A prospective controlled trial of endobronchial ultrasound-guided transbronchial needle aspiration compared with mediastinoscopy for mediastinal lymph node staging of lung cancer

Yasufuku, Kazuhiro; Pierre, Andrew; Darling, Gail; Perrot, Marc de; Waddell, Thomas G.; Johnston, Michael; Santos, Gilda da Cunha; Geddie, William; Boerner, Scott; Le, Lisa W.; Keshavjee, Shaf

doi:10.1016/j.jtcvs.2011.08.037

Cited by 474 publications

(391 citation statements)

References 24 publications

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“…Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive technique with a high diagnostic yield in the diagnosis and staging of lung cancer (Herth et al, 2008;Cetinkaya et al, 2011;Yasufuku et al, 2011). Additionally, numerous studies have reported the successful diagnosis of sarcoidosis by EBUS-TBNA (Garwood et al 2007;Tremblay and Stather, 2009).…”

Section: Introductionmentioning

confidence: 99%

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in the Diagnosis of Lymphoma

Şentürk¹,

Babaoğlu²,

Kılıç³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is highly accurate in diagnosing mediastinal lymphadenopathies of lung cancer and benign disorders. However, the utility of EBUS-TBNA in the diagnosis of mediastinal lymphomas is unclear. The aim of this study was to determine the diagnostic value of EBUS-TBNA in patients with suspected lymphoma. Materials and Methods: Sixty-eight patients with isolated mediastinal lymphadenopathy and suspected of lymphoma were included in the study. EBUS-TBNA was performed on outpatients under moderate sedation. The sensitivity, specificity, negative predictive value and diagnostic accuracy of EBUS-TBNA were calculated. Results: Sixty-four patients were diagnosed by EBUS-TBNA, but four patients with non-diagnostic EBUS-TBNA required surgical procedures. Thirty-five (51.5%) patients had sarcoidosis, six (8.8%) had reactive lymphadenopathy, nine (13.3%) had tuberculosis, one (1.5%) had squamous cell carcinoma, two (2.9%) had sarcoma and fifteen (22%) had lymphoma (follicular center cell, large B-cell primary, and Hodgkin lymphomas in three, two, and ten, respectively). Of the 15 lymphoma patients, thirteen were diagnosed by EBUS and two by thoracotomy and mediastinoscopy. The sensitivity, specificity, negative predictive value, and diagnostic accuracy of EBUS-TBNA for the diagnosis of lymphoma were calculated as 86.7%, 100%, 96.4%, and 97%, respectively. Conclusions: EBUS-TBNA can be employed in the diagnosis of mediastinal lymphoma, instead of more invasive surgical procedures.

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Section: Introductionmentioning

confidence: 99%

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in the Diagnosis of Lymphoma

Şentürk¹,

Babaoğlu²,

Kılıç³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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“…Its overall sensitivity and specificity is comparable to mediastinoscopy, as shown in several studies 30, 31. Although this technology has rapidly been disseminated throughout several pulmonary fellowship programs, establishing competency in linear EBUS remains a subject of debate.…”

Section: Discussionmentioning

confidence: 94%

Influence of trainee involvement on procedural characteristics for linear endobronchial ultrasound

et al. 2017

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BackgroundLinear endobronchial ultrasound (EBUS) is a safe and effective method for the diagnostic sampling of mediastinal lymph nodes. However, there is a learning curve associated with the procedure and operator experience influences diagnostic yield. We sought to determine if trainee involvement during EBUS influences procedural characteristics, complication rate, and diagnostic yield.MethodsWe performed a retrospective analysis of 220 subjects who underwent an EBUS procedure at our center from December 2012 to June 2013. Procedures were performed by six different interventional pulmonologists with substantial experience with EBUS or by a trainee under their direct supervision. Procedural characteristics and complications were recorded. Diagnostic yield and specimen adequacy were compared between groups.Results EBUS was performed in 220 patients with a trainee involved (n = 116) or by staff physician alone (n = 104). Patient characteristics, and the number and size of lymph node stations sampled were similar. EBUS duration was longer (16.0 vs. 13.7 minutes; P = 0.002) and the total dose of lidocaine used was higher (322.3 vs. 304.2 mg; P = 0.045) when a trainee was involved. The rate of adequate specimens sampled was comparable between the groups (92.0 vs. 92.0%; P = 0.60). Diagnostic yield was lower when a trainee was involved in the EBUS procedure (52.6 vs. 68.3%; P = 0.02).ConclusionTrainee involvement significantly increased EBUS duration and the dose of local anesthesia used for the procedure. Diagnostic yield was lower when a trainee was involved. Factors accounting for this difference in yield, despite adequate samples being obtained, warrant further investigation.

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“…Recently, the development of EBUS transbronchial needle aspiration or endooesophageal ultrasound-guided needle aspiration (EUS) has allowed for more accurate staging of proximal hilar and all mediastinal stations [24,25]. As chest CT, PET-CT or PET scan do not have a specificity, negative predictive value or accuracy of 100%, it is recommended that patients with negative lymph nodes on PET or PET-CT, but enlarged nodes on staging CT still undergo proper staging of mediastinal nodes through EBUS/EUS or mediastinoscopy, before thoracotomy [26,27]. Again, if results remain inconclusive, a surgical biopsy (VATS preferably) may help stage mediastinal lymph nodes accurately.…”

Section: Clinical and Surgical Stagingmentioning

confidence: 99%

“…Mediastinal lymph nodes should be reassessed following neoadjuvant treatment. EBUS and EUS seem at least as good as mediastinoscopy for that task, in experienced hands [27]. When lobectomy is the anticipated type of lung resection, chemoradiotherapy can be used with an acceptable risk of mortality and complications.…”

Section: N2 Diseasementioning

confidence: 99%

Surgery for nonsmall cell lung cancer

Lang-Lazdunski

2013

European Respiratory Review

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Surgery remains the best curative option in patients with early stage lung cancer (stage I and II). Developments in minimally invasive techniques now allow surgeons to perform lung resections on elderly patients, patients with poor pulmonary function or significant cardiopulmonary comorbidities. New techniques, such as stereotactic radiotherapy and ablative procedures, are being evaluated in early-stage lung cancer and may represent an alternative to surgery in patients unfit for lung resection. Perioperative mortality rates have dropped significantly at most institutions in the past two decades and complications are managed more efficiently. Progress in imaging and staging techniques have helped cut futile thoracotomy rates and offer patients the most adequate treatment options. Large randomised trials have helped clarify the role of neoadjuvant, induction and adjuvant chemotherapy, as well as radiotherapy. Surgery remains an essential step in the multimodality therapy of selected patients with advanced-stage lung cancer (stage III and IV). Interventional and endoscopic techniques have reduced the role of surgery in the diagnosis and staging of nonsmall cell lung cancer, but surgery remains an important tool in the palliation of advanced-stage lung cancer. Large national/international surgical databases have been developed and predictive risk-models for surgical mortality/morbidity published by learned surgical societies. Nonetheless, lung cancer overall survival rates remain deceptively low and it is hoped that early detection/screening, better understanding of tumour biology and development of biomarkers, and development of efficient targeted therapies will help improve the prognosis of lung cancer patients in the next decade. @ERSpublications Despite progress in surgical techniques, radiotherapy techniques and targeted therapy, lung cancer prognosis remains poor

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A prospective controlled trial of endobronchial ultrasound-guided transbronchial needle aspiration compared with mediastinoscopy for mediastinal lymph node staging of lung cancer

Abstract: EBUS-TBNA and mediastinoscopy achieve similar results for the mediastinal staging of lung cancer. As performed in this study, EBUS-TBNA can replace mediastinoscopy in patients with potentially resectable non-small cell lung cancer.

Cited by 474 publications

References 24 publications

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in the Diagnosis of Lymphoma

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in the Diagnosis of Lymphoma

Influence of trainee involvement on procedural characteristics for linear endobronchial ultrasound

Surgery for nonsmall cell lung cancer

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