Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in the Nodal Staging of Stereotactic Ablative Body Radiotherapy Patients

Vial, Macarena R.; Khan, Kashif Ali; O’Connell, Oisin; Peng, Shaohua; Gomez, Daniel R.; Chang, Joe Y.; Rice, David C.; Mehran, Reza J.; Jimenez, Carlos J.; Grosu, Horiana B.; Ost, David; Eapen, George A.

doi:10.1016/j.athoracsur.2016.09.106

Cited by 36 publications

(20 citation statements)

References 14 publications

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“…Two ongoing prospective trials are investigating the additive value of EBUS-TBNA after PET/CT prior to SBRT (NCT01786590; NCT02719847). If these studies confirm the results of Vial et al [59] by showing an equally low rate of nodal involvement in patients without mediastinal disease on PET/CT and no decrease in regional failures, then we believe an EBUS-TBNA should not be added to the routine diagnostic work-up of all SBRT candidates. The main application of EBUS-TBNA prior to SBRT will be to downstage clinical N1 patients, making them suitable for stereotactic radiotherapy (as shown by Vial et al [59]).…”

Section: Discussionsupporting

confidence: 80%

“…The concordance of PET/CT with EBUS Transbronchial Needle Aspiration (EBUS-TBNA) for intrathoracic nodal assessment prior to SBRT was retrospectively examined by Vial et al [59]. All 246 patients had biopsy proven NSCLC and were potential SBRT candidates with a tumor size smaller than 5 cm with no clinical radiographic evidence of distant metastasis or mediastinal (N2) nodal disease.…”

Section: Discussionmentioning

confidence: 99%

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Nodal recurrence after stereotactic body radiotherapy for early stage non-small cell lung cancer: Incidence and proposed risk factors

Wink

Baardwijk

Troost

et al. 2017

Cancer Treatment Reviews

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Stereotactic body radiotherapy (SBRT) is an alternative to surgery for patients with early stage non-small cell lung cancer (NSCLC) who are inoperable due to comorbid disease or who refuse surgery. SBRT results in an excellent local control rate of more than 90%, which is comparable to surgery, while short and long-term overall toxicity is low. Surgically treated patients are often more extensively staged pre-operatively, e.g. with endobronchial ultrasound and/or mediastinoscopy, and typically undergo intra-operative lymph node dissection or sampling. Occult nodal metastases (ONM), detected by lymph node dissection, have been shown to increase the incidence of regional recurrence (RR) after surgery, which is associated with poor outcome. In patients undergoing SBRT, however, definite pathological nodal staging is lacking and so other ways to identify patients at high risk for ONM and RR are desirable. The aim of this systematic review is to summarize the incidence of, and risk factors for, RR after SBRT and compare these to those after surgery. The available evidence shows the incidence of RR after SBRT or surgery to be comparable, despite more elaborate pre- and intra-operative lymph node evaluation in surgical patients. However, the fact that this finding is based on mostly retrospective studies in which the majority of patients treated with SBRT were inoperable, needs to be taken into consideration. For now, there is no evidence that inoperable clinical stage I patients with no indication of pathological lymph nodes on PET/CT will benefit from more invasive lymph node staging prior to SBRT.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Nodal recurrence after stereotactic body radiotherapy for early stage non-small cell lung cancer: Incidence and proposed risk factors

Wink

Baardwijk

Troost

et al. 2017

Cancer Treatment Reviews

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“…It is therefore not surprising that a combination of the two procedures has now been recommended by a recent European guideline [4]. The adoption of EUS-B-FNA is likely to be increasingly important with greater use of systematic lymph node staging prior to radical [20] or stereotactic treatment of NSCLC [21].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic ultrasound fine-needle aspiration by experienced pulmonologists: a cusum analysis

et al. 2017

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Endobronchial ultrasound transbronchial needle aspiration (EBUS TBNA) is an established, minimally invasive way to sample intrathoracic abnormalities. The EBUS scope can be passed into the oesophagus to perform endoscopic ultrasound with bronchoscope-guided fine-needle aspiration (EUS-B-FNA). In cases of suspected lung cancer, a combination of the two techniques is now recommended by consensus guidelines. EBUS TBNA is usually performed by pulmonologists; however, the learning curve for EUS-B-FNA, which may be performed during the same procedure, has not been described.A multicentre, observational Australian study, using prospectively collected data from three experienced pulmonologists was conducted. Cumulative sum (cusum) analysis was used to generate visual learning curves.A total of 152 target lesions were sampled in 137 patients, with an overall sensitivity for malignancy of 94.8%. The sensitivity for malignant lesions outside of the 2009 International Association for the Study of Lung Cancer lymph node map (largely intraparenchymal lesions) was 92.9%. All three operators were competent by conventional cusum criteria. There was one case of pneumothorax, and no episodes of mediastinitis or oesophageal perforation were observed.Our data suggest that experienced pulmonologists can safely and accurately perform EUS-B-FNA, with a high diagnostic sensitivity for both lymph node and non-nodal lesions.

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“…A study evaluating the additive diagnostic benefit of CP-EBUS when considering SBRT found EBUS-TBNA led to stage shift in 47 out of 266 patients (18%). Patients were upstaged, and therefore considered ineligible for SBRT, but 40 (54%) were also down staged to N0 after EBUS-TBNA, and therefore became SBRT eligible (40). Studies are ongoing (NCT01786590 and NCT02719847) comparing CP-EBUS to PET scan and its additive benefit for use in patients being considered for SBRT.…”

Section: Bronchoscopy and Sbrtmentioning

confidence: 99%

Fiducial marker placement for stereotactic body radiation therapy via convex probe endobronchial ultrasound: a case series and review of literature

et al. 2018

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Convex probe endobronchial ultrasound (CP-EBUS) and stereotactic body radiotherapy (SBRT) are valuable tools in the diagnosis, staging, and treatment of thoracic malignancies. With widespread clinical adoption, novel uses of CP-EBUS beyond mediastinal diagnosis and staging continue to be discovered. SBRT is an attractive treatment strategy in early-stage lung cancer and oligo-metastatic disease of the chest when a surgical approach is either not feasible or desirable. Accurate application of SBRT is aided by the placement of radio-opaque fiducial markers (FM) to compensate for respiratory cycle movements. We describe eight patients with central thoracic lesions, either known or suspected to be malignant, who underwent EBUS bronchoscopy with lesion sampling and successful intralesional placement of modified FM via our technique, review the existing literature on this topic, and discuss the nuances of coding and billing aspects of FM placement.

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Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in the Nodal Staging of Stereotactic Ablative Body Radiotherapy Patients

Cited by 36 publications

References 14 publications

Nodal recurrence after stereotactic body radiotherapy for early stage non-small cell lung cancer: Incidence and proposed risk factors

Nodal recurrence after stereotactic body radiotherapy for early stage non-small cell lung cancer: Incidence and proposed risk factors

Endoscopic ultrasound fine-needle aspiration by experienced pulmonologists: a cusum analysis

Fiducial marker placement for stereotactic body radiation therapy via convex probe endobronchial ultrasound: a case series and review of literature

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