Endobronchial Ultrasound Guided Transbronchial Needle Aspiration for Mediastinal Staging in a Community Medical Center

Warren, Whittney; Hagaman, Jared T.

doi:10.1513/annalsats.201603-216bc

Cited by 2 publications

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“…Of the included studies or subgroups, 11 described the accuracy of mediastinoscopy after negative or inconclusive endosonography findings. Four studies evaluated EBUS plus mediastinoscopy 13,[38][39][40] , three evaluated EUS plus mediastinoscopy, 13,24,41 and four evaluated EBUS plus EUS, followed by mediastinoscopy. 5,13,29,32 Two studies were RCTs, with only one of them reporting adequate concealment of allocation and no blinding used in either of them.…”

Section: Unforeseen N2 Disease After Ebus And/or Eus With Subsequent mentioning

confidence: 99%

Unforeseen N2 Disease after Negative Endosonography Findings with or without Confirmatory Mediastinoscopy in Resectable Non–Small Cell Lung Cancer: A Systematic Review and Meta-Analysis

Bousema

Dorp

Noyez³

et al. 2019

Journal of Thoracic Oncology

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Introduction: Confirmatory mediastinoscopy after negative endosonography findings is advised by the guidelines on patients with resectable NSCLC and suspected intrathoracic nodes on fludeoxyglucose F 18 positron emission tomography-computed tomography. Its role however is under debate owing to its limited nodal metastasis detection rate, morbidity, associated treatment delay, and unknown impact on survival. Methods: Systematic review and meta-analysis of studies on invasive mediastinal staging in patients with (suspected) NSCLC. The Medline, Embase, and Cochrane databases were searched until September 19, 2018, without year or language restrictions. The Quality Assessment Tool for Diagnostic Accuracy Studies, version 2, was used to evaluate the risk of bias and applicability of the included studies. Rates of unforeseen N2 disease were assessed for endobronchial ultrasound and/or endoscopic ultrasound staging strategies with or without confirmatory mediastinoscopy. Additionally, the complication rates of cervical video mediastinoscopy for mediastinal staging of NSCLC were investigated. Results: A total of 5073 articles were found, of which 42 studies or subgroups (covering a total of 3248 patients undergoing the surgical reference standard of treatment) were considered in the analysis. Random effects metaanalysis of endosonography with or without confirmatory mediastinoscopy showed rates of unforeseen N2 disease of 9.6% (95% confidence interval [CI]: 7.8%-11.7%, I 2 ¼ 30%) versus 9.9% (95% CI: 6.3%-15.2%, I 2 ¼ 73%), respectively. Random effects meta-analysis of mediastinoscopy (eight studies [1245 patients in total]) showed a complication rate of 6.0% (95% CI: 4.8%-7.5%), with laryngeal recurrent nerve palsy accounting for 2.8% (95% CI: 2.0%-4.0%). Conclusion: The rate of unforeseen N2 disease after negative endosonography findings was similar in patients undergoing immediate lung tumor resection to those undergoing confirmatory mediastinoscopy first, at the cost of 6.0% rate of complications by mediastinoscopy.

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Section: Unforeseen N2 Disease After Ebus And/or Eus With Subsequent mentioning

confidence: 99%

Unforeseen N2 Disease after Negative Endosonography Findings with or without Confirmatory Mediastinoscopy in Resectable Non–Small Cell Lung Cancer: A Systematic Review and Meta-Analysis

Bousema

Dorp

Noyez³

et al. 2019

Journal of Thoracic Oncology

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“…Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) was developed by Yasufuku et al [1][2][3][4] and is now widely used as a biopsy procedure for the diagnosis of lesions adjacent to the trachea or central bronchi, and for the staging of malignancy. Recently, with progress in molecular analysis, the role of EBUS-TBNA has evolved from a primarily diagnostic and staging modality for managing lung cancer to one of the main techniques for obtaining tumor samples for molecular testing for genetic analyses and predictive biomarkers testing.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the harvest volume between maneuvers of endobronchial ultrasound-guided transbronchial needle aspiration including the “cross-fanning technique”

et al. 2023

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Recently, a certain volume of biopsy specimens has been required for genetic testing of tumors using endobronchial ultrasoundguided transbronchial needle aspiration (EBUS-TBNA). This study aimed to verify the superiority of our newly devised EBUS-TBNA biopsy technique, the "cross-fanning technique," which combines rotation and up-down maneuvers, by comparing its harvest volume with that of other maneuvers. Using a bronchoscope simulator, ultrasonic bronchoscope, and 21-gauge puncture needle, we compared the weight of silicone biopsy specimens obtained by the following 4 procedures: Conventional maneuver; Up-down maneuver; Rotation maneuver, and; Cross-fanning technique. Each procedure was repeated 24 times in total, rotating the sequences of the maneuvers, and the operator/assistant pair to align the conditions. The means ± standard deviations of the sample volumes for each puncture technique were as follows: 2.8 ± 1.2 mg; 3.1 ± 1.6 mg; 3.7 ± 1.2 mg, and; 3.9 ± 1.2 mg. There was a significant difference between the 4 groups (P = .024). The post hoc test showed a statistically significant difference between techniques A and D (P = .019). This study showed that the cross-fanning technique might contribute to the increased volume of tissue samples obtained by EBUS-TBNA biopsy.

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Endobronchial Ultrasound Guided Transbronchial Needle Aspiration for Mediastinal Staging in a Community Medical Center

Abstract: EBUS-TBNA is accurate in detecting mediastinal metastasis of lung cancer in the community setting. PET-CT without uptake in lymph nodes reduces the likelihood of malignancy but cannot rule out mediastinal involvement.

Cited by 2 publications

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Unforeseen N2 Disease after Negative Endosonography Findings with or without Confirmatory Mediastinoscopy in Resectable Non–Small Cell Lung Cancer: A Systematic Review and Meta-Analysis

Unforeseen N2 Disease after Negative Endosonography Findings with or without Confirmatory Mediastinoscopy in Resectable Non–Small Cell Lung Cancer: A Systematic Review and Meta-Analysis

Comparison of the harvest volume between maneuvers of endobronchial ultrasound-guided transbronchial needle aspiration including the “cross-fanning technique”

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