Efficacy and Safety of the eXcelon Transbronchial Aspiration Needle in Mediastinal Lymph Node Enlargement: A Case-Control Study

Fernández-Villar, Alberto; Leiro, Virginia; Blanco, M.; Represas-Represas, Cristina; Botana, Maribel; González, A.; Piñeiro, Luis

doi:10.1159/000097496

Cited by 16 publications

(10 citation statements)

References 37 publications

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“…Therefore, current guidelines describe that NSCLC patients with suspected LN involvement should undergo tissue sampling for pathological confirmation before surgical interventions [1,2,3]. For this aim, transbronchial needle aspiration (TBNA) has been sometimes attempted, but the procedure is not easy and the diagnostic yield is not sufficient [28,29]. Recent surgical and mediastinoscopic techniques for N-staging, such as transcervical extended mediastinal lymphadenectomy (TEMLA) and video-assisted mediastinoscopic lymphadenectomy (VAMLA), have become more accurate [30,31], but these procedures are still invasive, costly and require general anesthesia, as well as a long time and substantial manpower.…”

Section: Discussionmentioning

confidence: 99%

Mediastinal Lymph Node Staging in Potentially Resectable Non-Small Cell Lung Cancer: A Prospective Comparison of CT and EUS/EUS-FNA

et al. 2009

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Background: Mediastinal lymph node staging (N-staging) is essential to optimize the treatment in non-small cell lung cancer (NSCLC). Transesophageal endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) has recently been introduced as a complementary method. However, in most reports, EUS-FNA has been performed in patients who have demonstrated enlarged lymph nodes (LNs) on CT findings. The yield of EUS/EUS-FNA in patients without enlarged mediastinal LNs by CT has so far only been evaluated in a few reports. Aims: Our aim was to compare the diagnostic accuracy of CT and EUS with or without EUS-FNA (EUS/EUS-FNA) prospectively, for N-stage in all patients with potentially resectable NSCLC, including patients with and without mediastinal LN enlargement based on CT findings. Methods: Eighty consecutive patients with potentially resectable NSCLC based on CT findings were enrolled in this prospective comparative study, and underwent EUS/EUS-FNA. Results: Pathological N-stage was established in 78 patients, while in another 2 cases, malignant pleural effusion was proven by EUS-FNA, and we avoided further N-staging. In the 78 patients, the prevalence of malignant mediastinal LNs was 21%. The accuracy of EUS/EUS-FNA (91%) was significantly higher than that of CT (71%). The negative predictive value of EUS/EUS-FNA was 90%. In addition, EUS-FNA identified 2 patients as N3 disease in 56 patients without mediastinal LN involvement on CT. Conclusions: EUS/EUS-FNA gave more accurate N-staging in patients with possibly resectable NSCLC than CT, and is thus considered to be useful to determine the optimal treatment strategy.

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Section: Discussionmentioning

confidence: 99%

Mediastinal Lymph Node Staging in Potentially Resectable Non-Small Cell Lung Cancer: A Prospective Comparison of CT and EUS/EUS-FNA

et al. 2009

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“…Its utility in the diagnosis of endobronchial and peripheral lesions and the ability to provide a diagnosis in a minimally invasive way has been confirmed by several studies and has made it an extremely valuable procedure in routine bronchoscopy [18,19,20,21,22,23,24,25]. TBNA has been reported to be an underused technique for various reasons [25].…”

Section: Discussionmentioning

confidence: 99%

Patients’ Satisfaction with Flexible Bronchoscopy in a Hospital-Based Community Practice

Bernasconi

Chhajed²,

Müller³

et al. 2009

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Background: There are no data about patients’ satisfaction with a first bronchoscopy in community practice. Objectives: The aim of this study was to assess the satisfaction with flexible bronchoscopy and the willingness to return for the procedure if needed in hospital-based community practice. Methods: Prospective administration of a questionnaire before and after flexible bronchoscopy with inclusion of 126 patients in the analysis. Results: The reliability analysis demonstrated a good internal consistency of the questionnaire with a mean Cronbach α of 0.7 (range 0.63–0.76). Health status and overall satisfaction with bronchoscopy were reported as poor by 31 (25%) and 0 (0%) patients, fair by 34 (27%) and 3 (2%) patients, good by 47 (37%) and 51 (40%) patients and very good by 9 (7%) and 70 (56%) patients, respectively. Overall willingness to return for a flexible bronchoscopy if necessary was 98% (123/126). Transbronchial needle aspiration (TBNA) was the most often performed diagnostic procedure (74/126, 59%). Mean duration of the bronchoscopy in patients with and without TBNA was 30 and 19 min, respectively (p < 0.001). However, TBNA did not influence patient’s satisfaction. Preprocedure anxiety was reported by 26 of 51 patients (51%) and 24 of these patients (92%) rated their anxiety as unjustified after the procedure. Conclusions: Overall satisfaction and willingness to return for a flexible bronchoscopy in community practice are extremely high and these are independent of whether TBNA is undertaken or not.

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“…Those patients for whom a final diagnosis could not be obtained were excluded from the study. Part of these patients were included in some previous studies [6,14,15]. …”

Section: Methodsmentioning

confidence: 99%

Validity and reliability of transbronchial needle aspiration for diagnosing mediastinal adenopathies

et al. 2010

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BackgroundThe aim is to assess the validity and reliability of transbronchial needle aspiration (TBNA) of mediastinal and hilar adenopathies and to evaluate factors predictive of TBNA outcome.MethodsWe performed an analysis of prospectively collected data of patients (n = 580) who underwent TBNA (n = 685) from January 1998 to December 2007 in our center. Validity and reliability were evaluated for the overall sample and according to specific pathology. Factors predicting the successful acquisition of diagnostic samples were analyzed by multivariate analysis.ResultsOverall sensitivity, specificity, accuracy, and positive and negative predictive (NPV) values for TBNA were 68%, 100%, 68.8%, 100%, and 10%, respectively. The most sensitive and accurate TBNAs were obtained for patients with small cell lung carcinoma and the worst results were for patients with lymphomas. NPV were similar for all pathologies. The most predictive factors of outcome were adenopathy size and the presence of indirect signs at the puncture site.ConclusionThe sensitivity and accuracy of TBNA are high in small cell lung cancer, followed by other types of carcinoma, sarcoidosis, and tuberculosis, and low for lymphoproliferative diseases. The NPV of TBNA for all individual pathologies is low. The size of the adenopathy and the presence of indirect signs at the puncture site predict the achievement of diagnostic samples.

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Efficacy and Safety of the eXcelon Transbronchial Aspiration Needle in Mediastinal Lymph Node Enlargement: A Case-Control Study

Cited by 16 publications

References 37 publications

Mediastinal Lymph Node Staging in Potentially Resectable Non-Small Cell Lung Cancer: A Prospective Comparison of CT and EUS/EUS-FNA

Mediastinal Lymph Node Staging in Potentially Resectable Non-Small Cell Lung Cancer: A Prospective Comparison of CT and EUS/EUS-FNA

Patients’ Satisfaction with Flexible Bronchoscopy in a Hospital-Based Community Practice

Validity and reliability of transbronchial needle aspiration for diagnosing mediastinal adenopathies

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