Remediastinoscopy after induction chemotherapy in non-small cell lung cancer

Mateu-Navarro, Miquel; Rami–Porta, Ramón; Bastús-Piulats, Romà; Cirera-Nogueras, Luis; González-Pont, Guadalupe

doi:10.1016/s0003-4975(00)01437-5

Cited by 113 publications

(67 citation statements)

References 19 publications

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“…Provided N2 disease is confirmed by initial EBUS (or EUS) sampling, restaging after the induction treatment that is of paramount importance to assess the important prognostic factor that is downstaging [22][23][24][25], might then be performed with mediastinoscopy. On the opposite, following initial staging with mediastinoscopy, remediastinoscopy is a difficult surgery performed by a limited number of thoracic surgeons [26,27]. Furthermore, although ultrasound guided needle aspiration may allow confirmation of the persistence of lymph node metastasis, it is not well suited to give a precise staging information such as single versus multiple level N2 disease or presence of extracapsular disease that will be considered as a clear contra-indication to surgical resection.…”

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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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: 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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“…This initial approach may also confer an advantage in the context of multi-modal treatment. Provided N2 disease is confirmed by initial TBNA sampling, re-staging after an induction treatment, which is of paramount importance to assess the important prognostic factor that is downstaging [22][23][24], might be performed with mediastinoscopy without the limitations that this examination shows when it follows a previous one (remediastinoscopy) [25,26].…”

Section: Limitations Of the Studymentioning

confidence: 99%

Endobronchial ultrasound and positron emission tomography positive mediastinal lymph nodes

Plat

Pierard²,

Haller³

et al. 2006

European Respiratory Journal

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Positron emission tomography with 18F-fluoro-2-deoxy-D-glucose (FDG-PET) is more accurate than computed tomography for staging of mediastinal (hilar) lymph nodes. In the case of positive findings, tissue sampling of lymph nodes is required. The diagnostic/staging yield of transbronchial needle aspiration (TBNA) following endobronchial ultrasound (EBUS) localisation was assessed in this particular clinical setting. The number of avoided surgical procedures was evaluated.All consecutive patients referred for staging and/or diagnosis of mediastinal FDG-PET positive lesions were included. Data were prospectively collected. TBNA sampling of lymph nodes was performed after EBUS localisation. If no diagnosis was reached, further surgical sampling or adequate follow-up was performed.From January 2003 to June 2004, 33 patients were included. The average number of TBNA samples per patient was 4.2¡1.5. Cytological or histological diagnoses were obtained in 27 (82%) of the patients, of which 78% were obtained after previous EBUS localisation. In 25 (76%) of the 33 patients, surgical staging procedures were suppressed.In conclusion, transbronchial needle aspiration after endobronchial ultrasound localisation should be considered as a primary method of evaluation of lymph nodes positive by positron emission tomography with 18F-fluoro-2-deoxy-D-glucose, and may replace the majority of surgical mediastinal staging/diagnostic procedures.

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“…Herth and colleagues retrospectively reviewed 124 cases of patients with proven stage IIIA, N2-positive lung cancer who underwent neoadjuvant chemotherapy followed by restaging CP EBUS-TBNA and subsequent surgical resection and lymphadenectomy (41). Although the CP EBUS-TBNA sensitivity in this setting is lower than newly diagnosed patients (76%), the yield paralleled that reported with CM in this setting (70-75%) (42)(43)(44). Similar to lung cancer staging, establishing lymph node involvement in malignant pleural mesothelioma has importance to determine therapeutic options.…”

Section: Lung Cancer Stagingmentioning

confidence: 88%

Advances in Diagnostic Bronchoscopy

Haas

Vachani

Sterman

2010

Am J Respir Crit Care Med

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Diagnostic bronchoscopy has undergone two major paradigm shifts in the last 40 years. First, the advent of flexible bronchoscopy gave chest physicians improved access to the tracheobronchial tree with a rapid learning curve and greater patient comfort compared with rigid bronchoscopy. The second paradigm shift has evolved over the last 5 years with the proliferation of new technologies that have significantly enhanced the diagnostic capabilities of flexible bronchoscopy compared with traditional methods. At the forefront of these new technologies is endobronchial ultrasound. In its various forms, endobronchial ultrasound has improved diagnostic yield for pulmonary masses, nodules, intrathoracic adenopathy, and disease extent, thereby reducing the need for more invasive surgical interventions. Various navigational bronchoscopy systems have become available to increase flexible bronchoscope access to small peripheral pulmonary lesions. Furthermore, various modalities of airway assessment, including optical microscopic imaging technologies, may play significant roles in the diagnosis of a variety of pulmonary diseases in the future. Finally, the combination of new diagnostic bronchoscopy technologies and novel approaches in molecular analysis and biomarker assessment hold promise for enhanced diagnosis and personalized management of many pulmonary disorders. In this review, we provide a contemporary review of diagnostic bronchoscopy developments over the past decade.

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Remediastinoscopy after induction chemotherapy in non-small cell lung cancer

Cited by 113 publications

References 19 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 and positron emission tomography positive mediastinal lymph nodes

Advances in Diagnostic Bronchoscopy

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