Endobronchial ultrasound and positron emission tomography positive mediastinal lymph nodes

Abstract

Positron emission tomography with 18F-fluoro-2-deoxy-D-glucose (FDG-PET) is more accurate than computed tomography for staging of mediastinal (hilar) lymph nodes. In the case of positive findings, tissue sampling of lymph nodes is required. The diagnostic/staging yield of transbronchial needle aspiration (TBNA) following endobronchial ultrasound (EBUS) localisation was assessed in this particular clinical setting. The number of avoided surgical procedures was evaluated.All consecutive patients referred for staging and/or diagnosis of mediastinal FDG-PET positive lesions were included. Data were prospectively collected. TBNA sampling of lymph nodes was performed after EBUS localisation. If no diagnosis was reached, further surgical sampling or adequate follow-up was performed.From January 2003 to June 2004, 33 patients were included. The average number of TBNA samples per patient was 4.2¡1.5. Cytological or histological diagnoses were obtained in 27 (82%) of the patients, of which 78% were obtained after previous EBUS localisation. In 25 (76%) of the 33 patients, surgical staging procedures were suppressed.In conclusion, transbronchial needle aspiration after endobronchial ultrasound localisation should be considered as a primary method of evaluation of lymph nodes positive by positron emission tomography with 18F-fluoro-2-deoxy-D-glucose, and may replace the majority of surgical mediastinal staging/diagnostic procedures.

Endobronchial ultrasound and value of PET for prediction of pathological results of mediastinal hot spots in lung cancer patients

“…FDG-PET and CT scan images were always available but data on quantitative assessment including standardized uptake value (SUV) or lymph node size (CT scan) were most often missing due to non standardized initial diagnostic work-up done in 27 different centres. As previously reported, the procedure performed under local anaesthesia was well tolerated and side effects, notably cough, were seldom encountered [15]. In one patient with COPD, however, chest pain occurred during the procedure and chest X-ray confirmed a pneumothorax that required chest tube drainage.…”

“…Herth and colleagues [16] have elegantly shown that this lymph node sampling technique is better than the conventional "blinded" TBNA. Recently, we have assessed the role of prior evaluation of FDG-PET positive lymph nodes using ultrasonic catheters before TBNA in patients with various clinical presentations and the overall diagnostic yield was 82 % [15]. For obvious reasons, however, the development of the new echo-bronchoscope allowing real-time guided TBNA will probably replace the indirect ultrasonic probe technique.…”

Interobserver agreement in determining non-small cell lung cancer subtype in specimens acquired by EBUS-TBNA

“…Original reports confirming the excellent diagnostic accuracy of EBUS-TBNA in evaluation of the mediastinum did not compare NSCLC subtype diagnoses to those obtained at surgical resection [1,28,29]. Therefore, while diagnostic accuracy of EBUS-TBNA for detection of NSCLC matches [30], or even exceeds [31], that of mediastinoscopy, the accuracy in determination of NSCLC subtype remains unclear.…”

Effectiveness and safety of endobronchial ultrasound-transbronchial needle aspiration: a systematic review

“…Only three studies reported having observed agitation [31], cough [20,31], and presence of blood [9] at the puncture site.…”