Endobronchial ultrasound guided transbronchial needle aspiration for staging of lung cancer

Yasufuku, Kazuhiro; Chiyo, Masako; Koh, Eitetsu; Moriya, Yasumitsu; Iyoda, Akira; Sekine, Yasuo; Shibuya, Kiyoshi; Iwamoto, Toshihiko; Fujisawa, Takehiko

doi:10.1016/j.lungcan.2005.07.013

Cited by 415 publications

(302 citation statements)

References 17 publications

(30 reference statements)

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“…(23) In contrast, when we compare our results with the initial results of other groups, we can conclude that the difficulties we faced are common. One group of authors chose to exclude the results of the first 10 patients from their data, on the grounds that this would be the number of procedures required for completion of the learning curve.…”

Section: Discussionmentioning

confidence: 56%

Punção aspirativa guiada por ultrassom endobrônquico no diagnóstico e estadiamento de linfadenopatia mediastinal: experiência inicial no Brasil

et al. 2012

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Objective: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a new method for the diagnosis and staging of mediastinal lymph nodes. The objective of this study was to evaluate the preliminary results obtained with EBUS-TBNA in the diagnosis of lesions and mediastinal lymph node staging. Methods: We evaluated patients with tumors or mediastinal adenopathy, diagnosed with or suspected of having lung cancer. The procedures were performed with the patients under sedation or under general anesthesia. Material was collected by EBUS-TBNA, after which it was prepared on slides, fixed in either absolute alcohol (for cytology) or formalin (for cell-block analysis). Results: We included 50 patients (30 males). The mean age was 58.3 ± 13.5 years. We performed 201 biopsies of 81 lymph nodes or mediastinal masses (mean of 2.5 punctures/biopsy). The quantity of material was considered appropriate for cytology in 37 patients (74%), 21 (57%) of whom were thus diagnosed with malignancy. Of the remaining 16 patients, 1 was diagnosed with tuberculosis, 6 entered clinical follow-up, and 9 underwent further investigation (2 diagnosed with neoplasmfalse-negative results). The yield was higher when the procedure was performed for diagnostic purposes, as well as being higher in patients with lesions in multiple stations and in biopsies involving the subcarinal lymph node station. One patient had endobronchial bleeding, which was resolved with local measures. There were no deaths among the patients evaluated. Conclusions: This preliminary experience shows that EBUS-TBNA is a safe procedure. Our diagnostic yield, although lower than that reported in the literature, was consistent with the learning curve for the method.Keywords: Ultrasonography, interventional; Biopsy, fine-needle; Neoplasm staging; Lung neoplasms; Bronchoscopy. ResumoObjetivo: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA, punção aspirativa por agulha guiada por ultrassom endobrônquico) é um método novo em diagnóstico e estadiamento linfonodal mediastinal. O objetivo do estudo foi avaliar os resultados preliminares obtidos com EBUS-TBNA no diagnóstico de lesões e no estadiamento linfonodal mediastinal. Métodos: Foram avaliados pacientes com tumores ou adenopatias mediastinais e com diagnóstico ou suspeita de câncer de pulmão. Os procedimentos foram realizados com os pacientes sob sedação ou anestesia geral. O material coletado foi preparado em lâminas fixadas em álcool absoluto para citologia e em formol para bloco de células. Resultados: Foram incluídos 50 pacientes (30 do sexo masculino), com média de idade de 58,3 ± 13,5 anos. Foram realizadas 201 punções em 81 linfonodos ou massas mediastinais (média de 2,5 punções). O material obtido foi considerado adequado para análise citológica em 37 pacientes (74%), dos quais 21 (57%) foram diagnosticados com malignidade. Nos 16 pacientes remanescentes, 1 teve diagnóstico de tuberculose, 6 tiveram seguimento clínico, e 9 foram submetidos a investigação adicional...

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Section: Discussionmentioning

confidence: 56%

Punção aspirativa guiada por ultrassom endobrônquico no diagnóstico e estadiamento de linfadenopatia mediastinal: experiência inicial no Brasil

et al. 2012

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“…The majority of studies do not differentiate between these subgroups and this is an important drawback. Even though the current authors could find no observable differences in studies that exclusively enrolled patients with NSCLC [12,13,15,17] or that primarily analyse mediastinal and hilar metastasis [9,13,17,20] in comparison to those that include only patients with mediastinal metastases [12,18,24], additional studies are required to clarify the effectiveness of this test in different clinical situations.…”

Section: Generalisability Of the Published Resultsmentioning

confidence: 64%

“…It is readily acknowledged that EBUS-TBNA calls for in-depth, practical training in the interpretation of ultrasonographic images [36], and a lower degree of effectiveness and a greater proportion of adverse effects may thus be obtained by other, less-experienced teams. In fact, 45% of all the data available comes from the Heidelberg group of HERTH and co-workers [15][16][17], increasing to 60% if the patients of YASUFUKU and co-workers [9,[12][13][14] are included.…”

Section: Generalisability Of the Published Resultsmentioning

confidence: 99%

“…Sample size ranged 18-502 patients. Seven of the largest-sized prospective studies were conducted by the Japanese group of YASUFUKU and co-workers [9,[12][13][14] and the multicentre group of HERTH and co-workers [15][16][17] with main contributions from Germany, Denmark and the USA. Table 1 summarises the characteristics of all original studies along with the main results.…”

Section: Effectiveness In Bronchopulmonary Carcinomamentioning

confidence: 99%

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

Varela-Lema

Fernández-Villar²,

Ruano-Raviña

2009

European Respiratory Journal

377

255

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The aim of the present systematic review was to assess the effectiveness and safety of real time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in patients with suspected or known bronchopulmonary carcinoma, as well as in other clinical indications presented by lymphatic adenopathies.A systematic review was carried out in November 2007 and updated in April 2008 using the main databases. Inclusion and exclusion criteria were applied to the papers retrieved.A total of 20 publications were included. Of these, 14 were original studies that investigated the clinical usefulness of the technique in visualising and staging lymph nodes in patients with suspected or established lung cancer. Sensitivity ranged 85-100% and negative predictive value ranged 11-97.4%. Three studies assessed the clinical usefulness of the technique in the diagnosis of sarcoidosis. EBUS-TBNA was diagnostic in 88-93% of patients. One retrospective study evaluated the use of EBUS-TBNA in the diagnosis of lymphoma. None of the studies included in the present review reported important complications.Endobronchial ultrasound-guided transbronchial needle aspiration is a safe and highly accurate procedure for the examination and staging of mediastinal and hilar lymph nodes in patients with known or suspected lung malignancy. The evidence is promising for sarcoidosis but is not sufficient for lymphoma.

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“…New diagnostic modalities like endobronchial ultrasound-guided transbronchial needle aspiration are increasingly being used to stage lung cancer through evaluation of mediastinal and hilar lymph nodes for metastasis. 39 These new minimally invasive sampling procedures provide opportunities, but to fully take advantage of their promise, more sensitive analytic approaches capable of interrogating very small amounts of tissue must be developed. As the field moves from simple mutational analysis of one or a few genes to more challenging assays like whole pathway DNA mutation testing and complex expression-based assays using proteomic or transcriptomic measurements, the need for simple and reliable methods of isolating relatively pure cell populations will become essential, 40 and the use of microdissection is likely to be an integral component of such approaches.…”

Section: Discussionmentioning

confidence: 99%

EGFR and KRAS mutation analysis in cytologic samples of lung adenocarcinoma enabled by laser capture microdissection

Roy‐Chowdhuri

Pham

et al. 2012

Modern Pathology

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The discovery of activating mutations in EGFR and KRAS in a subset of lung adenocarcinomas was a major advance in our understanding of lung adenocarcinoma biology, and has led to groundbreaking studies that have demonstrated the efficacy of tyrosine kinase inhibitor therapy. Fine-needle aspirates and other cytologic procedures have become increasingly popular for obtaining diagnostic material in lung carcinomas. However, frequently the small amount of material or sparseness of tumor cells obtained from cytologic preparations limit the number of specialized studies, such as mutation analysis, that can be performed. In this study we used laser capture microdissection to isolate small numbers of tumor cells to assess for EGFR and KRAS mutations from cell block sections of 19 cytology samples from patients with known lung adenocarcinomas. We compared our results with previous molecular assays that had been performed on either surgical or cytology specimens as part of the patient's initial clinical work-up. Not only were we able to detect the identical EGFR or KRAS mutation that was present in the patient's prior molecular assay in every case, but we were also able to consistently detect the mutation from as few as 50 microdissected tumor cells. Furthermore, isolating a more pure population of tumor cells resulted in increased sensitivity of mutation detection as we were able to detect mutations from laser capture microdissection-enriched cases where the tumor load was low and traditional methods of whole slide scraping failed. Therefore, this method can not only significantly increase the number of lung adenocarcinoma patients that can be screened for EGFR and KRAS mutations, but can also facilitate the use of cytologic samples in the newly emerging field of molecular-based personalized therapies.

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Endobronchial ultrasound guided transbronchial needle aspiration for staging of lung cancer

Cited by 415 publications

References 17 publications

Punção aspirativa guiada por ultrassom endobrônquico no diagnóstico e estadiamento de linfadenopatia mediastinal: experiência inicial no Brasil

Punção aspirativa guiada por ultrassom endobrônquico no diagnóstico e estadiamento de linfadenopatia mediastinal: experiência inicial no Brasil

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

EGFR and KRAS mutation analysis in cytologic samples of lung adenocarcinoma enabled by laser capture microdissection

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