collected 408 EBUS-TBNA cytologic samples from 313 patients: 223 samples were positive for metastatic involvement and 185 were nonmetastatic. The latter included 137 true-negative and 48 false-negative results. The final diagnosis comprised 271 metastatic and 137 nonmetastatic lymph nodes. The overall sensitivity for cancer was 82% and diagnostic accuracy was 88%. Sensitivity and accuracy per year were as follows: first year, 78% and 82% in 90 nodal samples; second year, 83% and 89% in 144 nodal samples; third year, 85% and 91% in 174 nodal samples. CONCLUSIONS EBUS-TBNA can be considered as a reliable tool even if performed by operators without previous experience in this procedure, and the diagnostic yield continues to increase progressively over a long time.
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Usefulness of Conventional Transbronchial Needle Aspiration for Sampling of Mediastinal Lymph Nodes in Lung Cancer. J Bronchology Interv Pulmonol 2016; 22:294-9. [PMID: 26351968 DOI: 10.1097/lbr.0000000000000202] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Transbronchial needle aspiration (TBNA) is recognized as a valuable tool for the sampling of mediastinal lymph nodes. In this study, we report data about the diagnostic yield of conventional TBNA in the diagnosis and staging of lung cancer. METHODS All patients with suspected lung cancer who underwent bronchoscopy with conventional TBNA in the years 2008 to 2012 were evaluated. TBNA was performed on mediastinal lymph nodes enlarged at chest computed tomography scan and/or with increased fluorodeoxyglucose uptake on positron emission tomography/computed tomography scan. Cytologic results derived from TBNA have been compared, with the final diagnosis obtained with other more invasive procedures and/or with a clinical-radiologic follow-up of at least 12 months. RESULTS TBNA was performed on 375 patients. However, 19 patients were lost to follow-up, and data from 356 patients with a total 459 TBNA specimens were analyzed. TBNA was positive for metastatic involvement of lymph nodes in 172 of 282 patients with cancer, with a sensitivity of 61%. Sensitivity achieved 65% when we considered the total of 459 TBNA specimens. The overall diagnostic accuracy of TBNA was 69%. The nodal stations more frequently examined were 7 (subcarinal: 190 TBNAs), 4R (right lower paratracheal: 147 TBNAs), and 10R (right hilar: 76 TBNAs), with a sensitivity of 66%, 66%, and 67%, respectively. CONCLUSION Conventional TBNA remains a useful method for the diagnosis and staging of lung cancer, with a good diagnostic yield in several nodal stations.
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Ramieri MT, Marandino F, Visca P, Salvitti T, Gallo E, Casini B, Giordano FR, Frigieri C, Caterino M, Carlini S, Rinaldi M, Ceribelli A, Pennetti A, Alò PL, Marino M, Pescarmona E, Filippetti M. Usefulness of conventional transbronchial needle aspiration in the diagnosis, staging and molecular characterization of pulmonary neoplasias by thin-prep based cytology: experience of a single oncological institute. J Thorac Dis 2016; 8:2128-37. [PMID: 27621869 PMCID: PMC4999774 DOI: 10.21037/jtd.2016.07.62] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 06/24/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Conventional transbronchial needle aspiration (c-TBNA) contributed to improve the bronchoscopic examination, allowing to sample lesions located even outside the tracheo-bronchial tree and in the hilo-mediastinal district, both for diagnostic and staging purposes. METHODS We have evaluated the sensitivity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of the c-TBNA performed during the 2005-2015 period for suspicious lung neoplasia and/or hilar and mediastinal lymphadenopathy at the Thoracic endoscopy of the Thoracic Surgery Department of the Regina Elena National Cancer Institute, Rome. Data from 273 consecutive patients (205 males and 68 females) were analyzed. RESULTS Among 158 (58%) adequate specimens, 112 (41%) were neoplastic or contained atypical cells, 46 (17%) were negative or not diagnostic. We considered in the analysis first the overall period; then we compared the findings of the first [2005-2011] and second period [2012-2015] and, finally, only those of adequate specimens. During the overall period, sensibility and accuracy values were respectively of 53% and 63%, in the first period they reached 41% and 53% respectively; in the second period sensibility and accuracy reached 60% and 68%. Considering only the adequate specimens, sensibility and accuracy during the overall period were respectively of 80% and 82%; the values obtained for the first period were 68% and 72%. Finally, in the second period, sensibility reached 86% and accuracy 89%. Carcinoma-subtyping was possible in 112 cases, adenocarcinomas being diagnosed in 50 cases; further, in 30 cases molecular predictive data could be obtained. CONCLUSIONS The c-TBNA proved to be an efficient method for the diagnosis/staging of lung neoplasms and for the diagnosis of mediastinal lymphadenopathy. Endoscopist's skill and technical development, associated to thin-prep cytology and to a rapid on site examination (ROSE), were able to provide by c-TBNA a high diagnostic yield and molecular predictive data in advanced lung carcinomas.
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Affiliation(s)
| | | | - Paolo Visca
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Tommaso Salvitti
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Enzo Gallo
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Beatrice Casini
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | | | - Claudia Frigieri
- Anaesthesia and Intensive Care Complex Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Mauro Caterino
- Department of Radiology, Regina Elena National Cancer Institute, Rome, Italy
| | - Sandro Carlini
- Department of Thoracic Surgery, Regina Elena National Cancer Institute, Rome, Italy
| | - Massimo Rinaldi
- Medical Oncology “B” Department, Regina Elena National Cancer Institute, Rome, Italy
| | - Anna Ceribelli
- Medical Oncology “A” Department, Regina Elena National Cancer Institute, Rome, Italy
| | - Annarita Pennetti
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Pier Luigi Alò
- Department of Pathology, “F. Spaziani” Hospital, ASL Frosinone, Italy
| | - Mirella Marino
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Edoardo Pescarmona
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Massimo Filippetti
- Department of Thoracic Surgery, Regina Elena National Cancer Institute, Rome, Italy
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Mishra MM, Reynolds JP, Sturgis CD, Booth CN. Diagnosis of mediastinal lesions unassociated with lung carcinoma diagnosed by endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA). J Am Soc Cytopathol 2016; 5:189-195. [PMID: 31042508 DOI: 10.1016/j.jasc.2016.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 02/01/2016] [Accepted: 02/05/2016] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is a safe, cost-effective, and accurate diagnostic modality for the lung/mediastinum. Although some studies have been published on EBUS-TBNA of isolated mediastinal lesions, none have been reported from the United States. This study examines EBUS-TBNA for diagnosis of isolated mediastinal lesions. MATERIALS AND METHODS All cases of mediastinal EBUS-TBNA (defined in radioanatomic terms) during a 7-year period (July 2007-September 2014) were obtained from the anatomic pathology database. Pathologic reports, clinical notes, bronchoscopy notes, and imaging studies were reviewed. Only patients with a mediastinal lesion or non-pulmonary parenchyma-based lesions sampled by EBUS-TBNA without a prior or synchronous lung carcinoma were included in this study. RESULTS Of the 3005 EBUS-TBNA cases accessioned during this time period at our institute, 47 fulfilled the inclusion criteria. The median patient age was 61 years (range: 27-84 years). Both genders were nearly equally represented. A definitive cytologic interpretation was rendered in 40 out of 47 cases (85.1%). Malignancies included non-pulmonary carcinomas (8), sarcomas (5), hematolymphoid malignancies (5), neuroendocrine neoplasm (1), melanoma (1), and undifferentiated malignancy (1). Surgical follow-up was available in 18 of 47 cases (38.3%). There was cytologic-histologic correlation in 16 of 18 cases (88.9%). Surgical follow-up of all cysts diagnosed by cytology were benign cysts. Over the 7-year period, an increasing proportion of all EBUS-TBNAs performed were for mediastinal lesions unassociated with lung carcinoma. CONCLUSIONS EBUS-TBNA has a high accuracy rate when used to diagnose mediastinal lesions unassociated with lung carcinoma. Its utility as a primary diagnostic modality in this setting needs to be explored further.
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Affiliation(s)
- Manisha M Mishra
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jordan P Reynolds
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Charles D Sturgis
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Christine N Booth
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio.
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Yang H, Zhang Y, Wang KP, Ma Y. Transbronchial needle aspiration: development history, current status and future perspective. J Thorac Dis 2016; 7:S279-86. [PMID: 26807275 DOI: 10.3978/j.issn.2072-1439.2015.11.36] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Transbronchial needle aspiration (TBNA) technology was underutilized by clinicians because it is "blind". Recent development of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) renewed the interest and confident of TBNA. TBNA without EBUS is referred as conventional transbronchial needle aspiration (C-TBNA). METHODS This paper focuses on C-TBNA technology development history, present situation and future development to do a detailed introduction. RESULTS TBNA is a simple, cost effective and minimally invasive technique for diagnosing disease of the mediastinum and lung in adult as well as children patients. CONCLUSIONS More improvements of TBNA technology should be made, including employing technological advances to perfect the instruments and techniques, focusing on patient comfort, optimizing yield, simplifying instruments, maximizing ease of use and minimizing training requirements for the pulmonologist. The ideal TBNA scope deserves further evaluation and study.
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Affiliation(s)
- Huizhen Yang
- 1 Department of Respiratory and Critical Care Medicine, People's Hospital, Zhengzhou University, Zhengzhou 450003, China ; 2 Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200092, China ; 3 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Yuan Zhang
- 1 Department of Respiratory and Critical Care Medicine, People's Hospital, Zhengzhou University, Zhengzhou 450003, China ; 2 Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200092, China ; 3 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Ko-Pen Wang
- 1 Department of Respiratory and Critical Care Medicine, People's Hospital, Zhengzhou University, Zhengzhou 450003, China ; 2 Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200092, China ; 3 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Yun Ma
- 1 Department of Respiratory and Critical Care Medicine, People's Hospital, Zhengzhou University, Zhengzhou 450003, China ; 2 Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200092, China ; 3 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
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Motegi H, Kobayashi H, Terasaka S, Yamaguchi S, Ishi Y, Ito Y, Houkin K. Application of endoscopic ultrasonography to intraventricular lesions. Acta Neurochir (Wien) 2016; 158:87-92. [PMID: 26542528 DOI: 10.1007/s00701-015-2617-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 10/16/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Anatomical landmarks such as choroid plexus and foramen of Monro are very important to undergo intraventricular surgery safely and effectually. These landmarks would be unclear in cases with a huge cyst or repeat surgery. We report the usability and precautions to apply a bronchoscope with an ultrasonic convex probe to intraventricular surgery. METHODS Two patients diagnosed with obstructive hydrocephalus, one with a large cyst and the other with recurrent craniopharyngioma in the third ventricle, were applied to the EBUS system. RESULTS In both patients, the EBUS system was applied safely, and lesions beyond the wall of ventricles or the cyst were visible. Color Doppler ultrasonography detected choroid plexus and internal cerebral veins. Furthermore, we performed real-time ultrasound-guided cyst puncture safely on the case with a large cyst. The most important precaution is that the curved portion of the EBUS system is too long to be bent within cerebral ventricles. CONCLUSIONS The new EBUS system with an ultrasonic convex probe is a novel and effectual device to perform intraventricular surgery.
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Li W, Zhang T, Chen Y, Liu C, Peng W. Diagnostic Value of Convex Probe Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in Mediastinal Tuberculous Lymphadenitis: A Systematic Review and Meta-Analysis. Med Sci Monit 2015; 21:2064-72. [PMID: 26177653 PMCID: PMC4510950 DOI: 10.12659/msm.894526] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been widely used in the diagnosis of mediastinal lymphadenopathies. Here, we performed a systematic review and meta-analysis to explore the diagnostic value of EBUS-TBNA in mediastinal tuberculous lymphadenopathy (TBLA). Material/Methods PubMed, EMBASE, and Sinoced were systematically searched for articles published in English or Chinese that reported the diagnostic yield of EBUS-TBNA in mediastinal TBLA. The quality of studies was assessed using the QualSyst tool. Using 95% confidence intervals (CI), the diagnostic yields of EBUS-TBNA were calculated for the individual studies, and the results were then pooled using a random-effects model. Heterogeneity and publication bias were also assessed. Results A total of 14 studies, consisting of 684 patients with mediastinal TBLA, were finally included. The pooled diagnostic yield of EBUS-TBNA for mediastinal TBLA was 80% (95% CI: 74–86%). Significant heterogeneity (I2=77.9%) and significant publication bias were detected (Begg’s test p=0.05 and Egger’s test p=0.02). From subgroup analyses, significant differences in the diagnostic yield of EBUS-TBNA were associated with Asian vs. European (UK) studies, retrospective vs. prospective studies, those employing rapid on-site cytological evaluation vs. not, those employing different anesthetic types, and those employing smear vs. culture. However, microbiological examination and the number of lymph node passes did not have a significant effect on the diagnostic yield of EBUS-TBNA. Fifteen minor complications for EBUS-TBNA were reported. Conclusions EBUS-TBNA appears to be an efficacious and safe procedure and should be used as an initial diagnostic tool for mediastinal TBLA.
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Affiliation(s)
- Wei Li
- Department of Respiratory Disease, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China (mainland)
| | - Ting Zhang
- Department of Respiratory Disease, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China (mainland)
| | - Yuqing Chen
- Department of Respiratory Disease, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China (mainland)
| | - Chao Liu
- Department of Respiratory Disease, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China (mainland)
| | - Wenjia Peng
- Department of Epidemiology and Health Statistics, Bengbu Medical College, Bengbu, Anhui, China (mainland)
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Meta-analysis of 21- Versus 22-G Aspiration Needle During Endobronchial Ultrasound-guided Transbronchial Needle Aspiration. J Bronchology Interv Pulmonol 2015; 22:107-13. [DOI: 10.1097/lbr.0000000000000159] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Xia Y, Ma Y, Arias S, Lee H, Wang KP. Utilization of the International Association for the Study of Lung Cancer and Wang's nodal map for the identification of mediastinum and hilar lymph nodes. Thorac Cancer 2015; 6:464-8. [PMID: 26273402 PMCID: PMC4511325 DOI: 10.1111/1759-7714.12206] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Accepted: 10/31/2014] [Indexed: 12/25/2022] Open
Abstract
Background Transbronchial needle aspiration (TBNA), serving as a remarkably invaluable and minimally invasive technique, has been widely used for the diagnosis and staging of mediastinal adenopathy and masses. To date, the International Association for the Study of Lung Cancer (IASLC) and Wang's nodal map are two well-documented intrathoracic lymph node guidelines for the TBNA procedure. Method We characterized IASLC's and Wang's map, and interpreted the correlation of the two maps station by station. Results The pivotal role of IASLC map is to determine N descriptor in the tumor node metastasis (TNM) staging system of lung cancer, whilst Wang's map is employed to facilitate the localization of biopsy sites for bronchoscopists during TBNA performance. Furthermore, stations 1, 3 and 5 in Wang’ map are equivalent to 4R station in IASLC’ system, while stations 4 and 6 in Wang's account for IASLC station 4L as N2 stations. In addition, Wang's stations 2, 8 and 10 are correlated with station 7 in IASLC's. Wang's stations 7 and 9 are responsible for station 11R in IASLC's map. Conclusion Given their unique benefits and limitations, and the practical links between the two maps, it appears reasonable to highlight the significance of their complementary utilization upon TBNA performance and lung cancer staging.
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Affiliation(s)
- Yang Xia
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine Hangzhou, Zhejiang, China ; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine Baltimore, Maryland, USA
| | - Yun Ma
- Department of Respiratory and Critical Care Medicine, People's Hospital, Zhengzhou University Zhengzhou, Henan, China ; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine Baltimore, Maryland, USA
| | - Sixto Arias
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine Baltimore, Maryland, USA
| | - Hans Lee
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine Baltimore, Maryland, USA
| | - Ko-Pen Wang
- Department of Respiratory and Critical Care Medicine, People's Hospital, Zhengzhou University Zhengzhou, Henan, China ; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine Baltimore, Maryland, USA
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Liu H, Zhou J, Feng QL, Wan G, Xie YJ, Gu HT. Minimally invasive endoscopic staging for mediastinal lymphadenopathy in lung cancer: a systematic review protocol. BMJ Open 2014; 4:e005707. [PMID: 25082423 PMCID: PMC4120311 DOI: 10.1136/bmjopen-2014-005707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Minimally invasive endoscopic biopsy techniques have been widely available as potential alternatives for mediastinal lesions staging in patients with known or suspected lung cancer. Previous efforts have been made to evaluate the diagnostic performance of specific endoscopic modality alone at the level of the mediastinum for staging lung cancer, however, few studies focus on the accuracy of comparisons between different endoscopic modalities, especially at the level of any individual lymph node station. The objective of our study is to determine the diagnostic yields of different endoscopic modalities for staging mediastinal lymphadenopathy in lung cancer, especially concerning the individual lymph node station. METHODS/DESIGN A systematic electronic search of MEDLINE, EMBASE, SinoMed and ISI Web of Science were performed to identify studies evaluating endoscopic modalities accuracy with restriction of English and Chinese languages from inception to an update until May 2014. Data were extracted with the patient as the unit of analysis with regards to the abilities of different endoscopic modalities at the level of mediastinum and particular lymph node station. The methodological quality was assessed independently according to the Quality Assessment of Diagnostic Accuracy Study (QADAS) criteria. An exact binomial rendition of bivariate mixed-effects regression model was used to estimate the pooled sensitivity and specificity. Also, pre-post probability analysis, publication bias analysis and sensitivity analysis were performed for a synthesis of knowledge of this context. DISSEMINATION The findings will advance our better available knowledge of optimal clinical decision-making when dealing with staging of mediastinal metastasis in lung cancer. TRIAL REGISTRATION NUMBER PROSPERO-NIHR Prospective Register of Systematic Reviews (CRD42014009792).
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Affiliation(s)
- Hong Liu
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jie Zhou
- Department of Ultrasonography, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qiao-ling Feng
- Key Laboratory of Diagnostic Medicine of Education Ministry, Institute of Laboratory Medicine, Chongqing Medical University, Chongqing, China
| | - Gang Wan
- Department of Radiation Oncology, Affiliated Cancer Hospital of Guangxi Medical University, Nanning, China
| | - Yong-jun Xie
- National Center for Medical Simulation of China, Chengdu Medical College, Chengdu, China
- Department of Histo-anatomy, School of Basic Medical Sciences, Chengdu Medical College, Chengdu, China
| | - Hai-tao Gu
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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