Endoscopic ultrasound in lung cancer patients with a normal mediastinum on computed tomography

Wallace, Michael B.; Ravenel, James G.; Block, Mark I.; Fraig, Mostafa; Silvestri, Gerard A.; Wildi, Stephan M.; Schmulewitz, Nathan; Varadarajulu, Shyam; Roberts, Stacey; Hoffman, Brenda J.; Hawes, Robert H.; Reed, Carolyn E.

doi:10.1016/j.athoracsur.2003.10.009

Cited by 143 publications

(96 citation statements)

References 17 publications

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“…In particular, in the setting of staging of NSCLC, where nodal involvement is key to patient management, ultrasound-guided needle aspiration has been found to perform very well, with sensitivities for EUS-FNA of 88-100% [9] and from 92% to 96% for EBUS-TBNA [10,11]. The excellent results were also obtained for normal sized and hilar lymph nodes [12][13][14].…”

Section: Discussionmentioning

confidence: 51%

Endobronchial ultrasound-guided lymph node biopsy with transbronchial needle forceps: a pilot study

Herth

Schüler²,

Gompelmann³

et al. 2011

European Respiratory Journal

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One limitation of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the size of the available needles, frequently yielding only cells for cytological examination. The aim of this pilot study was to evaluate the efficacy and safety of newly developed needle forceps to obtain tissue for the histological diagnosis of enlarged mediastinal lymph nodes.Patients with enlarged, positron emission tomography (PET)-positive lymph nodes were included. The transbronchial needle forceps (TBNF), a sampling instrument combining the characteristics of a needle (bevelled tip for penetrating through the bronchial wall) with forceps (two serrated jaws for grasping tissue) was used through the working channel of the EBUS-TBNA scope. Efficacy and safety was assessed.50 patients (36 males and 14 females; mean age 51 yrs) with enlarged or PET-positive lymph nodes were included in this pilot study. In 48 (96%) patients penetration of the bronchial wall was possible and in 45 patients tissue for histological diagnosis was obtained. In three patients TBNF provided inadequate material. For patients in whom the material was adequate for a histological examination, a specific diagnosis was established in 43 (86%) out of 50 patients (nonsmall cell lung cancer: n524; small cell lung cancer: n57; sarcoidosis: n54; Hodgkin's lymphoma: n54; tuberculosis: n52; and non-Hodgkin's lymphoma: n52).No clinically significant procedure-related complications were encountered.This study demonstrated that EBUS-TBNF is a safe procedure and provides diagnostic histological specimens of mediastinal lymph nodes.

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Section: Discussionmentioning

confidence: 51%

Endobronchial ultrasound-guided lymph node biopsy with transbronchial needle forceps: a pilot study

Herth

Schüler²,

Gompelmann³

et al. 2011

European Respiratory Journal

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“…The pooled sensitivity and specifi city of PET scanning is 74% and 85%, respectively, which is better than CT scanning (51% and 86%, respectively), but PET scan is less sensitive in normal-sized lymph nodes. 2 By EUS, Wallace et al 16 found 14 patients out of 69 (20.3%) with lymph a Indicates statistical signifi cance using a of 0.05. Estimates were calculated using a GEE logistic regression model as described in the "Statistical Analysis" section.…”

Section: Resultsmentioning

confidence: 99%

Using Endobronchial Ultrasound Features to Predict Lymph Node Metastasis in Patients With Lung Cancer

Memoli

El-Bayoumi

Pastis

et al. 2011

Chest

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A ppropriate staging of lung cancer is critical, as it predicts prognosis and dictates treatment. Radiographic staging with CT scan and PET scan can offer clues to the extent of disease, but pathologic confi rmation of malignancy and determination of the TNM stage for non-small cell lung cancer (NSCLC) dictates the treatment choice. 1 In practice, mediastinal lymph node involvement most often differentiates those who are surgical candidates from those who are not. 2 The current methods available to adequately stage the mediastinum include mediastinoscopy, videoassisted thoracoscopy, endoscopic ultrasound (EUS), endobronchial ultrasound (EBUS), transthoracic needle aspiration, and transbronchial needle aspiration. The American College of Chest Physicians practice guidelines state that "tissue should be obtained by whatever method is easiest to perform" depending on the size and location of the lymph node, the availability of the technology, and expertise in the local facility. 1 EBUS and EUS have gained acceptance as dependable procedures to stage lung cancer with comparable accuracy to surgical methods. 1,[3][4][5] The use of ultrasound facilitates the direct visualization of the lymph node during biopsy and may offer information regarding nodal characteristics of malignant nodes.Purpose: Reliable staging of the mediastinum determines TNM classifi cation and directs therapy for non-small cell lung cancer (NSCLC). Our aim was to evaluate predictors of mediastinal lymph node metastasis in patients undergoing endobronchial ultrasound (EBUS). Methods: Patients with known or suspected lung cancer undergoing EBUS for staging were included. Lymph node radiographic characteristics on chest CT/PET scan and ultrasound characteristics of size, shape, border, echogenicity, and number were correlated with rapid on-site evaluation (ROSE) and fi nal pathology. Logistic regression (estimated with generalized estimating equations to account for correlation across nodes within patients) was used with cancer (vs normal pathology) as the outcome. ORs compare risks across groups, and testing was performed with two-sided a of 0.05. Results: Two hundred twenty-seven distinct lymph nodes (22.5% positive for malignancy) were evaluated in 100 patients. Lymph node size, by CT scan and EBUS measurements, and round and oval shape were predictive of mediastinal metastasis. Increasing size of lymph nodes on EBUS was associated with increasing malignancy risk ( P 5 .0002). When adjusted for CT scan size, hypermetabolic lymph nodes on PET scan did not predict malignancy. Echogenicity and border contour on EBUS and site of biopsy were not signifi cantly associated with cancer. In 94.8% of lymph nodes with a clear diagnosis, the ROSE of the fi rst pass correlated with subsequent passes. Conclusions: Lymph node size on CT scan and EBUS and round or oval shape by EBUS are predictors of malignancy, but no single characteristic can exclude a visualized lymph node from biopsy. Further, increasing the number of samples taken is unlikely to signifi cant...

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“…The impact of EUS-FNA is significant in changing the management of patients with GI, pancreatic and pulmonary malignancy often resulting in the avoidance of unnecessary interventions or surgery. 35,36,37 Differentiation and screening for tumors of malignant from benign origin of gastrointestinal tract ( pancreatic, esophageal and gastric) can be done by EUS.…”

Section: Interventional Eus Proceduresmentioning

confidence: 99%

Endoscopic Ultrasound : A New Hope for Patients

Perveen

Dhir²,

Paramasivam³

et al. 2016

J. Bangladesh Coll. Phys.

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Endoscopic ultrasound in lung cancer patients with a normal mediastinum on computed tomography

Cited by 143 publications

References 17 publications

Endobronchial ultrasound-guided lymph node biopsy with transbronchial needle forceps: a pilot study

Endobronchial ultrasound-guided lymph node biopsy with transbronchial needle forceps: a pilot study

Using Endobronchial Ultrasound Features to Predict Lymph Node Metastasis in Patients With Lung Cancer

Endoscopic Ultrasound : A New Hope for Patients

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