Mediastinal Sampling with Endobronchial Ultrasound in Cancer Patients: Is It Always Metastatic?

Abstract

Objective. The overall management and prognosis of a cancer patient depends on the histopathology, molecular genetics and staging of the disease. Staging refers to the size and the spread of the cancer. Knowing the stage of the cancer helps us to determine the natural history of the disease and median survival. It also helps us plan the best treatment for the patient. Mediastinal staging with invasive modalities, like endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become important for appropriate tissue sampling in patients with mediastinal involvement in various benign and malignant diseases. Methods.A retrospective, cross-sectional study was done in a single tertiary care cancer centre from January, 2018 to December, 2018.The patients were referred for mediastinal staging and/or for diagnostic evaluation. The procedure EBUS-TBNA with rapid on-site evaluation (ROSE) was done for 123 patients as a day-care procedure in the bronchoscopy suite of the institution.Results. Out of the total of 123 cases that underwent EBUS, 119 patients had an EBUS-TBNA for lymph node assessment. Staging in lung cancer, breast cancer, colon cancer, renal cell carcinoma was done in 63 (52.9%) cases and diagnostic evaluation of either a mediastinal mass lesion or a lung mass with mediastinal extension of lymph nodal involvement was done in 56 (47.1%) cases. Out of the 63 cases those underwent EBUS-TBNA for staging, 39 (61.9%) cases were non metastatic; 15 (38.4%) were diagnosed with granulomatous inflammation and 24 (61.5%) cases had reactive lymphadenitis. The remaining 24 of 63 cases had metastatic disease. Out of the 56 cases for diagnostic evaluation, 17 (30.3%) had granulomatous inflammation, 7 (12.5%) had reactive lymphadenitis and 32 (57.1%) had malignant disease.Conclusions. Tissue pathology is always the crux to label a patient with the appropriate diagnosis. Moreover, accurate tissue sampling is important for mediastinal nodes in a diagnosed malignant disease, like lung cancer and breast cancer. This will help in appropriate staging and choose the proper treatment strategy.