Endoscopic Ultrasound–Guided Fine-Needle Aspiration in the Diagnosis and Staging of Lung Cancer and Its Impact on Surgical Staging

Annema, Jouke T.; Versteegh, Michel I.M.; Veselic, Maud; Voigt, Pieter; Rabe, Klaus F.

doi:10.1200/jco.2005.01.1965

Cited by 174 publications

(99 citation statements)

References 23 publications

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“…If selection is done by CT scan on the basis of lymph node short-axis >1 cm, one may expect that on the average, larger lymph nodes will be explored than when PET scan is used. Indeed, in the largest study on the staging of CT enlarged mediastinal lymph nodes using oesophageal ultrasound with fine needle aspiration, the mean size of sampled lymph nodes was 24 mm [13]. Despite differences in lymph node size and the fact that the latter study used rapid on-site cytological examination, both this latter and the present studies showed similar sensitivities and specificities of ultrasound guided sampling in the context of similar prevalence of lymph node metastasis.…”

Section: Discussionsupporting

confidence: 49%

“…The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated using the standard definitions, excluding patients in whom surgery was not undertaken to verify non contributive TBNA results. False-positive aspirations were considered unlikely and no surgical verification was then performed [13]. In fact, the main source of false positive result is likely to be a lung tumour abutting the main tracheo-bronchial tree but none of our patients showed this condition.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2008

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SummaryIn the staging of lung cancer with positron emission tomography (PET) positive mediastinal lymph nodes, tissue sampling is required. The performance of transbronchial needle aspiration (TBNA) using linear endobronchial ultrasound (real-time EBUS-TBNA) under local anaesthesia and the value of PET for prediction of pathological results were assessed in that setting. The number of eluded surgical procedures was evaluated. All consecutive patients with suspected/proven lung cancers and FDG-PET positive mediastinal adenopathy were included. If no diagnosis was reached, further surgical sampling was required. Lymph node SUVmax (maximum standardized uptake value) was assessed in patients whose PET was performed in the leading centre. One hundred and six patients were included. The average number of TBNA samples per patient was 4.9 ±1.1. The prevalence of lymph node metastasis was 58%. Sensitivity, accuracy and negative predictive value of EBUS-TBNA in the staging of mediastinal hot spots were 95, 97 and 91%. Patients without malignant lymph node involvement showed lower SUVmax (respective median values of 3.7 and 10.0; p < 0.0001 ). Surgical procedures were eluded in 56% of the patients. Real-time EBUS-TBNA should be preferred over mediastinoscopy as the first step procedure in the staging of PET mediastinal hot spots in lung cancer patients. In case of negative EBUS, surgical staging procedure should be undertaken. The addition of SUVmax cut-off may allow further refinement but needs validation.

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Section: Discussionsupporting

confidence: 49%

Section: Discussionmentioning

confidence: 99%

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

et al. 2008

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“…Endoscopic ultrasound (EUS)-guided fine-needle aspiration has been reported as an endoscopic option to evaluate the mediastinum [9][10][11][12]. Unfortunately, it does not allow for airway inspection during the procedure.…”

mentioning

confidence: 99%

Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically normal mediastinum

Herth

Ernst²,

Eberhardt³

et al. 2006

European Respiratory Journal

279

161

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Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) can sample enlarged mediastinal lymph nodes in patients with nonsmall cell lung cancer (NSCLC). To date, EBUS-TBNA has only been used to sample nodes visible on computed tomography (CT). The aim of the present study was to determine the accuracy of EBUS-TBNA in sampling nodes f1 cm in diameter.NSCLC patients with CT scans showing no enlarged lymph nodes (no node .1 cm) in the mediastinum underwent EBUS-TBNA. Identifiable lymph nodes at locations 2r, 2l, 4r, 4l, 7, 10r, 10l, 11r and 11l were aspirated. All patients underwent subsequent surgical staging. Diagnoses based on aspiration results were compared with those based on surgical results.In 100 patients (mean age 58.9 yrs; 68 males), 119 lymph nodes ranging 5-10 mm in size were detected and sampled. Malignancy was detected in 19 patients but missed in two; all diagnoses were confirmed by surgical findings. The mean diameter of the punctured lymph nodes was 8.1 mm. The sensitivity of EBUS-TBNA for detecting malignancy was 92.3%, specificity was 100%, and the negative predictive value was 96.3%. No complications occurred.In conclusion, endobronchial ultrasound-guided transbronchial needle aspiration can accurately sample even small mediastinal nodes, therefore avoiding unnecessary surgical exploration in one out of six patients who have no computed tomography evidence of mediastinal disease. Potentially operable patients with no signs of mediastinal involvement on computed tomography may benefit from pre-surgical endobronchial ultrasound-guided transbronchial needle aspiration and staging.

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“…The dedicated ultrasound scanner, mounted on a side viewing videogastroscope enables tissue visualization at a radius of 2-10 cm around the esophagus. The sensitivity of EUS-FNA has been reported to range between 74 and 92 % [29][30][31]. Two recent meta-analyses, combining more than 1000 patients have determined the sensitivity to be closer to 83-84 % [5,25].…”

Section: Eus-fnamentioning

confidence: 99%

Mediastinoscopy in the era of endobronchial ultrasound: when should it be performed?

Hanna

Yasufuku

2012

Curr Respir Care Rep

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Accurate mediastinal lymph node staging is critical for patients with non-small cell lung cancer (NSCLC). Although cervical mediastinoscopy has been regarded as the method of choice for mediastinal staging in NSCLC, emergence of minimally invasive sonography, for example endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound fine needle aspiration (EUS-FNA), has led to questions about the routine use of mediastinoscopy. EBUS-TBNA has access to all the mediastinal lymph nodes accessible by mediastinoscopy but also extends to the N1 nodes. EUS-FNA enables access to paraesophageal (station 8) and pulmonary ligament (station 9) lymph nodes, which are not accessible by either mediastinoscopy or EBUS-TBNA. On the basis of current evidence, sonographic staging is the recommended choice for patients with high pretest probability of lymph node metastatic involvement; all negative results should, however, be verified by mediastinoscopy, especially in centers with low expertise. For patients with low pretest probability, mediastinoscopy may be omitted.

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Endoscopic Ultrasound–Guided Fine-Needle Aspiration in the Diagnosis and Staging of Lung Cancer and Its Impact on Surgical Staging

Abstract: EUS-FNA qualifies as the initial staging procedure of choice for patients with (suspected) lung cancer and enlarged mediastinal LNs. Implementation of EUS-FNA in staging algorithms for lung cancer might reduce the number of surgical staging procedures considerably.

Cited by 174 publications

References 23 publications

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

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

Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically normal mediastinum

Mediastinoscopy in the era of endobronchial ultrasound: when should it be performed?

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