Combined Endosonographic Mediastinal Lymph Node Staging in Positron Emission Tomography and Computed Tomography Node-Negative Non–Small-Cell Lung Cancer in High-Risk Patients

Hegde, Poornima; Molina, Juan Carlos; Thivierge-Southidara, Maureen; Jain, Ratnali; Gowda, Akshatha; Ferraro, Pasquale; Liberman, Moïshe

doi:10.1053/j.semtcvs.2019.07.007

Cited by 11 publications

(7 citation statements)

References 39 publications

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“…30 In order to increase the diagnostic accuracy of metastatic N1 LNs, endobronchial ultrasound (EBUS) or endoscopic ultrasound fine needle aspiration (EUS-FNS) combined PET/CT are recommended for the detection of metastatic N1 LNs in CT or PET-CT negative LNs. 31 Limitations of our study include its small size. Only 185 patients with 431 LN stations were included; this may have introduced bias.…”

Section: Discussionmentioning

confidence: 92%

Development and validation of tumor‐to‐blood based nomograms for preoperative prediction of lymph node metastasis in lung cancer

Yanhua

et al. 2021

Thoracic Cancer

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Background: To develop and validate tumor-to-blood based nomograms for preoperative prediction of lymph node (LN) metastasis in patients with lung cancer (LC). Methods: A prediction model was developed in a primary cohort comprising 330 LN stations from patients with pathologically confirmed LC, these data having been gathered from January 2016 to June 2019. Tumor-to-blood variables of LNs were calculated from positron emission tomography-computed tomography (PET-CT) images of LC and the short axis diameters of LNs were measured on CT images. Tumor-toblood variables, number of stations suspected of harboring LN metastasis according to PET, and independent clinicopathological risk factors were included in the final nomograms. After being internally validated, the nomograms were used to assess an independent validation cohort containing 101 consecutive LN stations accumulated from July 2019 to March 2020. Results: Four tumor-to-blood variables (left atrium, inferior vena cava, liver, and aortic arch) and the maximum standardized uptake value (SUVmax) for LNs were found to be significantly associated with LN status (p < 0.001 for both primary and validation cohorts). Five predictive nomograms were built. Of these, one with LN SUVmax/ left atrium SUVmax was found to be optimal for predicting LN status with AUC 0.830 (95% confidence interval [CI]: 0.774-0.886) in the primary cohort and AUC 0.865 (95% CI: 0.782-0.948) in the validation cohort. All models showed good discrimination, with a modest C-index, and good calibration in both primary and validation cohorts. Conclusions: We have developed tumor-to-blood based nomograms that incorporate identified clinicopathological risk factors and facilitate preoperative prediction of LN metastasis in LC patients.

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Section: Discussionmentioning

confidence: 92%

Development and validation of tumor‐to‐blood based nomograms for preoperative prediction of lymph node metastasis in lung cancer

Yanhua

et al. 2021

Thoracic Cancer

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“…NPV of combined EBUS/EUS in this patient population is 91% (59). The authors concluded that in a radiologically normal mediastinum, surgical exploration of the mediastinum can be omitted if the results of the biopsy done for staging of NSCLC are negative by combined EBUS/EUS (59,60).…”

Section: Role Of Combined Ebus/eus In Accessing a Radiologically Normal Mediastinummentioning

confidence: 89%

Endoscopic ultrasound in interventional pulmonology

Ho¹,

Hegde²

2020

Shanghai Chest

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Lung cancer is the leading cause of cancer related deaths worldwide. Accurate staging of the mediastinum is essential to determine the appropriate treatment plan in patients with potentially operable non-small cell lung cancers (NSCLC). Traditionally, the gold standard test in mediastinal staging has been cervical mediastinoscopy. However, this procedure is invasive, requires general anesthesia, and is associated with significant risk. Training in endoscopic ultrasound (EUS) techniques in addition to endobronchial ultrasound (EBUS) allows for diagnosis and complete staging of lung cancer in a single session, thereby decreasing healthcare cost, time delays, increased sedation time, and patient discomfort. With its superior cost-effectiveness and reduced risk profile compared to conventional mediastinoscopy, endoscopic approach has replaced mediastinoscopy as the initial step in lung cancer staging and diagnosis. Here we discuss the utility of EUS along with combined EBUS with EUS, and highlight some of the technical aspects of the procedure. We will review the current role of EUS technique for the evaluation of mediastinal adenopathy and staging of lung cancer. We will also briefly discuss its use in diagnosing mediastinal infection and granulomatous lesions in the thoracic cavity.

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“…Therefore, in the presence of radiologically normal mediastinal LNs, the staging of combined endosonographic LNs has been proposed in the pre-treatment staging of high-risk patients with NSCLC. [ 31 ] This study suggests that ultrasonographic data be used more widely in the diagnosis of mediastinal and hilar LNs.…”

Section: Discussionmentioning

confidence: 99%

The value of endobronchial ultrasound-guided transbronchial needle aspiration, 18-fluorodeoxyglucose positron emission tomography/computed tomography, and ultrasonography imaging techniques in the diagnosis of mediastinal and/or hilar malignant, anthracotic, and other benign lymph nodes

Korkmaz¹,

Demirbaş²,

Vatansev³

2021

Medicine

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Introduction: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a simple, reliable, minimally invasive and effective procedure. However, a surgical technique may be required, if the results are negative. Therefore, there is a need for new studies to increase the diagnostic value of EBUS-TBNA and provide additional information to guide the biopsy in performing the procedure. Here, we aimed to investigate the diagnostic value of EBUS-TBNA and 18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in diagnosis of hilar and/or mediastinal lymph nodes (LNs). It was also aimed to determine the contributions of real-time ultrasonography (USG) images of LNs to distinguishing between the malignant and benign LNs during EBUS-TBNA, and in the diagnosis of anthracotic LNs. Material and Method: In the retrospective study including 545 patients, 1068 LNs were sampled by EBUS-TBNA between January 2015 and February 2020. EBUS-TBNA, 18-FDG PET/CT and images of USG were investigated in the diagnosis of mediastinal and/or hilar malignant, anthracotic and other benign LNs. Results: The sensitivity, specificity, positive predictive value and negative predictive value of EBUS-TBNA were found as 79.5, 98.1, 89.5, and 91.7%, respectively. Mean maximum standardized uptake value (SUVmax) values of 18F-FDG PET/CT were 6.31±4.3 in anthracotic LNs and 5.07 ± 2.53 in reactive LNs. Also, mean SUVmax of malignant LNs was 11.02 ± 7.30 and significantly higher than that of benign LNs. In differentiation of malignant-benign tumors, considering the cut off value of 18F-FDG PET/CT SUVmax as 2.72, the sensitivity and specificity was 99.3 and 11.7%, but given the cut off value as 6.48, the sensitivity, specificity, positive predictive value and negative predictive value was found as 76.5, 64, 20.49, and 78.38% for benign LNs, respectively. Compared LNs as to internal structure and contour features, malignant LNs had most often irregular contours and heterogeneous density. Anthracotic, reactive and other benign LNs were most frequently observed as regular contours and homogeneous density. The difference between malignant and benign LNs was significant. Conclusion: EBUS can contribute to the differential diagnosis of malignant, anthracotic and other benign LNs. Such contributions can guide clinician bronchoscopists during EBUS-TBNA. The triple modality of EBUS-TBNA, 18FDG PET/CT, and USG may increase the diagnostic value in hilar and mediastinal lymphadenopathies.

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Combined Endosonographic Mediastinal Lymph Node Staging in Positron Emission Tomography and Computed Tomography Node-Negative Non–Small-Cell Lung Cancer in High-Risk Patients

Cited by 11 publications

References 39 publications

Development and validation of tumor‐to‐blood based nomograms for preoperative prediction of lymph node metastasis in lung cancer

Development and validation of tumor‐to‐blood based nomograms for preoperative prediction of lymph node metastasis in lung cancer

Endoscopic ultrasound in interventional pulmonology

The value of endobronchial ultrasound-guided transbronchial needle aspiration, 18-fluorodeoxyglucose positron emission tomography/computed tomography, and ultrasonography imaging techniques in the diagnosis of mediastinal and/or hilar malignant, anthracotic, and other benign lymph nodes

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