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Baskin AS, Burapachaisri K, Guha S, Velotta JB. The Landmark Series: Advances in Preoperative Mediastinal Lymph Node Staging for Non-small Cell Lung Cancer (NSCLC). Ann Surg Oncol 2025; 32:3175-3186. [PMID: 40025361 PMCID: PMC11976788 DOI: 10.1245/s10434-025-17008-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2024] [Accepted: 01/28/2025] [Indexed: 03/04/2025]
Abstract
Accurate mediastinal staging is essential for determining the extent of lung cancer, predicting prognosis, and guiding treatment strategies. Current clinical guidelines recommend preoperative invasive mediastinal staging for most patients with potentially resectable lung cancer, as imaging modalities alone often lack sensitivity and specificity. Invasive mediastinal staging techniques are categorized into surgical (e.g., cervical mediastinoscopy, video-assisted thoracic surgery) and nonsurgical (i.e., minimally invasive) approaches. Although cervical mediastinoscopy has historically been the gold standard, minimally invasive techniques have gained prominence in recent decades. These approaches, including endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), and combined EBUS/EUS, provide improved accuracy and reduced morbidity compared with traditional surgical methods. EBUS-TBNA facilitates access to a broad range of lymph node stations with real-time ultrasound guidance, while EUS-FNA complements EBUS by enabling transesophageal lymph node sampling. Together, these techniques enable a more comprehensive mediastinal staging. This review examines five key trials that explore the expanding role of endobronchial and endoscopic techniques in mediastinal staging for non-small cell lung cancer, demonstrating how these advancements have transformed the diagnostic landscape.
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Affiliation(s)
- Alison S Baskin
- Department of Surgery, University of California-San Francisco, San Francisco, CA, USA
| | | | - Shreya Guha
- California Northstate University College of Medicine, Elk Grove, CA, USA
| | - Jeffrey B Velotta
- University of California-San Francisco School of Medicine, San Francisco, CA, USA.
- Department of Thoracic Surgery, Kaiser Permanente Northern California, Oakland, CA, USA.
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Okasha H, Gadour E, Tayyab GUN, Seicean A, Hicham E, Emad E, Alamri T, Tehami N, Faraj HI, Alzamzamy A, Hussein H, Tag-Adeen M, Elbasiony M, Al-Lehibi A, Saleh S, Houmani Z, Abdelghani M, Ragab K, Ismaili Z, Drir O, Ghoneem E, Abdallah O, Rebiai S, Pausawasdi N, Rouibaa F, Borahma M, Atalla H, Farouk M, Altonbary A. Comprehensive analysis of endoscopic ultrasound (EUS) in mediastinal lesions: patient characteristics, diagnostic outcomes, safety, and efficacy: a multi-country study. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2025; 37:25. [DOI: 10.1186/s43162-025-00409-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Accepted: 01/31/2025] [Indexed: 02/10/2025] Open
Abstract
Abstract
Background
Mediastinal lesions are tumors that develop mainly from structures commonly located in the three compartments of the mediastinum and the paravertebral areas. The diagnosis of these lesions is primarily based on imaging studies such as computed tomography and magnetic resonance imaging, which confirm the presence of the lesions and suspected metastatic disease. The study aims to determine the factors that determine the diagnostic accuracy and yield of endoscopic ultrasound (EUS) in diagnosing mediastinal lesions.
Methods
This multi-country study involved a list of centers providing EUS services across ten countries—the United Kingdom, Algeria, Egypt, Iraq, Kingdom of Saudi Arabia (KSA), Lebanon, Morocco, Pakistan, Romania, and Thailand. The appropriate information was collected regarding EUS-FNA and EUS-FNB procedures, including needle types, nature of lesion, needle passes, and complications of the techniques. The frequency/percentage conveyed data on the qualitative variables. The p-values were obtained using the Chi-square two-tailed exact test. The significance of the analysis was defined as p < 0.05. All the syntheses were performed using the Statistical Package for the Social Sciences (SPSS version 27; SPSS Inc., Chicago, IL, USA).
Results
A total of 439 participants were involved in this study, 255 (58.1%) males and 184 (41.9%) females, with a mean age of 55.73
$$\pm$$
±
14.93 years. EUS-FNA and EUS-FNB diagnostic yield was influenced by needle types, needle size, number of needle passes, and lesion size. Among females, 44.6% were diagnosed with EUS-FNA, 42.8% with EUS-FNB, and 50.0% with EUS-FNA and FNB. Conversely, 55.4% of males were diagnosed using EUS-FNA and 57.2% with EUS-FNB. The association between gender and the diagnostic method, however, was statistically insignificant (p = 0.197). Needles with smaller diameters (22G) offered greater diagnostic yield than needles with larger diameters (19G). A minimal number of needle passes (between 2 and 4) showed a higher diagnostic yield than a higher number of needle passes (> 5). EUS-FNB accounted for a 0.5% complication incidence rate each for fever, pain, thoracic pain, and hemorrhage. EUS-FNA had no complication rate. Patients undergoing EUS-FNA, EUS-FNB, or both procedural examinations had no significant complications (p = 0.085).
Conclusion
The diagnostic yield of EUS procedures is affected by needle types, number of needle passes, lesion size, and needle size. Besides, EUS-FNA and EUS-FNB are infrequently associated with various complication rates. These techniques are safe and offer higher diagnostic yield when utilized responsibly by endosonographers.
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Sumi T, Ishigooka T, Matsuura K, Ikeda T, Koshino Y, Suzuki K, Arioka K, Yamada Y, Chiba H. Transesophageal ultrasound-guided bronchoscopic Acquire TBNB versus Vizishot2 TBNA needles for neoplastic lesions: A retrospective study. Respir Investig 2024; 62:1021-1026. [PMID: 39236512 DOI: 10.1016/j.resinv.2024.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/10/2024] [Accepted: 08/26/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND Lung cancer is often diagnosed at an advanced stage; however, it has shown improved therapeutic efficacy with the introduction of molecularly targeted drugs and immune checkpoint inhibitors, necessitating accurate molecular diagnosis for effective treatment planning. Traditional sampling techniques, including endobronchial ultrasound-guided transbronchial needle aspiration, frequently require multiple biopsies to obtain sufficient tissues for multiplex testing, highlighting the need for more efficient methods. Therefore, we explored the diagnostic utility of endoscopic ultrasound with bronchoscope-guided fine-needle biopsy (EUS-B-FNB) versus fine-needle aspiration (EUS-B-FNA) in patients with lung cancer, focusing on tissue sample collection for molecular testing. The introduction of the Franseen needle in EUS-B-FNB, characterized by three beveled edges, allows for more tissue collection in cylinder form. METHODS We retrospectively analyzed the data of 97 patients who underwent EUS-B-FNB or EUS-B-FNA at Hakodate Goryoukaku Hospital and evaluated diagnostic yields, safety, and nucleic acid concentrations using collected specimens. RESULTS The diagnostic yields of EUS-B-FNB and EUS-B-FNA were comparable (92.2% vs. 92.3%), with no significant differences in complications. However, EUS-B-FNB provided significantly higher DNA and RNA concentrations (DNA; 41.05 vs. 10.20 ng/mL; P < 0.0001, RNA; 36.80 vs. 11.80 ng/mL; P = 0.0009), essential for comprehensive molecular testing. CONCLUSION This study highlights the potential of EUS-B-FNB for enhancing the molecular diagnosis of lung cancer by ensuring adequate tissue sample collection for multiplex testing, paving the way for personalized medicine. This technique is comparable in safety and efficacy to traditional methods while offering a substantial improvement in the quality of molecular diagnostics.
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Affiliation(s)
- Toshiyuki Sumi
- Department of Pulmonary Medicine, Hakodate Goryoukaku Hospital, 38-3 Goryoukaku-Cho, Hakodate-shi, Hokkaido, 040-8611, Japan; Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, 060-8543, Japan.
| | - Taiki Ishigooka
- Department of Pulmonary Medicine, Hakodate Goryoukaku Hospital, 38-3 Goryoukaku-Cho, Hakodate-shi, Hokkaido, 040-8611, Japan; Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, 060-8543, Japan
| | - Keigo Matsuura
- Department of Pulmonary Medicine, Hakodate Goryoukaku Hospital, 38-3 Goryoukaku-Cho, Hakodate-shi, Hokkaido, 040-8611, Japan; Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, 060-8543, Japan
| | - Takumi Ikeda
- Department of Pulmonary Medicine, Hakodate Goryoukaku Hospital, 38-3 Goryoukaku-Cho, Hakodate-shi, Hokkaido, 040-8611, Japan; Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, 060-8543, Japan
| | - Yuta Koshino
- Department of Pulmonary Medicine, Hakodate Goryoukaku Hospital, 38-3 Goryoukaku-Cho, Hakodate-shi, Hokkaido, 040-8611, Japan; Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, 060-8543, Japan
| | - Keito Suzuki
- Department of Pulmonary Medicine, Hakodate Goryoukaku Hospital, 38-3 Goryoukaku-Cho, Hakodate-shi, Hokkaido, 040-8611, Japan; Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, 060-8543, Japan
| | - Kotomi Arioka
- Department of Surgical Pathology, Hakodate Goryoukaku Hospital, Hokkaido, 040-8611, Japan
| | - Yuichi Yamada
- Department of Pulmonary Medicine, Hakodate Goryoukaku Hospital, 38-3 Goryoukaku-Cho, Hakodate-shi, Hokkaido, 040-8611, Japan
| | - Hirofumi Chiba
- Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, 060-8543, Japan
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Griffiths S, Power L, Breen D. Pulmonary endoscopy - central to an interventional pulmonology program. Expert Rev Respir Med 2024; 18:843-860. [PMID: 39370862 DOI: 10.1080/17476348.2024.2413561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 09/12/2024] [Accepted: 10/03/2024] [Indexed: 10/08/2024]
Abstract
INTRODUCTION Pulmonary endoscopy occupies a central role in Interventional Pulmonology and is frequently the mainstay of diagnosis of respiratory disease, in particular lung malignancy. Older techniques such as rigid bronchoscopy maintain an important role in central airway obstruction. Renewed interest in the peripheral pulmonary nodule is driving major advances in technologies to increase the diagnostic accuracy and advance new potential endoscopic therapeutic options. AREAS COVERED This paper describes the role of pulmonary endoscopy, in particular ultrasound in the diagnosis and staging of lung malignancy. We will explore the recent expansion of ultrasound to include endoscopic ultrasound - bronchoscopy (EUS-B) and combined ultrasound (CUS) techniques. We will discuss in detail the advances in the workup of the peripheral pulmonary nodule.We performed a non-systematic, narrative review of the literature to summarize the evidence regarding the indications, diagnostic yield, and safety of current bronchoscopic sampling techniques. EXPERT OPINION EBUS/EUS-B has revolutionized the diagnosis and staging of thoracic malignancy resulting in more accurate assessment of the mediastinum compared to mediastinoscopy alone, thus reducing the rate of futile thoracotomies. Although major advances in the assessment of the peripheral pulmonary nodule have been made, the role of endoscopy in this area requires further clarification and investigation.
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Affiliation(s)
- Sally Griffiths
- Interventional Respiratory Unit, Galway University Hospitals, Galway, Ireland
| | - Lucy Power
- Interventional Respiratory Unit, Galway University Hospitals, Galway, Ireland
| | - David Breen
- Interventional Respiratory Unit, Galway University Hospitals, Galway, Ireland
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Hubaud V, De Lesquen H, Avaro JP. [Changes in mediastinal lymph node sampling practices]. Rev Mal Respir 2024; 41:549-561. [PMID: 39179425 DOI: 10.1016/j.rmr.2024.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 06/28/2024] [Indexed: 08/26/2024]
Abstract
INTRODUCTION While mediastinoscopy is considered the gold standard for mediastinal node sampling, it is to some extent being superseded by endobronchial ultrasound. The objective of this study was to evaluate the different practices in our center regarding mediastinal lymph node sampling in lung cancer patients. METHODS Data were collected from patients having undergone mediastinal lymph node sampling by video-assisted-mediastinoscopy (VM) or by endobronchial ultrasound (EBUS) in our center between August 2020 and July 2023. The modalities of the two procedures and their diagnostic accuracy were analyzed, as was their evolution over time. RESULTS The 362 patients comprised 217 who were sampled by EBUS and 145 by VM. Overall, the procedures became more frequent, with EBUS tending to supersede VM. The number of harvested lymph nodes gradually grew, and less unforeseen lymph node invasion and upstaging occurred. CONCLUSION The arrival in our center of endobronchial ultrasound yielded an overall increase of lymph node sampling despite a decrease in the number of mediastinoscopy procedures performed. Reinforced compliance with guidelines is needed to improve the diagnostic accuracy of these techniques and to better ensure quality of care.
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Affiliation(s)
- V Hubaud
- Service de chirurgie thoracique, hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France.
| | - H De Lesquen
- Service de chirurgie thoracique, hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France
| | - J-P Avaro
- Service de chirurgie thoracique, hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France
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Rodriguez GR, Trachiotis GD, Mullenix PS, Antevil JL. Minimally Invasive with Maximal Yield: A Narrative Review of Current Practices in Mediastinal Lymph Node Staging in Non-Small Cell Lung Cancer. J Laparoendosc Adv Surg Tech A 2024; 34:773-785. [PMID: 38727568 DOI: 10.1089/lap.2024.0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2024] Open
Abstract
Background: Lung cancer remains the leading cause of cancer deaths in the United States despite declining incidence and improved outcomes because of advancements in early detection and development of novel therapies. Accurate mediastinal lymph node staging is crucial for determining prognosis and guiding treatment decisions, particularly for non-small cell lung cancer (NSCLC). Materials and Methods: A systematic search of PubMed was conducted to identify English language articles published between January 2010 and January 2024 focusing on preoperative lymph node staging in adults with NSCLC. Case series, observational studies, randomized trials, guidelines, narrative reviews, systematic reviews, and meta-analyses were included. Results: Various imaging modalities, surgical and nonsurgical procedures for mediastinal lymph node staging were reviewed, including positron emission tomography with computed tomography, cervical mediastinoscopy, video-assisted cervical mediastinoscopy, anterior mediastinotomy, video-assisted thoracoscopy, endobronchial ultrasound-guided fine needle aspiration (EBUS-FNA), transesophageal endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), and computed tomography-guided percutaneous lymph node biopsy. EBUS-FNA emerged as the preferred initial staging procedure because of its high sensitivity and low complication rate. Combining it with other procedures or confirmatory testing may be helpful in determining appropriate treatment. Conclusions: Although cervical mediastinoscopy remains a valuable confirmatory procedure in select cases, its role as a first-line staging modality is diminishing with the widespread adoption of EBUS-FNA and EUS-FNA. The combination of EBUS-FNA and EUS-FNA allows access to nearly all mediastinal lymph node stations with high diagnostic accuracy. Future research may further refine the selection criteria for invasive mediastinal staging procedures, ultimately optimizing patient outcomes in the management of NSCLC.
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Affiliation(s)
- Gustavo R Rodriguez
- Department of Surgery, George Washington University Hospital, Washington, District of Columbia, USA
| | - Gregory D Trachiotis
- Department of Surgery, George Washington University Hospital, Washington, District of Columbia, USA
- Division of Cardiothoracic Surgery and Heart Center, Washington DC Veterans Affairs Medical Center, Washington, District of Columbia, USA
| | - Philip S Mullenix
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Jared L Antevil
- Department of Surgery, George Washington University Hospital, Washington, District of Columbia, USA
- Division of Cardiothoracic Surgery and Heart Center, Washington DC Veterans Affairs Medical Center, Washington, District of Columbia, USA
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7
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Badaoui A, De Wergifosse M, Rondelet B, Deprez PH, Stanciu-Pop C, Bairy L, Eucher P, Delos M, Ocak S, Gillain C, Duplaquet F, Pirard L. Improved Accuracy and Sensitivity in Diagnosis and Staging of Lung Cancer with Systematic and Combined Endobronchial and Endoscopic Ultrasound (EBUS-EUS): Experience from a Tertiary Center. Cancers (Basel) 2024; 16:728. [PMID: 38398119 PMCID: PMC10886864 DOI: 10.3390/cancers16040728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/07/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Combined endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound-guided tissue acquisition (EUS-TA) are accurate procedures for the diagnosis and staging of mediastinal lymph nodes (MLNs) in lung cancer. However, the respective contribution of separate and combined procedures in diagnosis and staging has not been fully studied. The aim of this study was to assess their respective performances. METHODS Patients with suspected malignant MLNs in lung cancer or recurrence identified by PET-CT who underwent combined EBUS-TBNA and EUS-TA were retrospectively reviewed. RESULTS A total of 141 patients underwent both procedures. Correct diagnosis was obtained in 82% with EBUS-TBNA, 91% with EUS-TA, and 94% with the combined procedure. The overall sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of EBUS-TBNA, EUS-TA, and the combined procedure for diagnosing malignancy were [75%, 100%, 100%, 58%], [87%, 100%, 100%, 75%], and [93%, 100%, 100%, 80%], respectively, with a significantly better sensitivity of the combined procedure (p < 0.0001). Staging (82/141 patients) was correctly assessed in 74% with EBUS-TBNA, 68% with EUS-TA, and 85% with the combined procedure. The overall sensitivity, specificity, PPV, and NPV of EBUS-TBNA, EUS-TA, and the combined procedure for lung cancer staging were [62%, 100%, 100%, 55%], [54%, 100%, 100%, 50%], and [79%, 100%, 100%, 68%], respectively, significantly better in terms of sensitivity for the combined procedure (p < 0.001). CONCLUSION The combined EBUS-EUS approach in lung cancer patients showed better accuracy and sensitivity in diagnosis and staging when compared with EBUS-TBNA and EUS-TA alone.
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Affiliation(s)
- Abdenor Badaoui
- Department of Gastroenterology and Hepatology, CHU UCL Namur, Université catholique de Louvain, 5530 Yvoir, Belgium; (A.B.); (C.G.)
| | - Marion De Wergifosse
- Department of Pneumology, CHU UCL Namur, Université catholique de Louvain, 5530 Yvoir, Belgium; (M.D.W.); (S.O.); (F.D.)
| | - Benoit Rondelet
- Department of Vascular and Thoracic Surgery, CHU UCL Namur, Université catholique de Louvain, 5530 Yvoir, Belgium; (B.R.); (P.E.)
| | - Pierre H. Deprez
- Department of Gastroenterology and Hepatology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, 1200 Bruxelles, Belgium;
| | - Claudia Stanciu-Pop
- Department of Pathological Anatomy, CHU UCL Namur, Université catholique de Louvain, 5530 Yvoir, Belgium; (C.S.-P.); (M.D.)
| | - Laurent Bairy
- Department of Anesthesiology, CHU UCL Namur, Université catholique de Louvain, 5530 Yvoir, Belgium;
| | - Philippe Eucher
- Department of Vascular and Thoracic Surgery, CHU UCL Namur, Université catholique de Louvain, 5530 Yvoir, Belgium; (B.R.); (P.E.)
| | - Monique Delos
- Department of Pathological Anatomy, CHU UCL Namur, Université catholique de Louvain, 5530 Yvoir, Belgium; (C.S.-P.); (M.D.)
| | - Sebahat Ocak
- Department of Pneumology, CHU UCL Namur, Université catholique de Louvain, 5530 Yvoir, Belgium; (M.D.W.); (S.O.); (F.D.)
- Pole of Pneumology, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, 1200 Bruxelles, Belgium
| | - Cédric Gillain
- Department of Gastroenterology and Hepatology, CHU UCL Namur, Université catholique de Louvain, 5530 Yvoir, Belgium; (A.B.); (C.G.)
| | - Fabrice Duplaquet
- Department of Pneumology, CHU UCL Namur, Université catholique de Louvain, 5530 Yvoir, Belgium; (M.D.W.); (S.O.); (F.D.)
| | - Lionel Pirard
- Department of Pneumology, CHU UCL Namur, Université catholique de Louvain, 5530 Yvoir, Belgium; (M.D.W.); (S.O.); (F.D.)
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Schwalk AJ, Niroula A, Schimmel M. What is new in mediastinal staging? Curr Opin Pulm Med 2024; 30:25-34. [PMID: 37851368 DOI: 10.1097/mcp.0000000000001022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
PURPOSE OF REVIEW Appropriate staging is of utmost importance in nonsmall cell lung cancer (NSCLC), as the pathologic stage dictates both overall prognosis and appropriate therapeutic pathways. This article seeks to review the current recommendations for mediastinal staging of NSCLC and available modalities to achieve this. Landmark publications pertaining to recent advancements in NSCLC treatments are also highlighted and the role of specific bronchoscopic modalities for tissue acquisition are reviewed. RECENT FINDINGS Recent advancements in the treatment of NSCLC have made accurate mediastinal staging more important than ever. Guidelines and recommendations outlining patients that warrant invasive mediastinal staging are available and a systematic approach should be utilized when sampling is performed. Ensuring the adequacy of tissue for the growing number of molecular biomarkers that must be tested has been the focus of many recent studies. SUMMARY Appropriate mediastinal staging is crucial for the management of patients with NSCLC as is obtaining adequate tissue for diagnostic and therapeutic purposes. EBUS-TBNA is sufficient for the diagnosis of nonsmall cell and small cell lung carcinomas, but EBUS-guided intranodal forceps and cryobiopsy may provide more optimal specimen for patients with benign disease, such as sarcoidosis, or in cases of lymphoma. Further studies are necessary to better delineate the role of these techniques in the diagnosis and staging of mediastinal diseases before they become the primary diagnostic modalities.
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Affiliation(s)
- Audra J Schwalk
- University of Texas Southwestern Medical Center, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Dallas, Texas
| | - Abesh Niroula
- Emory University School of Medicine, Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Atlanta, Georgia, USA
| | - Matthew Schimmel
- Emory University School of Medicine, Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Atlanta, Georgia, USA
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Buerlein RCD, Shami VM. Endoscopic Diagnosis of Extra-Luminal Cancers. Gastrointest Endosc Clin N Am 2024; 34:19-36. [PMID: 37973229 DOI: 10.1016/j.giec.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
The last 2 decades have seen an emergence of endoscopic technologies and techniques allowing for minimally invasive modalities for assessing and sampling lesions outside of the gastrointestinal lumen, including the chest, abdomen, and pelvis. Incorporating these new endoscopic approaches has revolutionized the diagnosis and staging of extra-luminal malignancies and has enabled more accessible and safer tissue acquisition.
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Affiliation(s)
- Ross C D Buerlein
- Division of Gastroenterology and Hepatology, University of Virginia Health System, Box 800708, Charlottesville, VA 22908, USA.
| | - Vanessa M Shami
- Division of Gastroenterology and Hepatology, University of Virginia Health System, Box 800708, Charlottesville, VA 22908, USA
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10
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Mena Casado NB, Cuesta Martín M. A Red Herring to Iatrogenic Pneumothorax. Arch Bronconeumol 2023:S0300-2896(23)00102-3. [PMID: 36990914 DOI: 10.1016/j.arbres.2023.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/26/2023] [Accepted: 02/27/2023] [Indexed: 03/29/2023]
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Danilevskaya OV, Chernikova EN, Esakov YS, Averyanov AV, Karnaukhov NS, Shishin KV. [Transbronchial cryobiopsy for mediastinal lesions: a pilot study]. Khirurgiia (Mosk) 2023:16-24. [PMID: 38010014 DOI: 10.17116/hirurgia202311116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
OBJECTIVE To describe a novel transbronchial cryobiopsy technique for mediastinal lesions after initial ultrasound assessment and EBUS-TBNA. MATERIAL AND METHODS Transbronchial cryobiopsy (TBCB) was performed in 35 patients with suspicious mediastinal lesions between November 2020 and September 2022. Age of patients ranged from 22 to 75 years (median 50 [39; 62]). Men-to-women ratio was 13:22. RESULTS According to morphological data, patients with sarcoidosis (n=13), NSCLC (n=7) and metastases of other tumors (n=3) prevailed. There were patients with B-cell lymphoma (n=1), Castleman disease (n=1) and small cell lung cancer (n=2). Among 15 biopsies for immunohistochemical examination, samples were sufficient for final morphological conclusion in 11 (73.3%) cases (95% CI 48.5-89.1). In 4 (11.4%) cases (95% CI 4.5-26), examination was uninformative. Repeated biopsy was performed in 2 cases, and sarcoidosis of thoracic lymph nodes was confirmed. Sensitivity, specificity and accuracy of transbronchial cryobiopsy were 93.3, 100 and 94%, respectively. There were no clinically significant complications. In one case, chest X-ray revealed pneumomediastinum without need for additional treatment. CONCLUSION Transbronchial mediastinal cryobiopsy is a perspective method for diagnosis of mediastinal neoplasms. Apparently, this approach may be advisable in patients with suspected sarcoidosis or lymphoproliferative diseases.
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Affiliation(s)
- O V Danilevskaya
- Research Pulmonology Institute of the Federal Medical Biological Agency, Moscow, Russia
- Moscow City Clinical Oncology Hospital No. 1, Moscow, Russia
| | | | - Yu S Esakov
- Moscow City Clinical Oncology Hospital No. 1, Moscow, Russia
| | - A V Averyanov
- Research Pulmonology Institute of the Federal Medical Biological Agency, Moscow, Russia
| | | | - K V Shishin
- Loginov Moscow Clinical Research Center, Moscow, Russia
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12
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Liu X, Yang K, Guo W, Ye M, Liu S. Mediastinal Nodal Staging Performance of Combined Endobronchial and Esophageal Endosonography in Lung Cancer Cases: A Systematic Review and Meta-Analysis. Front Surg 2022; 9:890993. [PMID: 35677749 PMCID: PMC9168235 DOI: 10.3389/fsurg.2022.890993] [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] [Received: 03/07/2022] [Accepted: 04/27/2022] [Indexed: 02/05/2023] Open
Abstract
By searching lliteratures till January 5, 2022, we evaluated the role of the mediastinal nodal staging of endobronchial ultrasound-guided fine-needle aspiration (EBUS) and endoscopic ultrasound-guided fine-needle aspiration (EUS) in lung cancer. A total of 20 studies with 2,961 patients were included in this study. The pooled sensitivity, specificity, PLR, and NLR for EBUS were 0.79, 0.97, 27.29, and 0.25, respectively. EUS showed staging performance similar to EBUS. The staging performance was significantly improved when combining EBUS + EUS.
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Affiliation(s)
- Xiaozhen Liu
- Department of Ultrasonography, Zhongshan People's Hospital (ZSPH), Zhongshan, China
| | - Kun Yang
- Department of Ultrasonography, Zhongshan People's Hospital (ZSPH), Zhongshan, China
| | - Weihong Guo
- Department of Respiratory Medicine, Zhongshan People's Hospital (ZSPH), Zhongshan, China
| | - Muqi Ye
- Department of Ultrasonography, Zhongshan People's Hospital (ZSPH), Zhongshan, China
| | - Shaozhong Liu
- Department of Ultrasonography, Zhongshan People's Hospital (ZSPH), Zhongshan, China
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13
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Rodríguez De Dios N, Navarro-Martin A, Cigarral C, Chicas-Sett R, García R, Garcia V, Gonzalez JA, Gonzalo S, Murcia-Mejía M, Robaina R, Sotoca A, Vallejo C, Valtueña G, Couñago F. GOECP/SEOR radiotheraphy guidelines for non-small-cell lung cancer. World J Clin Oncol 2022; 13:237-266. [PMID: 35582651 PMCID: PMC9052073 DOI: 10.5306/wjco.v13.i4.237] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 08/27/2021] [Accepted: 04/09/2022] [Indexed: 02/06/2023] Open
Abstract
Non-small cell lung cancer (NSCLC) is a heterogeneous disease accounting for approximately 85% of all lung cancers. Only 17% of patients are diagnosed at an early stage. Treatment is multidisciplinary and radiotherapy plays a key role in all stages of the disease. More than 50% of patients with NSCLC are treated with radiotherapy (curative-intent or palliative). Technological advances-including highly conformal radiotherapy techniques, new immobilization and respiratory control systems, and precision image verification systems-allow clinicians to individualize treatment to maximize tumor control while minimizing treatment-related toxicity. Novel therapeutic regimens such as moderate hypofractionation and advanced techniques such as stereotactic body radiotherapy (SBRT) have reduced the number of radiotherapy sessions. The integration of SBRT into routine clinical practice has radically altered treatment of early-stage disease. SBRT also plays an increasingly important role in oligometastatic disease. The aim of the present guidelines is to review the role of radiotherapy in the treatment of localized, locally-advanced, and metastatic NSCLC. We review the main radiotherapy techniques and clarify the role of radiotherapy in routine clinical practice. These guidelines are based on the best available evidence. The level and grade of evidence supporting each recommendation is provided.
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Affiliation(s)
- Núria Rodríguez De Dios
- Department of Radiation Oncology, Hospital del Mar, Barcelona 08003, Spain
- Radiation Oncology Research Group, Hospital Del Mar Medical Research Institution, Barcelona 08003, Spain
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona 08003, Spain
| | - Arturo Navarro-Martin
- Department of Radiation Oncology, Thoracic Malignancies Unit, Hospital Duran i Reynals. ICO, L´Hospitalet de L, Lobregat 08908, Spain
| | - Cristina Cigarral
- Department of Radiation Oncology, Hospital Clínico de Salamanca, Salamanca 37007, Spain
| | - Rodolfo Chicas-Sett
- Department of Radiation Oncology, ASCIRES Grupo Biomédico, Valencia 46004, Spain
| | - Rafael García
- Department of Radiation Oncology, Hospital Ruber Internacional, Madrid 28034, Spain
| | - Virginia Garcia
- Department of Radiation Oncology, Hospital Universitario Arnau de Vilanova, Lleida 25198, Spain
| | | | - Susana Gonzalo
- Department of Radiation Oncology, Hospital Universitario La Princesa, Madrid 28006, Spain
| | - Mauricio Murcia-Mejía
- Department of Radiation Oncology, Hospital Universitario Sant Joan de Reus, Reus 43204, Tarragona, Spain
| | - Rogelio Robaina
- Department of Radiation Oncology, Hospital Universitario Arnau de Vilanova, Lleida 25198, Spain
| | - Amalia Sotoca
- Department of Radiation Oncology, Hospital Ruber Internacional, Madrid 28034, Spain
| | - Carmen Vallejo
- Department of Radiation Oncology, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
| | - German Valtueña
- Department of Radiation Oncology, Hospital Clínico Universitario Lozano Blesa, Zaragoza 50009, Spain
| | - Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario Quirónsalud, Madrid 28223, Spain
- Department of Radiation Oncology, Hospital La Luz, Madrid 28003, Spain
- Department of Clinical, Universidad Europea, Madrid 28670, Spain
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14
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Tanaka E, Oda N, Kobayashi S, Ogawa T, Mitani R, Nawa T, Takata I, Ueki T, Okada H. Mediastinal Lymph Node Metastasis of Esophageal Cancer with Esophageal Stenosis Diagnosed via Transesophageal Endoscopic Ultrasound with Bronchoscope-guided Fine-needle Aspiration. Intern Med 2022; 61:1007-1010. [PMID: 34511572 PMCID: PMC9038477 DOI: 10.2169/internalmedicine.8214-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
An 80-year-old man underwent follow-up examinations after endoscopic submucosal dissection (ESD) for esophageal cancer. Computed tomography showed enlarged lymph nodes of the right recurrent nerve. The patient had esophageal stenosis due to repeated ESD for multiple esophageal tumors. The stenosis made the passage of an endoscopic ultrasound (EUS) scope through the esophagus difficult. Thus, an endobronchial ultrasound bronchoscope, which had a thinner diameter than that of the EUS scope, was used for transesophageal endoscopic ultrasound with bronchoscope-guided fine-needle aspiration. This technique led to the diagnosis of mediastinal lymph node metastasis of esophageal cancer.
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Affiliation(s)
- Emi Tanaka
- Department of Internal Medicine, Fukuyama City Hospital, Japan
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Naohiro Oda
- Department of Internal Medicine, Fukuyama City Hospital, Japan
| | - Sayo Kobayashi
- Department of Internal Medicine, Fukuyama City Hospital, Japan
| | | | - Reo Mitani
- Department of Internal Medicine, Fukuyama City Hospital, Japan
| | - Toru Nawa
- Department of Internal Medicine, Fukuyama City Hospital, Japan
| | - Ichiro Takata
- Department of Internal Medicine, Fukuyama City Hospital, Japan
| | - Toru Ueki
- Department of Internal Medicine, Fukuyama City Hospital, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
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15
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Marshall T, Kalanjeri S, Almeida FA. Lung cancer staging, the established role of bronchoscopy. Curr Opin Pulm Med 2022; 28:17-30. [PMID: 34720099 DOI: 10.1097/mcp.0000000000000843] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW Lung cancer is the leading cause of cancer-related deaths worldwide. In the absence of distant metastases, accurate mediastinal nodal staging determines treatment approaches to achieve most favourable outcomes for patients. Mediastinal staging differentiates N0/N1 disease from N2/N3 in surgical candidates. Likewise, presence of nodal involvement in nonsurgical candidates who are being considered for stereotactic body radiation therapy is also critical. This review article seeks to discuss the current options available for mediastinal staging in nonsmall cell lung cancer (NSCLC), particularly the role of bronchoscopy. RECENT FINDINGS Although several techniques are available to stage the mediastinum, bronchoscopy with EBUS-TBNA with or without EUS-FNA appears to be superior in most clinical situations based on its ability to concomitantly diagnose and stage at once, safety, accessibility to the widest array of lymph node stations, cost and low risk of complications. However, training and experience are required to achieve consistent diagnostic accuracy with EBUS-TBNA. SUMMARY EBUS-TBNA with or without EUS-FNA is considered the modality of choice in the diagnosis and staging of NSCLC in both surgical and nonsurgical candidates.
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Affiliation(s)
- Tanya Marshall
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, Ohio
| | - Satish Kalanjeri
- Pulmonary and Critical Care Medicine, Harry S. Truman Memorial Veterans Hospital
- Pulmonary and Critical Care Medicine, University of Missouri School of Medicine, Columbia, Missouri
| | - Francisco Aecio Almeida
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
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16
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Ashok A, Jiwnani SS, Karimundackal G, Bhaskar M, Shetty NS, Tiwari VK, Niyogi DM, Pramesh CS. Controversies in Mediastinal Staging for Nonsmall Cell Lung Cancer. Indian J Med Paediatr Oncol 2021. [DOI: 10.1055/s-0041-1739345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
AbstractMediastinal lymph nodal involvement in nonsmall cell lung cancer plays a crucial role in deciding treatment strategy. Survival falls markedly with increasing involvement of mediastinal nodal stations. Hence, accurate staging of the mediastinum with lowest morbidity is of utmost importance. A wide array of invasive and noninvasive modalities that complement each other in assessing the nodes are available at our disposal. Guidelines recommend noninvasive imaging as the initial step in the staging algorithm for all tumors, followed by invasive staging. No single modality has proven to be the ideal method to stage the mediastinum when used alone. In the present decade, minimally invasive endobronchial ultrasound (EBUS) has challenged the position of surgical mediastinoscopy, which has been the gold standard, historically. However, a negative EBUS needs to be confirmed by surgical mediastinoscopy. Video-assisted mediastinoscopic lymphadenectomy has also come to the forefront in last two decades and has shown exceptional results, when performed in experienced centers. This review details the various modalities of mediastinal staging and the controversies surrounding the optimal method of staging, restaging after neoadjuvant therapy, and the most cost-effective strategy.
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Affiliation(s)
- Apurva Ashok
- Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sabita S. Jiwnani
- Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - George Karimundackal
- Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Maheema Bhaskar
- Department of Pulmonology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nitin S. Shetty
- Division of Interventional Radiology, Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Virendra Kumar Tiwari
- Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Devayani M. Niyogi
- Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - C. S. Pramesh
- Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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17
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Factors Influencing Concordance of PD-L1 Expression between Biopsies and Cytological Specimens in Non-Small Cell Lung Cancer. Diagnostics (Basel) 2021; 11:diagnostics11101927. [PMID: 34679625 PMCID: PMC8534501 DOI: 10.3390/diagnostics11101927] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/07/2021] [Accepted: 10/16/2021] [Indexed: 02/06/2023] Open
Abstract
PD-L1 expression assessed by immunohistochemical staining is used for the selection of immunotherapy in non-small cell lung cancer (NSCLC). Appropriate validation of PD-L1 expression in cytology specimens is important as cytology is often the only diagnostic material in NSCLC. In a previous study comprising two different cohorts of paired biopsies and cytological specimens, we found a fairly good cyto-histological correlation of PD-L1 expression in one, whereas only a moderate correlation was found in the other cohort. Therefore, that cohort with additional new cases was now further investigated for the impact of preanalytical factors on PD-L1 concordance in paired biopsies and cytological specimens. A total of 100 formalin-fixed paraffin-embedded cell blocks from 19 pleural effusions (PE), 17 bronchial brushes (BB), and 64 bronchoalveolar lavage (BAL) and concurrent matched biopsies from 80 bronchial biopsies and 20 transthoracic core biopsies from NSCLC patients were stained using the PD-L1 28-8 assay. Using the cutoffs ≥1%, ≥5%, ≥10%, and ≥50% positive tumour cells, the overall agreement between histology and cytology was 77-85% (κ 0.51-0.70) depending on the applied cutoff value. The concordance was better for BALs (κ 0.53-0.81) and BBs (κ 0.55-0.85) than for PEs (κ -0.16-0.48), while no difference was seen for different types of biopsies or histological tumour type. A high number of tumour cells (>500) in biopsies was associated with better concordance at the ≥50% cutoff. In conclusion, the study results suggest that PEs may be less suitable for evaluation of PD-L1 due to limited cyto-histological concordance, while a high amount of tumour cells in biopsies may be favourable when regarding cyto-histological PD-L1 concordance.
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18
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Cordovilla R, López-Zubizarreta M, Velasco A, Álvarez A, Rodríguez M, Gómez A, Hernández-Mezquita MÁ, Iglesias M. The Value of a Systematic Protocol Using Endobronchial Ultrasound and Endoscopic Ultrasound in Staging of Lung Cancer for Patients with Imaging iN0–N1 Disease. Biomed Hub 2021; 6:92-101. [PMID: 34950670 PMCID: PMC8613614 DOI: 10.1159/000519034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/04/2021] [Indexed: 11/19/2022] Open
Abstract
<b><i>Introduction:</i></b> We hypothesize that systematic, combined, and multidisciplinary study of the mediastinum (endobronchial ultrasound [EBUS] and endoscopic ultrasound [EUS]) in patients with NSCLC with radiologically normal mediastinum improves the results of mediastinal staging obtained with EBUS alone. <b><i>Material and Methods:</i></b> A retrospective study of the prospective database collected on the patients with NSCLC with a radiologically normal mediastinum and an indication for systematic staging with EBUS and EUS. EBUS staging was followed by EUS in patients in which the results from the pathological analysis of EBUS were negative. <b><i>Results:</i></b> Forty-five patients were included in the analysis. The combination of EBUS followed by EUS provided better results than EBUS alone: sensitivity (S) 95% versus 80%, negative predictive value (NPV) 96.15% versus 86.21%, negative likelihood ratio 0.05 versus 0.20, and post-test probability 3.8% versus 13.8%. This represents an increase in S (15%), the validity index (6.6%), and NPV (9.9%) compared to EBUS alone. There were 4 false negatives (FNs) (8.8%) with the EBUS test alone. After adding EUS, 3 more cases were positive (6.6%) and only 1 FN (2.2%). <b><i>Conclusions:</i></b> In patients with NSCLC and a radiographically normal mediastinum, a systematic and combined staging with EBUS and EUS show higher sensitivity in the detection of mediastinal metastasis than with the use of EBUS alone. The high accuracy of the test means that the use of mediastinoscopy is not necessary to confirm the results in these patients. Since the availability of EUS is low, it may be advisable for the interventional pulmonologist to receive training in EUS-b.
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Affiliation(s)
- Rosa Cordovilla
- Interventional Pulmonology Unit, Pulmonary Department, Salamanca University Hospital, Salamanca, Spain
- *Rosa Cordovilla,
| | - Marco López-Zubizarreta
- Interventional Pulmonology Unit, Pulmonary Department, Salamanca University Hospital, Salamanca, Spain
| | - Antonio Velasco
- Gastroenterologist Department, Salamanca University Hospital, Salamanca, Spain
| | - Alberto Álvarez
- Gastroenterologist Department, Salamanca University Hospital, Salamanca, Spain
| | - Marta Rodríguez
- Cytopathology Unit, Pathology Department, Salamanca University Hospital, Salamanca, Spain
| | - Asunción Gómez
- Cytopathology Unit, Pathology Department, Salamanca University Hospital, Salamanca, Spain
| | | | - Miguel Iglesias
- Interventional Pulmonology Unit, Pulmonary Department, Salamanca University Hospital, Salamanca, Spain
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19
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Lozekoot PWJ, Daemen JHT, van den Broek RR, Maessen JG, Gronenschild MHM, Vissers YLJ, Hulsewé KWE, de Loos ER. Surgical mediastinal lymph node staging for non-small-cell lung carcinoma. Transl Lung Cancer Res 2021; 10:3645-3658. [PMID: 34584863 PMCID: PMC8435384 DOI: 10.21037/tlcr-21-364] [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] [Received: 05/01/2021] [Accepted: 06/30/2021] [Indexed: 12/25/2022]
Abstract
Background The current preferred approach for surgical mediastinal staging of non-small-cell lung carcinoma is video-assisted mediastinoscopy. An alternative technique in which lymph nodes are resected instead of biopsied is video-assisted mediastinoscopic lymphadenectomy (VAMLA) that is suggested to be superior in detecting N2 disease. Yet, evidence is conflicting and furthermore limited by sample size. The objective was to compare mediastinal staging through VAMLA and video-assisted mediastinoscopy. Methods A single-center cohort study was conducted. All consecutive patients that underwent surgical mediastinal staging of non-small-cell lung carcinoma by VAMLA (2011 to 2018) were compared to historic video-assisted mediastinoscopy controls (2007 to 2011). Patients with negative surgical mediastinal staging underwent subsequent anatomical resection with systematic regional lymphadenectomy. Primary outcome was the sensitivity and negative predictive value for detecting N2 disease. Results Two-hundred-sixty-nine video-assisted mediastinoscopic lymphadenectomies and 118 video-assisted mediastinoscopies were performed. The prevalence of N2 disease was 20% and 26% respectively in the VAMLA and video-assisted mediastinoscopy group, while the rate of unforeseen pN2 resulting from lymph node dissection during anatomical resection was 4% and 11%, respectively. Invasive staging using VAMLA demonstrated superior sensitivity of 0.82 and a negative predictive value of 0.96 when compared to video-assisted mediastinoscopy (0.62 and 0.89, respectively), offering a 64% decrease in risk of unforeseen pN2 following anatomical resection. However, VAMLA is also associated with a 75% risk increase on complications (P=0.36). Conclusions We conclude that performing invasive mediastinal lymph node assessment for staging of non-small-cell lung carcinoma, VAMLA should be the preferred technique with superior sensitivity and negative predictive value in detecting N2 disease. Though, VAMLA is also associated with an increased risk of complications.
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Affiliation(s)
- Pieter W J Lozekoot
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Jean H T Daemen
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands.,Faculty of Health, Medicine and Life Sciences (FHML), School for Oncology and Developmental Biology (GROW), Maastricht, The Netherlands
| | - Robert R van den Broek
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Faculty of Health, Medicine and Life Sciences (FHML), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | | | - Yvonne L J Vissers
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Karel W E Hulsewé
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Erik R de Loos
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
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20
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Diebels I, Hendriks JMH, Van Meerbeeck JP, Lauwers P, Janssens A, Yogeswaran SK, Van Schil PEY. Evaluation of mediastinoscopy in mediastinal lymph node staging for non-small-cell lung cancer. Interact Cardiovasc Thorac Surg 2021; 32:270-275. [PMID: 33257953 DOI: 10.1093/icvts/ivaa263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 08/12/2020] [Accepted: 09/17/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES The purpose of this study was to assess the quality of video-assisted cervical mediastinoscopy (VACM) in the staging of non-small-cell lung cancer (NSCLC) at the Antwerp University Hospital with a focus on test effectiveness indicators, morbidity and unforeseen pN2 results. METHODS All consecutive VACM workups of cases of NSCLC performed between January 2010 and December 2015 were included to assess overall test quality and effectiveness. Quality assurance was performed in accordance with the recommendations of the European Society of Gastrointestinal Endoscopy and European Society of Thoracic Surgeons (ESTS) where appropriate. RESULTS A total of 168 video-assisted cervical mediastinoscopies were included. A total of 91.7% of the procedures were performed in accordance with the ESTS guideline. An unforeseen pN2 staging was identified in 10 anatomical lung resections (8.6%). Statistical analysis showed no significant association between VACM performed in accordance with the ESTS guideline and the presence of pN2 positive lymph nodes [χ2 (1) = 0.61; P = 0.57] and no association between VACM performed in accordance with the ESTS guideline and overall futile thoracotomy [χ2 (1) = 0.76; P = 0.50]. Calculations revealed a sensitivity of 81.8 [95% confidence interval (CI) 69.1-90.9], specificity of 100%, positive predictive value of 100%, negative predictive value of 91.9% (95% CI 86.6-95.2) and diagnostic accuracy of 94.1% (95% CI 89.33-97.11). CONCLUSIONS Overall, 91.7% of the VACM were performed in accordance with the ESTS guideline. This process resulted in a sensitivity of 81.8%, a negative predictive value of 91.9% and an unforeseen pN2 rate of 8.6%.
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Affiliation(s)
- Ian Diebels
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Jeroen M H Hendriks
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Jan P Van Meerbeeck
- Department of Pulmonology and Thoracic Oncology, Antwerp University Hospital, Antwerp, Belgium
| | - Patrick Lauwers
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Annelies Janssens
- Department of Pulmonology and Thoracic Oncology, Antwerp University Hospital, Antwerp, Belgium
| | - Suresh K Yogeswaran
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Paul E Y Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium
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21
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Okubo Y, Matsumoto Y, Tanaka M, Imabayashi T, Uezono Y, Watanabe SI, Tsuchida T. Clinical validity of 25-gauge endobronchial ultrasound-guided transbronchial needle in lymph node staging of lung cancer. J Thorac Dis 2021; 13:3033-3041. [PMID: 34164194 PMCID: PMC8182540 DOI: 10.21037/jtd-20-3383] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Endobronchial ultrasound-guided transbronchial needle aspiration is recommended for lymph node (LN) staging in lung cancer. Although 22-gauge needles are widely used, they may make some stations difficult to puncture owing to an acute angle. A thinner 25-gauge needle was introduced in Japan at the end of 2016 and offered structural advantages such as improved flexibility and penetrability. We aimed to validate the clinical utility of the 25-gauge needle in LN staging. Methods Patients who underwent endobronchial ultrasound-guided transbronchial needle aspiration for LN staging of lung cancer using the 25-gauge needle at our institution between November 2016 and March 2019 were included. Patient characteristics, staging procedures, pathology findings, and genetic testing success rates were assessed. Results Data of 130 patients were included in the analysis. The sampling rate was 87.6% (589/672 lesions). In addition to stations #4R, #7, and #11, which are generally easy to puncture, multiple stations (40.1%) were sampled. The diagnostic accuracy of combined computed tomography and fluorodeoxyglucose positron emission tomography was 82.3% and that of additional endobronchial ultrasound-guided transbronchial needle aspiration was 96.9%. The overall sensitivity, specificity, and positive and negative predictive values validated using resected specimens were 97.1% (34/35), 100% (41/41), 100% (34/34), and 97.6% (41/42), respectively. The success rate of genetic testing was 100% (34/34). Conclusions The new 25-gauge needle enabled us to approach a wide range of LNs with a desirable sampling rate and diagnostic accuracy in LN staging using endobronchial ultrasound-guided transbronchial needle aspiration, while providing enough tissue for genetic testing.
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Affiliation(s)
- Yu Okubo
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tsukiji, Chuo-ku, Tokyo, Japan.,Department of Thoracic Surgery, National Cancer Center Hospital, Tsukiji, Chuo-ku, Tokyo, Japan.,Department of Comprehensive Oncology, Nagasaki University Graduate School of Biomedical Sciences, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Yuji Matsumoto
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tsukiji, Chuo-ku, Tokyo, Japan.,Department of Thoracic Oncology, National Cancer Center Hospital, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Midori Tanaka
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Tatsuya Imabayashi
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Yasuhito Uezono
- Department of Comprehensive Oncology, Nagasaki University Graduate School of Biomedical Sciences, Tsukiji, Chuo-ku, Tokyo, Japan.,Division of Cancer Pathophysiology, National Cancer Center Research Institute, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Shun-Ichi Watanabe
- Department of Thoracic Surgery, National Cancer Center Hospital, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Takaaki Tsuchida
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tsukiji, Chuo-ku, Tokyo, Japan
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22
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Rossi G, Petrone MC, Arcidiacono PG. A narrative review of the role of endoscopic ultrasound (EUS) in lung cancer staging. MEDIASTINUM (HONG KONG, CHINA) 2021; 5:1. [PMID: 35118307 PMCID: PMC8794446 DOI: 10.21037/med-20-51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/22/2020] [Indexed: 11/17/2022]
Abstract
Lung cancer is one of the most common solid malignant disease and an accurate staging is required for planning the most appropriate treatment. Surgery or local radiotherapy are the elective treatment for localized disease, however, the presence of mediastinal malignant lymph nodes can affect the role of surgery as a first-line therapy and a chemotherapy and/or radiotherapy treatment are recommended. Currently endoscopic ultrasound (EUS) in the mediastinum has brought the important advantage of a minimal-invasive diagnostic approach for the diagnosis and staging of malignant conditions, having the possibility of sampling lesions or lymph nodes in real-time. EUS' diagnostic capabilities have increased over time and currently it represents an excellent approach for the staging of lung cancer, especially combined to endobronchial ultrasound (EBUS). Last generation EUS equipments (echoendoscopes, ultrasound processors, needles) and tools [contrast-enhanced EUS (CH-EUS), elastography] can help the endosonographer during the ultrasound evaluation and they can increase the accuracy of lung cancer staging. A systematic method of evaluation of all the visible lymph nodes stations is fundamental to complete the lung cancer staging, as well as a correct endoscopic room organization of the equipments, healthcare personnel and devices.
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Affiliation(s)
- Gemma Rossi
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita Salute San Raffaele University, Milan, Italy
| | - Maria Chiara Petrone
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita Salute San Raffaele University, Milan, Italy
| | - Paolo Giorgio Arcidiacono
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita Salute San Raffaele University, Milan, Italy
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Quigley D, Nadarajan P, O Connell F. Transoesophageal endobronchial ultrasound-guided needle aspiration (EUS-B-NA) for poorly accessible thoracic lesions: a case series. BMJ Case Rep 2020; 13:13/12/e239170. [PMID: 33303510 DOI: 10.1136/bcr-2020-239170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Endobronchial ultrasound (EBUS) has long been a common diagnostic tool used in the diagnosis of pulmonary pathologies. In the last decade, increased interest has been shown in its usage via the oesophagus for sampling lesions inaccessible via the airways. We describe three cases in which we used this modality to biopsy lesions not visualised via conventional EBUS and which would be too risky to be attempted via a CT-guided biopsy with a high likelihood of complications. More focused education on using EBUS via the oesophagus for respiratory trainees could greatly improve overall clinical practice. It improves the diagnostic yield of lesions and prevents subsequent referral to gastrointestinal colleagues which may delay diagnosis especially during the COVID-19 pandemic as was the case in our patient cohort where services are already limited. EBUS, due to its smaller size, is less irritant to the upper airways and requires less sedation than endoscopic ultrasound (EUS) scopes. It is also shorter than an EUS scope improving manoeuvrability. Each of our cases resulted in early histological diagnosis and subsequent appropriate treatment.
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Affiliation(s)
- David Quigley
- Respiratory, St James's Hospital, Dublin, Leinster, Ireland
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Xu J, An Z, He Z, Lv W, Hu J. [Current Status and Development of Interventional Techniques for Pulmonary Diseases]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 23:436-439. [PMID: 32517446 PMCID: PMC7309538 DOI: 10.3779/j.issn.1009-3419.2020.102.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Bronchoscope is the core part of the interventional diagnosis and treatment technology for lung diseases, which has experienced more than 100 years of development history. It has gradually formed a diagnosis and treatment model of pulmonary diseases with cooperation of multi-clinical disciplines, deep integration of interventional minimally invasive techniques, and cross-integration of diversified diagnosis and treatment concepts. This article aimed to review the current status and development of interventional diagnosis and treatment techniques for lung diseases, and introduces the characteristics of the interventional treatment of our center.
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Affiliation(s)
- Jinming Xu
- Department of Thoracic Surgery, the First Affiliated Hospital of Zhejiang University, Zhejiang University School of Medicine,Hangzhou 310003, China
| | - Zhou An
- Department of Thoracic Surgery, the First Affiliated Hospital of Zhejiang University, Zhejiang University School of Medicine,Hangzhou 310003, China
| | - Zhehao He
- Department of Thoracic Surgery, the First Affiliated Hospital of Zhejiang University, Zhejiang University School of Medicine,Hangzhou 310003, China
| | - Wang Lv
- Department of Thoracic Surgery, the First Affiliated Hospital of Zhejiang University, Zhejiang University School of Medicine,Hangzhou 310003, China
| | - Jian Hu
- Department of Thoracic Surgery, the First Affiliated Hospital of Zhejiang University, Zhejiang University School of Medicine,Hangzhou 310003, China
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25
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Nessar R, Toennesen LL, Bodtger U, Christiansen IS, Clementsen PF. Endoscopic ultrasound-guided ascites aspiration in the hands of the chest physician using the EBUS endoscope in the oesophagus. Respir Med Case Rep 2020; 29:100998. [PMID: 31956479 PMCID: PMC6957818 DOI: 10.1016/j.rmcr.2020.100998] [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: 12/27/2019] [Revised: 01/03/2020] [Accepted: 01/05/2020] [Indexed: 12/25/2022] Open
Abstract
Background The use of the endobronchial ultrasound (EBUS) scope in the oesophagus, the so-called EUS-B procedure, for the diagnosis and staging of lung cancer is quickly gaining ground. Case presentation We here present a case demonstrating that EUS-B guided aspiration of intraperitoneal fluid (ascites) is possible. This has never been described before. The procedure was performed with the use of a 22 G needle in a 71 years old woman suspected of lung cancer. No complications were seen. Conclusion We hereby demonstrate that EUS-B fine needle aspiration from ascites fluid is feasible and appears to be safe.
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Affiliation(s)
- Rafi Nessar
- Department of Internal Medicine, Zealand University Hospital, Roskilde, 4000, Roskilde, Denmark
| | - Louise L Toennesen
- Department of Internal Medicine, Zealand University Hospital, Roskilde, 4000, Roskilde, Denmark.,Department of Pulmonary Medicine, Bispebjerg University Hospital, 2400, Copenhagen, Denmark
| | - Uffe Bodtger
- Department of Internal Medicine, Zealand University Hospital, Roskilde, 4000, Roskilde, Denmark.,Department of Respiratory Medicine, Naestved Hospital, 4700, Naestved, Denmark.,Institute for Regional Health Research, University of Southern Denmark, 5000, Odense, Denmark
| | | | - Paul Frost Clementsen
- Department of Internal Medicine, Zealand University Hospital, Roskilde, 4000, Roskilde, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, 2100, Copenhagen, University of Copenhagen and the Capital Region of Denmark, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark
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26
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D'Andrilli A, Maurizi G, Venuta F, Rendina EA. Mediastinal staging: when and how? Gen Thorac Cardiovasc Surg 2019; 68:725-732. [PMID: 31797211 DOI: 10.1007/s11748-019-01263-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 11/21/2019] [Indexed: 12/19/2022]
Abstract
Mediastinal staging for lung cancer includes both the assessment of mediastinal lymph nodes status before treatment and the postoperative pathological staging obtained by lymph-node removal performed during surgery. In patients with early stage NSCLC, the aim is to exclude with the highest certainty and the lowest morbidity the presence of mediastinal node involvement. Before treatment, mediastinal staging is based on imaging techniques, endoscopic techniques, and surgical procedures. Final pathological staging is based on lymph-node removal performed with lung resection according with different modalities (sampling, systematic dissection, etc.) and various approaches (thoracotomy, VATS, robotic). Data and indications from literature evidences are reported and discussed.
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Affiliation(s)
- Antonio D'Andrilli
- Department of Thoracic Surgery, Sapienza University, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189, Rome, Italy.
| | - Giulio Maurizi
- Department of Thoracic Surgery, Sapienza University, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189, Rome, Italy
| | - Federico Venuta
- Department of Thoracic Surgery, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Erino A Rendina
- Department of Thoracic Surgery, Sapienza University, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189, Rome, Italy
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27
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Southwood M, Krenz T, Cant N, Maurya M, Gazdova J, Maxwell P, McGready C, Moseley E, Hughes S, Stewart P, Salto-Tellez M, Groelz D, Rassl D. Systematic evaluation of PAXgene® tissue fixation for the histopathological and molecular study of lung cancer. JOURNAL OF PATHOLOGY CLINICAL RESEARCH 2019; 6:40-54. [PMID: 31571426 PMCID: PMC6966705 DOI: 10.1002/cjp2.145] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/04/2019] [Accepted: 09/13/2019] [Indexed: 12/25/2022]
Abstract
Whilst adequate for most existing pathological tests, formalin is generally considered a poor DNA preservative and use of alternative fixatives may prove advantageous for molecular testing of tumour material; an increasingly common approach to identify targetable driver mutations in lung cancer patients. We collected paired PAXgene® tissue-fixed and formalin-fixed samples of block-sized tumour and lung parenchyma, Temno-needle core tumour biopsies and fine needle tumour aspirates (FNAs) from non-small cell lung cancer resection specimens. Traditionally processed formalin fixed paraffin wax embedded (FFPE) samples were compared to paired PAXgene® tissue fixed paraffin-embedded (PFPE) samples. We evaluated suitability for common laboratory tests (H&E staining and immunohistochemistry) and performance for downstream molecular investigations relevant to lung cancer, including RT-PCR and next generation DNA sequencing (NGS). Adequate and comparable H&E staining was seen in all sample types and nuclear staining was preferable in PAXgene® fixed Temno tumour biopsies and tumour FNA samples. Immunohistochemical staining was broadly comparable. PFPE samples enabled greater yields of less-fragmented DNA than FFPE comparators. PFPE samples were also superior for PCR and NGS performance, both in terms of quality control metrics and for variant calling. Critically we identified a greater number of genetic variants in the epidermal growth factor receptor gene when using PFPE samples and the Ingenuity® Variant Analysis pipeline. In summary, PFPE samples are adequate for histopathological diagnosis and suitable for the majority of existing laboratory tests. PAXgene® fixation is superior for DNA and RNA integrity, particularly in low-yield samples and facilitates improved NGS performance, including the detection of actionable lung cancer mutations for precision medicine in lung cancer samples.
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Affiliation(s)
- Mark Southwood
- Pathology Research, Royal Papworth Hospital NHS Foundation Trust, University of Cambridge Clinical School of Medicine, Cambridge, UK
| | - Tomasz Krenz
- Sample Technologies Department, QIAGEN GmbH, Hilden, Germany
| | - Natasha Cant
- Sample Technologies Department, QIAGEN Ltd., Manchester, UK
| | - Manisha Maurya
- Northern Ireland Molecular Pathology Laboratory, Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK
| | - Jana Gazdova
- Northern Ireland Molecular Pathology Laboratory, Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK
| | - Perry Maxwell
- Northern Ireland Molecular Pathology Laboratory, Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK
| | - Claire McGready
- Northern Ireland Molecular Pathology Laboratory, Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK
| | - Ellen Moseley
- Pathology Research, Royal Papworth Hospital NHS Foundation Trust, University of Cambridge Clinical School of Medicine, Cambridge, UK
| | - Susan Hughes
- Northern Ireland Molecular Pathology Laboratory, Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK
| | - Peter Stewart
- Northern Ireland Molecular Pathology Laboratory, Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK
| | - Manuel Salto-Tellez
- Northern Ireland Molecular Pathology Laboratory, Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK
| | - Daniel Groelz
- Sample Technologies Department, QIAGEN GmbH, Hilden, Germany
| | - Doris Rassl
- Pathology Research, Royal Papworth Hospital NHS Foundation Trust, University of Cambridge Clinical School of Medicine, Cambridge, UK
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Costa ADS, Palomino ALM, Suzuki I, Scordamaglio PR, Gregorio MG, Jacomelli M. Endobronchial ultrasound: a minimally invasive technology to assist diagnosis of thoracic diseases. EINSTEIN-SAO PAULO 2019; 17:eMD4921. [PMID: 31508658 PMCID: PMC6718194 DOI: 10.31744/einstein_journal/2019md4921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 05/30/2019] [Indexed: 12/25/2022] Open
Abstract
The endobronchial ultrasound is a minimally invasive technique that simultaneously associates ultrasound and bronchoscopy, to visualize lung nodule or masses, airway wall, and structures adjacent to the tracheobronchial tree. Endobronchial ultrasound has been incorporated into clinical practice all over the world because of its low risk and high diagnostic yield in neoplastic and non-neoplastic disease.
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Affiliation(s)
| | | | - Iunis Suzuki
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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29
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Jiang L, Huang W, Liu J, Harris K, Yarmus L, Shao W, Chen H, Liang W, He J. Endosonography with lymph node sampling for restaging the mediastinum in lung cancer: A systematic review and pooled data analysis. J Thorac Cardiovasc Surg 2019; 159:1099-1108.e5. [PMID: 31590952 DOI: 10.1016/j.jtcvs.2019.07.095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 07/17/2019] [Accepted: 07/17/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Mediastinal restaging after induction treatment is still a difficult and controversial issue. We aimed to investigate the diagnostic accuracy of endobronchial ultrasound-guided transbronchial needle aspiration and endoscopic ultrasound-guided fine-needle aspiration for restaging the mediastinum after induction treatment in patients with lung cancer. METHODS Embase and PubMed databases were searched from conception to March 2019. Data from relevant studies were analyzed to assess sensitivity and specificity of endobronchial ultrasound-guided transbronchial needle aspiration and endoscopic ultrasound-guided fine-needle aspiration, and to fit the hierarchical summary receiver operating characteristic curves. RESULTS A total of 10 studies consisting of 558 patients fulfilled the inclusion criteria. All patients were restaged by endobronchial ultrasound-guided transbronchial needle aspiration, endoscopic ultrasound-guided fine-needle aspiration, or both. Negative results were confirmed by subsequent surgical approaches. There were no complications reported during any endosonography approaches reviewed. The pooled sensitivities of endobronchial ultrasound-guided transbronchial needle aspiration and endoscopic ultrasound-guided fine-needle aspiration were 65% (95% confidence interval [CI], 52-76) and 73% (95% CI, 52-87), respectively, and specificities were 99% (95% CI, 78-100) and 99% (95% CI, 90-100), respectively. The area under the hierarchical summary receiver operating characteristic curves were 0.85 (95% CI, 0.81-0.88) for endobronchial ultrasound-guided transbronchial needle aspiration and 0.99 (95% CI, 0.98-1) for endoscopic ultrasound-guided fine-needle aspiration. Moreover, for patients who received chemotherapy alone, the pooled sensitivity of endosonography with lymph node sampling for restaging was 66% (95% CI, 56-75), and specificity was 100% (95% CI, 34-100); for patients who received chemoradiotherapy, the results seemed similar with a sensitivity of 77% (95% CI, 47-92) and specificity of 99% (95% CI, 48-100). CONCLUSIONS Endosonography with lymph node sampling is an accurate and safe technique for mediastinal restaging of lung cancer.
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Affiliation(s)
- Long Jiang
- Department of Thoracic Surgery/Oncology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou, China
| | - Weizhe Huang
- Department of Thoracic Surgery, the First Affiliated Hospital, Medical College of Shantou University, Shantou, Guangdong, China
| | - Jun Liu
- Department of Thoracic Surgery/Oncology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou, China
| | - Kassem Harris
- Interventional Pulmonology Section, Pulmonary Critical Care Division, Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Lonny Yarmus
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Md
| | - Wenlong Shao
- Department of Thoracic Surgery/Oncology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou, China
| | - Hanzhang Chen
- Department of Thoracic Surgery/Oncology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou, China
| | - Wenhua Liang
- Department of Thoracic Surgery/Oncology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou, China
| | - Jianxing He
- Department of Thoracic Surgery/Oncology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou, China.
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30
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New Era of Endoscopic Ultrasound-Guided Tissue Acquisition: Next-Generation Sequencing by Endoscopic Ultrasound-Guided Sampling for Pancreatic Cancer. J Clin Med 2019; 8:jcm8081173. [PMID: 31387310 PMCID: PMC6723875 DOI: 10.3390/jcm8081173] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 07/20/2019] [Accepted: 08/02/2019] [Indexed: 12/14/2022] Open
Abstract
Pancreatic cancer is a lethal cancer with an increasing incidence. Despite improvements in chemotherapy, patients with pancreatic cancer continue to face poor prognoses. Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is the primary method for obtaining tissue samples of pancreatic cancer. Due to advancements in next-generation sequencing (NGS) technologies, multiple parallel sequencing can be applied to EUS-TA samples. Genomic biomarkers for therapeutic stratification in pancreatic cancer are still lacking, however, NGS can unveil potential predictive genomic biomarkers of treatment response. Thus, the importance of NGS using EUS-TA samples is becoming recognized. In this review, we discuss the recent advances in EUS-TA application for NGS of pancreatic cancer.
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31
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Sakairi Y, Nakajima T, Yoshino I. Role of endobronchial ultrasound-guided transbronchial needle aspiration in lung cancer management. Expert Rev Respir Med 2019; 13:863-870. [DOI: 10.1080/17476348.2019.1646642] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Yuichi Sakairi
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takahiro Nakajima
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
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Candoli P, Ceron L, Trisolini R, Romagnoli M, Michieletto L, Scarlata S, Galasso T, Leoncini F, Pasini V, Dennetta D, Marchesani F, Zotti M, Corbetta L. Competence in endosonographic techniques. Panminerva Med 2019; 61:249-279. [DOI: 10.23736/s0031-0808.18.03570-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Fielding D, Kurimoto N. Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Diagnosis and Staging of Lung Cancer. Clin Chest Med 2019; 39:111-123. [PMID: 29433708 DOI: 10.1016/j.ccm.2017.11.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS TBNA) is fundamental to the diagnosis of lung cancer, as many patients present with more advanced stages of lung cancer, with enlarged hilar and mediastinal lymph nodes. It also represents a way to sample pulmonary masses directly to make the diagnosis, whereby no other accessible tissue is present and the mass sits adjacent to a large central airway. Very importantly also, EBUS TBNA is the widely accepted first procedure in lung cancer staging. A combined procedure of EUS TBNA can be performed to improve diagnostic accuracy.
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Affiliation(s)
- David Fielding
- Department of Thoracic Medicine, Royal Brisbane and Womens Hospital, Third Floor, James Mayne Building, Butterfield Street, Herston 4029, Australia.
| | - Noriaki Kurimoto
- Division of Medical Oncology and Respiratory Medicine, Shimane University Hospital, 89-1, Enyacho, Izumo, Shimane 693-8501, Japan
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34
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Combined Endosonography Reduces Time to Diagnose Pulmonary Coccidioidomycosis. J Bronchology Interv Pulmonol 2018; 25:152-155. [PMID: 29346251 DOI: 10.1097/lbr.0000000000000454] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Coccidioidomycosis causes significant morbidity in endemic areas. In the absence of sensitive diagnostic serologic testing, clinicians have increasingly relied on lung and lymph node biopsies for diagnosis. Recently, endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) has been shown to be an excellent sampling method for the diagnosis and staging of lung cancers, especially when combined with endoscopic ultrasound guided fine needle aspiration (EUS-FNA). We present 13 consecutive cases where EBUS-TBNA and/or EUS-FNA of pulmonary lymph nodes were performed as part of the workup for pulmonary coccidioidomycosis. EBUS-TBNA+EUS-FNA led to diagnosis in all nine cases in which they were performed concurrently, and in the remaining 4 in which either was performed individually. BAL was performed in all cases with positive results in 5 (38%). The mean time to diagnose by EBUS/EUS (1.6 d) was significantly shorter than by bronchoalveolar lavage (6.3 d) (P=0.003). The findings indicate that combined EBUS-TBNA+EUS-FNA for lymph node biopsy facilitates early and accurate diagnosis of pulmonary coccidioidomycosis.
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Kirchner J, Sawicki LM, Nensa F, Schaarschmidt BM, Reis H, Ingenwerth M, Bogner S, Aigner C, Buchbender C, Umutlu L, Antoch G, Herrmann K, Heusch P. Prospective comparison of 18F-FDG PET/MRI and 18F-FDG PET/CT for thoracic staging of non-small cell lung cancer. Eur J Nucl Med Mol Imaging 2018; 46:437-445. [PMID: 30074073 DOI: 10.1007/s00259-018-4109-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/23/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To compare the diagnostic performance of 18F-FDG PET/MRI and 18F-FDG PET/CT for primary and locoregional lymph node staging in non-small cell lung cancer (NSCLC). METHODS In this prospective study, a total of 84 patients (51 men, 33 women, mean age 62.5 ± 9.1 years) with histopathologically confirmed NSCLC underwent 18F-FDG PET/CT followed by 18F-FDG PET/MRI in a single injection protocol. Two readers independently assessed T and N staging in separate sessions according to the seventh edition of the American Joint Committee on Cancer staging manual for 18F-FDG PET/CT and 18F-FDG PET/MRI, respectively. Histopathology as a reference standard was available for N staging in all 84 patients and for T staging in 39 patients. Differences in staging accuracy were assessed by McNemars chi2 test. The maximum standardized uptake value (SUVmax) and longitudinal diameters of primary tumors were correlated using Pearson's coefficients. RESULTS T stage was categorized concordantly in 18F-FDG PET/MRI and 18F-FDG PET/CT in 38 of 39 (97.4%) patients. Herein, 18F-FDG PET/CT and 18F-FDG PET/MRI correctly determined the T stage in 92.3 and 89.7% of patients, respectively. N stage was categorized concordantly in 83 of 84 patients (98.8%). 18F-FDG PET/CT correctly determined the N stage in 78 of 84 patients (92.9%), while 18F-FDG PET/MRI correctly determined the N stage in 77 of 84 patients (91.7%). Differences between 18F-FDG PET/CT and 18F-FDG PET/MRI in T and N staging accuracy were not statistically significant (p > 0.5, each). Tumor size and SUVmax measurements derived from both imaging modalities exhibited excellent correlation (r = 0.963 and r = 0.901, respectively). CONCLUSION 18F-FDG PET/MRI and 18F-FDG PET/CT show an equivalently high diagnostic performance for T and N staging in patients suffering from NSCLC.
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Affiliation(s)
- Julian Kirchner
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Moorenstrasse 5, D-40225, Dusseldorf, Germany.
| | - Lino M Sawicki
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Moorenstrasse 5, D-40225, Dusseldorf, Germany
| | - Felix Nensa
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147, Essen, Germany
| | - Benedikt M Schaarschmidt
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Moorenstrasse 5, D-40225, Dusseldorf, Germany
| | - Henning Reis
- Institute of Pathology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK) Essen, D-45147, Essen, Germany
| | - Marc Ingenwerth
- Institute of Pathology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK) Essen, D-45147, Essen, Germany
| | - Simon Bogner
- Department of Medical Oncology, University Hospital Essen, West German Cancer Center, University of Duisburg-Essen, D-45122, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery and Surgical Endoscopy, University Hospital Essen, Ruhrlandklinik, University of Duisburg-Essen, D-45147, Essen, Germany
| | - Christian Buchbender
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Moorenstrasse 5, D-40225, Dusseldorf, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147, Essen, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Moorenstrasse 5, D-40225, Dusseldorf, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, D-45147, Essen, Germany
| | - Philipp Heusch
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Moorenstrasse 5, D-40225, Dusseldorf, Germany
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Santos RSD, Jacomelli M, Franceschini JP, Suzuki I, Costa ADS, Shiang C, Palomino ALM. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in diagnosis of mediastinal lesions. ACTA ACUST UNITED AC 2018; 16:eAO4094. [PMID: 29768518 PMCID: PMC5998941 DOI: 10.1590/s1679-45082018ao4094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 09/19/2017] [Indexed: 12/25/2022]
Abstract
Objective To describe the results of endobronchial ultrasound-guided transbronchial needle aspiration in making diagnosis of mediastinal injuries associated to different causes. Methods A retrospective cross-sectional study of patients submitted to Endobronchial ultrasound-guided transbronchial needle aspiration at a private organization, between June 2013 and October 2016. All cases referred for collection of lymph nodes or peritracheal/peribronchial masses by endobronchial ultrasound-guided transbronchial needle aspiration, and evaluated through tomography or PET-CT were included. Interventional pulmonologists and thoracic surgeons with experience in the method did the procedures. Rapid on-site evaluation of fine needle aspiration was performed by an experienced pathologist. Material analysis included cytological smear and cytopathological analysis of paraffin-embedded cell blocks. Other specific analyses (immunocytochemistry, tests and cultures of infectious agents) were performed whenever necessary. Results We included 72 patients; 6 were excluded for presenting endobronchial lesions in which bronchoscopic biopsy could be performed, or intrathoracic lesions that were not accessible by endobronchial ultrasound-guided transbronchial needle aspiration. The mean age of 66 patients included for analysis was 61.17 years (±14.67 years), with a predominance of males (64%). Endobronchial ultrasound-guided transbronchial needle aspiration was definitive for diagnosis in 60 cases (91%). Three cases (4.5%) had inconclusive test results. There were no major complications related to the procedure. Conclusion Endobronchial ultrasound-guided transbronchial needle aspiration had a high diagnosis yield, with minimal morbidity, being an excellent option for diagnostic approach of patients with lymphadenopathy or intrathoracic lesions, and for neoplasm staging.
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Affiliation(s)
| | - Marcia Jacomelli
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.,Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Iunis Suzuki
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Altair da Silva Costa
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.,Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Ma H, An Z, Xia P, Cao J, Gao Q, Ren G, Xue X, Wang X, He Z, Hu J. Semi-quantitative Analysis of EBUS Elastography as a Feasible Approach in Diagnosing Mediastinal and Hilar Lymph Nodes of Lung Cancer Patients. Sci Rep 2018; 8:3571. [PMID: 29476168 PMCID: PMC5824841 DOI: 10.1038/s41598-018-22006-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 02/12/2018] [Indexed: 12/25/2022] Open
Abstract
This study aimed to semi-quantitatively evaluate the elastographic imaging color distribution of mediastinal and hilar lymph nodes (LNs), and explored its utility in helping define malignant and benign LNs for lung cancer patients. We prospectively collected patients who underwent preoperative mediastinal staging of suspected lung cancer by EBUS-TBNA. We analyzed the elastography color distribution of each LN and calculated the blue color proportion (BCP). The LN elastographic patterns were compared with the final EBUS-TBNA pathological results. A receiver operating characteristic (ROC) curve was constructed to evaluate the diagnostic value of BCP. We sampled and analyzed 79 LNs from 60 patients. The average BCP in malignant LNs was remarkably higher than that in benign LNs (57.1% versus 30.8%, P < 0.001). The area under the ROC curve (AUC) for the BCP was 0.86 (95% CI: 0.78–0.94). The best cutoff BCP for differentiating between benign and malignant LNs was determined as 36.7%. All the 16 LNs (20.3%) with a BCP lower than 27.9% were diagnosed as benign tissues. Our study suggests that elastography is a feasible technique that may safely help to predict LN metastasis during EBUS-TBNA. We found a clear BCP cutoff value to help define positive and negative LNs.
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Affiliation(s)
- Honghai Ma
- Department of Thoracic Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Zhou An
- Department of Thoracic Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Pinghui Xia
- Department of Thoracic Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Jinlin Cao
- Department of Thoracic Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Qiqi Gao
- Department of Pathology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Guoping Ren
- Department of Pathology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Xing Xue
- Department of Radiology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Xianhua Wang
- Department of Operation, Hangzhou Chinese Traditional Medicine Hospital, Hangzhou, 310003, China
| | - Zhehao He
- Department of Thoracic Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Jian Hu
- Department of Thoracic Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China.
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Apurva A, Tandon SP, Shetmahajan M, Jiwnani SS, Karimundackal G, Pramesh CS. Surgery for lung cancer—the Indian scenario. Indian J Thorac Cardiovasc Surg 2018. [DOI: 10.1007/s12055-017-0634-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Bugalho A, de Santis M, Slubowski A, Rozman A, Eberhardt R. Trans-esophageal endobronchial ultrasound-guided needle aspiration (EUS-B-NA): A road map for the chest physician. Pulmonology 2017; 24:32-41. [PMID: 29242047 DOI: 10.1016/j.rppnen.2017.10.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/15/2017] [Indexed: 12/25/2022] Open
Abstract
The endobronchial ultrasound (EBUS) scope has been increasingly used in the gastrointestinal tract (EUS-B). Scientific data proves its efficacy and safety to provide a complete lung cancer staging, when combined with EBUS-TBNA, and in the diagnosis of para-esophageal lesions. There are multiple barriers to start performing EUS-B but probably the most important ones are related to knowledge and training, so new operators should follow a structured training curriculum. This review aims to reflect the best current knowledge regarding EUS-B and provide a road map to assist those who are incorporating the technique into their clinical practice.
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Affiliation(s)
- A Bugalho
- Pulmonology Unit, CUF Infante Santo Hospital, CUF Descobertas Hospital, Instituto CUF Oncologia (I.C.O.), Portugal; Chronic Diseases Research Center (CEDOC), NOVA Medical School, Lisbon, Portugal.
| | - M de Santis
- Serviço de Pneumologia, Instituto Português de Oncologia (IPO), Coimbra, Portugal.
| | - A Slubowski
- Endoscopy Unit, John Paul II Hospital, Krakow and Endoscopy Unit, Pulmonary Hospital Zakopane, Poland.
| | - A Rozman
- University Clinic of Pulmonary and Allergic Diseases Golnik, Slovenia.
| | - R Eberhardt
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRCH), German Center for Lung Research (DZL), Heidelberg, Germany.
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40
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Wimaleswaran H, Farmer MW, Irving LB, Jennings BR, Steinfort DP. Pulmonologist-performed transoesophageal sampling for lung cancer staging using an endobronchial ultrasound video-bronchoscope: an Australian experience. Intern Med J 2017; 47:205-210. [PMID: 27860078 DOI: 10.1111/imj.13330] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 10/16/2016] [Accepted: 11/03/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Transoesophageal endobronchial ultrasound (EBUS) video-bronchoscope insertion provides pulmonologists access to conduct endoscopic fine-needle aspiration (EUS-B-FNA) of mediastinal lymph node (LN) lesions and also assist in lung cancer staging by sampling left adrenal gland (LAG) lesions. Limited literature has described additional diagnostic value whilst maintaining patient safety. To elicit whether combining endoscopic transoesophageal fine-needle aspiration using convex probe bronchoscope (EUS-B-FNA) and EBUS bronchoscopy enhances the diagnostic yield of mediastinal nodal staging in lung cancer, whilst maintaining safety. METHODS All eligible patients with paraoesophageal lesions on thoracic computed tomography (CT) underwent pulmonologist-performed EUS-B-FNA at two tertiary centres and were included in this prospective observational cohort study. RESULTS EUS-B-FNA sampling was performed at 69 mediastinal LN lesion sites, including 17 sites inaccessible to bronchoscopic sampling. Four LAG lesions were sampled via EUS-B-FNA. There were no complications. EBUS-TBNA was augmented by EUS-B-FNA because of accessibility of sampling lesions otherwise unamenable bronchoscopically, thereby increasing diagnostic utility. Diagnostic sensitivity of EUS-B-FNA for malignancy in mediastinal LN lesions was 88% (51 of 58). For mediastinal LN lesions not amenable to EBUS-TBNA, the sensitivity for diagnosis of malignancy via EUS-B-FNA was 88% (15 of 17). Diagnostic sensitivity of EUS-B-FNA for malignancy in LAG lesions was 50% (2 of 4). CONCLUSION EUS-B-FNA is a precise and safe approach in the evaluation and staging of lung cancer when performed by a pulmonologist. It complements and increases the diagnostic utility of EBUS-TBNA by further coverage of mediastinal LN stations and access to LAG lesions.
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Affiliation(s)
- Hari Wimaleswaran
- Deparment of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Michael W Farmer
- Department of Respiratory and Sleep Medicine, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Louis B Irving
- Deparment of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Barton R Jennings
- Department of Respiratory and Sleep Medicine, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Daniel P Steinfort
- Deparment of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
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41
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Fiorelli A, Raucci A, Cascone R, Reginelli A, Di Natale D, Santoriello C, Capuozzo A, Grassi R, Serra N, Polverino M, Santini M. Three-dimensional virtual bronchoscopy using a tablet computer to guide real-time transbronchial needle aspiration. Interact Cardiovasc Thorac Surg 2017; 24:567-575. [PMID: 28040772 DOI: 10.1093/icvts/ivw404] [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: 06/29/2016] [Accepted: 10/10/2016] [Indexed: 12/20/2022] Open
Abstract
Objectives We proposed a new virtual bronchoscopy tool to improve the accuracy of traditional transbronchial needle aspiration for mediastinal staging. Methods Chest-computed tomographic images (1 mm thickness) were reconstructed with Osirix software to produce a virtual bronchoscopic simulation. The target adenopathy was identified by measuring its distance from the carina on multiplanar reconstruction images. The static images were uploaded in iMovie Software, which produced a virtual bronchoscopic movie from the images; the movie was then transferred to a tablet computer to provide real-time guidance during a biopsy. To test the validity of our tool, we divided all consecutive patients undergoing transbronchial needle aspiration retrospectively in two groups based on whether the biopsy was guided by virtual bronchoscopy (virtual bronchoscopy group) or not (traditional group). The intergroup diagnostic yields were statistically compared. Results Our analysis included 53 patients in the traditional and 53 in the virtual bronchoscopy group. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy for the traditional group were 66.6%, 100%, 100%, 10.53% and 67.92%, respectively, and for the virtual bronchoscopy group were 84.31%, 100%, 100%, 20% and 84.91%, respectively. The sensitivity ( P = 0.011) and diagnostic accuracy ( P = 0.011) of sampling the paratracheal station were better for the virtual bronchoscopy group than for the traditional group; no significant differences were found for the subcarinal lymph node. Conclusions Our tool is simple, economic and available in all centres. It guided in real time the needle insertion, thereby improving the accuracy of traditional transbronchial needle aspiration, especially when target lesions are located in a difficult site like the paratracheal station.
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Affiliation(s)
- Alfonso Fiorelli
- Thoracic Surgery Unit, Seconda Università degli Studi di Napoli, Naples, Italy
| | - Antonio Raucci
- Department of Radiology, Seconda Università degli Studi di Napoli, Naples, Italy
| | - Roberto Cascone
- Thoracic Surgery Unit, Seconda Università degli Studi di Napoli, Naples, Italy
| | - Alfonso Reginelli
- Department of Radiology, Seconda Università degli Studi di Napoli, Naples, Italy
| | - Davide Di Natale
- Thoracic Surgery Unit, Seconda Università degli Studi di Napoli, Naples, Italy
| | - Carlo Santoriello
- Department of Pneumology and Endoscopic Unit, Ospedale Scarlato, Scafati, Italy
| | - Antonio Capuozzo
- Department of Pneumology and Endoscopic Unit, Ospedale Scarlato, Scafati, Italy
| | - Roberto Grassi
- Department of Radiology, Seconda Università degli Studi di Napoli, Naples, Italy
| | - Nicola Serra
- Department of Radiology, Seconda Università degli Studi di Napoli, Naples, Italy
| | - Mario Polverino
- Department of Pneumology and Endoscopic Unit, Ospedale Scarlato, Scafati, Italy
| | - Mario Santini
- Thoracic Surgery Unit, Seconda Università degli Studi di Napoli, Naples, Italy
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Naur TMH, Konge L, Nayahangan LJ, Clementsen PF. Training and certification in endobronchial ultrasound-guided transbronchial needle aspiration. J Thorac Dis 2017; 9:2118-2123. [PMID: 28840013 DOI: 10.21037/jtd.2017.06.89] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) plays a key role in the staging of lung cancer, which is crucial for allocation to surgical treatment. EBUS-TBNA is a complicated procedure and simulation-based training is helpful in the first part of the long learning curve prior to performing the procedure on actual patients. New trainees should follow a structured training programme consisting of training on simulators to proficiency as assessed with a validated test followed by supervised practice on patients. The simulation-based training is superior to the traditional apprenticeship model and is recommended in the newest guidelines. EBUS-TBNA and oesophageal ultrasound-guided fine needle aspiration (EUS-FNA or EUS-B-FNA) are complementary to each other and the combined techniques are superior to either technique alone. It is logical to learn and to perform the two techniques in combination, however, for lung cancer staging solely EBUS-TBNA simulators exist, but hopefully in the future simulation-based training in EUS will be possible.
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Affiliation(s)
- Therese Maria Henriette Naur
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Paul Frost Clementsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark.,Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
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Fiorelli A, Santoriello C, Di Natale D, Cascone R, Musella V, Mastromarino R, Serra N, Vicidomini G, Polverino M, Santini M. In the era of ultrasound technology, could conventional trans-bronchial needle aspiration still play a role in lung cancer mediastinal staging? J Thorac Dis 2017; 9:S386-S394. [PMID: 28603650 DOI: 10.21037/jtd.2017.04.13] [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] [Indexed: 12/25/2022]
Abstract
BACKGROUND To evaluate the feasibility of a combined strategy including conventional-trans-bronchial needle aspiration biopsy (C-TBNA) and endobronchial ultrasounds transbronchial needle aspiration (EBUS-TBNA) for sampling mediastinal adenopathies in patients with lung cancer in order to determinate whether in the era of ultrasound technology C-TBNA could still play a role in mediastinal staging. METHODS It was a retrospective multicenter study including all consecutive patients with lung cancer and radiological mediastinal adenopathies undergoing TBNA for mediastinal staging (January 2014 - July 2016). C-TBNA was performed as first diagnostic procedure. All negative C-TBNA results were corroborated by EBUS-TBNA, and, if EBUS-TBNA was negative, by mediastinoscopy or surgery. The diagnostic yield of C-TBNA were then calculated. RESULTS A total of 175 patients were included in the study for a total of 197 mediastinal adenopathies sampled. C-TBNA was positive in 125 cases and negative in 72 cases who underwent EBUS-TBNA. It was positive in 58 cases and negative in 14 patients. After surgical exploration (n=12) and mediastinoscopy (n=2), 11 patients did not present metastases (true negative) while 3 presented mediastinal involvement (false negative). Thus, C-TBNA had a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of 67.2%, 100%, 100%, 15.3% and 69.0%, respectively. The sensitivity increased for sampling paratracheal versus subcarinal stations (80% versus 49%; P<0.001); and large adenopathies (≥15 mm) versus small adenopathies (<15 mm) (83% versus 43%; P<0.001). In all re-staging patients (n=4), Conventional-TBNA results were false negative. CONCLUSIONS The combined use of C-TBNA and EBUS-TBNA as the most cost-effective strategy in the setting of mediastinal staging. C-TBNA performed before EBUS-TBNA is indicated for sampling large mediastinal adenopathies near to carina while EBUS-TBNA remains the first choice for puncturing small adenopathies far from carina and for re-staging after induction therapy.
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Affiliation(s)
- Alfonso Fiorelli
- Thoracic Surgery Unit, Seconda Università degli Studi di Napoli, Naples, Italy
| | - Carlo Santoriello
- Department of Pneumology and Endoscopic Unit, Ospedale Scarlato, Scafati, Italy
| | - Davide Di Natale
- Thoracic Surgery Unit, Seconda Università degli Studi di Napoli, Naples, Italy
| | - Roberto Cascone
- Thoracic Surgery Unit, Seconda Università degli Studi di Napoli, Naples, Italy
| | - Valentina Musella
- Thoracic Surgery Unit, Seconda Università degli Studi di Napoli, Naples, Italy
| | | | - Nicola Serra
- Department of Radiology, Seconda Università degli Studi di Napoli, Naples, Italy
| | - Giovanni Vicidomini
- Thoracic Surgery Unit, Seconda Università degli Studi di Napoli, Naples, Italy
| | - Mario Polverino
- Department of Radiology, Seconda Università degli Studi di Napoli, Naples, Italy
| | - Mario Santini
- Thoracic Surgery Unit, Seconda Università degli Studi di Napoli, Naples, Italy
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Sehgal IS, Dhooria S, Aggarwal AN, Behera D, Agarwal R. Endosonography Versus Mediastinoscopy in Mediastinal Staging of Lung Cancer: Systematic Review and Meta-Analysis. Ann Thorac Surg 2017; 102:1747-1755. [PMID: 27637288 DOI: 10.1016/j.athoracsur.2016.05.110] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 05/18/2016] [Accepted: 05/23/2016] [Indexed: 12/25/2022]
Abstract
Whether endosonography can replace mediastinoscopy as the initial procedure for mediastinal staging of non-small cell lung cancer remains controversial. Herein, we perform a systematic review of randomized controlled trials and observational studies (both procedures performed in same subjects) comparing the two procedures. Nine studies (960 subjects) were identified. The pooled risk-difference of the sensitivity of endosonography versus mediastinoscopy in observational studies and randomized controlled trials was 0.11 (95% confidence interval, -0.07 to 0.29) and 0.11 (95% confidence interval, -0.03 to 0.25), respectively suggesting equivalence of the two procedures. The complication rate was significantly lower with endosonographic procedures. Endoscopic ultrasound-guided fine needle aspiration/endobronchial ultrasound-guided transbronchial needle aspiration was found to have similar yield but lower complication rate compared to mediastinoscopy in the initial mediastinal staging of non-small cell lung cancer.
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Affiliation(s)
- Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashutosh Nath Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Digambar Behera
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Belanger AR, Akulian JA. An update on the role of advanced diagnostic bronchoscopy in the evaluation and staging of lung cancer. Ther Adv Respir Dis 2017; 11:211-221. [PMID: 28470104 PMCID: PMC5933547 DOI: 10.1177/1753465817695981] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Lung cancer remains a common and deadly disease. Many modalities are available to
the bronchoscopist to evaluate and stage lung cancer. We review the role of
bronchoscopy in the staging of the mediastinum with convex endobronchial
ultrasound (EBUS) and discuss emerging role of esophageal ultrasonography as a
complementary modality. In addition, we discuss advances in scope technology and
elastography. We review the bronchoscopic methods available for the diagnosis of peripheral
lung nodules including radial EBUS and navigational bronchoscopy (NB) with a
consideration of the basic methodologies and diagnostic accuracies. We conclude
with a discussion of the comparison of the various methodologies.
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Affiliation(s)
- Adam R Belanger
- Division of Pulmonary and Critical Care, Section of Interventional Pulmonology, University of North Carolina at Chapel Hill, NC, USA
| | - Jason A Akulian
- Assistant Professor of Medicine, Director, Section of Interventional Pulmonology, Division of Pulmonary and Critical Care, University of North Carolina at Chapel Hill, 8007 Burnett Womack Bldg., CB 7219, Chapel Hill, NC 27713, USA
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46
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Endobronchial and Endoscopic Ultrasound-Guided Transvascular Biopsy of Mediastinal, Hilar, and Lung Lesions. Ann Thorac Surg 2017; 103:951-955. [DOI: 10.1016/j.athoracsur.2016.08.111] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 08/29/2016] [Accepted: 08/31/2016] [Indexed: 12/25/2022]
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Hocke M, Ignee A, Dietrich C. Role of contrast-enhanced endoscopic ultrasound in lymph nodes. Endosc Ultrasound 2017; 6:4-11. [PMID: 28218194 PMCID: PMC5331842 DOI: 10.4103/2303-9027.190929] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 04/25/2016] [Indexed: 12/11/2022] Open
Abstract
Diagnosing unclear lymph node (LN) enlargements in the mediastinum and abdomen is the most important indication of endoscopic ultrasound (EUS)-fine needle aspiration (FNA) after the diagnosis and treatment of pancreatic diseases. Investigating LNs in these areas can happen in different clinical settings. Mostly, it is the first modality in general LN diseases without any peripheral LN enlargements. On the other hand, it can be the question of LN involvement in a known or suspected primary tumor. Due to EUS-FNA cytology, those questions can be answered highly, accurately. However, a primary discrimination of LNs might be helpful to increase the diagnostic value of the FNA cytology, especially in cases with multiple LN enlargements and hard to reach enlarged LNs for example by vessel interposition. Because of the unreliability of B-mode criteria, further diagnostic improvements such as elastography and contrast-enhanced EUS are investigated to increase the accuracy of the initial diagnosis.
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Affiliation(s)
- Michael Hocke
- Medical Department, Helios Klinikum Meiningen, D-98617 Meiningen, Germany
| | - Andre Ignee
- Medical Department, Caritas-Krankenhaus, D-97980 Bad Mergentheim, Germany
| | - Christoph Dietrich
- Medical Department, Caritas-Krankenhaus, D-97980 Bad Mergentheim, Germany
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48
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Labarca G, Aravena C, Ortega F, Arenas A, Majid A, Folch E, Mehta HJ, Jantz MA, Fernandez-Bussy S. Minimally Invasive Methods for Staging in Lung Cancer: Systematic Review and Meta-Analysis. Pulm Med 2016; 2016:1024709. [PMID: 27818796 PMCID: PMC5081694 DOI: 10.1155/2016/1024709] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/29/2016] [Accepted: 08/31/2016] [Indexed: 12/25/2022] Open
Abstract
Introduction. Endobronchial ultrasound (EBUS) is a procedure that provides access to the mediastinal staging; however, EBUS cannot be used to stage all of the nodes in the mediastinum. In these cases, endoscopic ultrasound (EUS) is used for complete staging. Objective. To provide a synthesis of the evidence on the diagnostic performance of EBUS + EUS in patients undergoing mediastinal staging. Methods. Systematic review and meta-analysis to evaluate the diagnostic yield of EBUS + EUS compared with surgical staging. Two researchers performed the literature search, quality assessments, data extractions, and analyses. We produced a meta-analysis including sensitivity, specificity, and likelihood ratio analysis. Results. Twelve primary studies (1515 patients) were included; two were randomized controlled trials (RCTs) and ten were prospective trials. The pooled sensitivity for combined EBUS + EUS was 87% (CI 84-89%) and the specificity was 99% (CI 98-100%). For EBUS + EUS performed with a single bronchoscope group, the sensitivity improved to 88% (CI 83.1-91.4%) and specificity improved to 100% (CI 99-100%). Conclusion. EBUS + EUS is a highly accurate and safe procedure. The combined procedure should be considered in selected patients with lymphadenopathy noted at stations that are not traditionally accessible with conventional EBUS.
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Affiliation(s)
- Gonzalo Labarca
- Facultad de Medicina, Universidad San Sebastián, Lientur 1457, Concepción 4080871, Chile
- Division of Internal Medicine, Complejo Asistencial Victor Rios Ruiz, Los Angeles, Chile
| | - Carlos Aravena
- Division of Pulmonary Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Ortega
- Division of Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alex Arenas
- Division of Internal Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Adnan Majid
- Divisions of Thoracic Surgery and Interventional Pulmonary, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Erik Folch
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Hiren J. Mehta
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | - Michael A. Jantz
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, FL, USA
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Linear endobronchial and endoesophageal ultrasound: a practice change in thoracic medicine. Curr Opin Pulm Med 2016; 22:281-8. [PMID: 26989819 DOI: 10.1097/mcp.0000000000000269] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW Linear endosonography, including intrathoracic lymph nodal sampling by endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) and endoesophageal ultrasound fine-needle aspiration (EUS-FNA), has an important role in the diagnosing and staging of lung cancer. Furthermore, endosonography is applied in the mediastinal evaluation of sarcoidosis, lymphoma, cysts, and nodal metastases of extrathoracic malignancies. Endosonography-related complications as well as sedation and training strategies are discussed. The purpose of this review is to summarize current practice, recent advances, and future directions. RECENT FINDINGS Lung cancer guidelines recommend endosonography - above mediastinoscopy - as the initial test for mediastinal nodal tissue staging. By introducing the EBUS-scope into the esophagus (EUS-B) - following an EBUS procedure - the complete mediastinum and the left adrenal gland can be investigated in a single scope procedure by one operator. In patients with suspected stage I/II sarcoidosis, EBUS-TBNA/EUS-FNA is the test with the highest granuloma detection rate. Diagnosing (recurrent) lymphoma is an increasingly accepted indication for endosonography. Systematic surveys showed that endosonography has a low complication rate. Simulator-based training and assessment tools measuring competency are important instruments to provide standardized and optimal implementation. SUMMARY Endosonography is generally accepted as a powerful and safe diagnostic test for various diseases affecting the mediastinum. Large-scale implementation is needed.
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50
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Zaric B, Kovacevic T, Stojsic V, Milovancev A. New technologies in diagnostic bronchoscopy - an age of meta-analyses. Expert Rev Med Devices 2016; 13:789-91. [PMID: 27477442 DOI: 10.1080/17434440.2016.1218276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Bojan Zaric
- a Institute for Pulmonary Diseases of Vojvodina , University of Novi Sad , Sremska Kamenica , Serbia
| | - Tomi Kovacevic
- a Institute for Pulmonary Diseases of Vojvodina , University of Novi Sad , Sremska Kamenica , Serbia
| | - Vladimir Stojsic
- a Institute for Pulmonary Diseases of Vojvodina , University of Novi Sad , Sremska Kamenica , Serbia
| | - Aleksandar Milovancev
- a Institute for Pulmonary Diseases of Vojvodina , University of Novi Sad , Sremska Kamenica , Serbia
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