Remediastinoscopy in restaging of lung cancer after induction therapy

Marra, Alessandro; Hillejan, Ludger; Fechner, S.; Stamatis, Georgios

doi:10.1016/j.jtcvs.2007.07.073

Cited by 72 publications

(44 citation statements)

References 26 publications

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“…Because we performed diagnostic tests in a high-prevalence setting of recurrent NSCLC, the increased prevalence resulted in a decreased NPV. However, the NPV was still comparable with previously reported NPVs for remediastinoscopy of 73.3-84.5% (26)(27)(28).…”

Section: Discussionsupporting

confidence: 87%

The Role of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration in the Diagnosis of Recurrent Non-small Cell Lung Cancer after Surgery

et al. 2013

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Objective Obtaining an accurate histopathological diagnosis is mandatory for the optimal treatment of patients who are suspected of having recurrent lung cancer. The purpose of this retrospective study was to investigate the usefulness of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for the diagnosis of recurrent non-small cell lung cancer (NSCLC) among patients who undergo curative surgical resection. Methods Consecutive patients who underwent convex probe EBUS-TBNA for mediastinal or hilar lymph node and peribronchial lung parenchymal lesions between May 2009 and May 2011 were included. The diagnostic sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were calculated on a per-lesion and per-patient basis. Results Forty-two patients who were suspected of having recurrent NSCLC underwent EBUS-TBNA to assess 53 mediastinal and hilar lymph nodes and seven peribronchial lung parenchymal lesions. Among the 60 lesions, recurrence of malignancy was confirmed in 41 lesions on EBUS-TBNA (36 lymph nodes and five peribronchial lung lesions). On a per-lesion basis, the diagnostic sensitivity, specificity, accuracy, PPV and NPV of EBUS-TBNA for confirming recurrence were 95.3%, 100%, 96.6%, 100% and 88.9%, respectively. On a per-person basis, the diagnostic sensitivity, specificity, accuracy, PPV and NPV were 94.3%, 100%, 95.2%, 100% and 77.8%, respectively. No serious complications related to the procedures were observed. Conclusion Convex probe EBUS-TBNA is a sensitive method for diagnosing recurrent NSCLC in patients with lymph node and peribronchial lung parenchymal lesions. Therefore, EBUS-TBNA should be considered first for the cytopathological diagnosis of recurrent NSCLC.

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Section: Discussionsupporting

confidence: 87%

The Role of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration in the Diagnosis of Recurrent Non-small Cell Lung Cancer after Surgery

et al. 2013

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“…This suggests that Med is also able to provide a prognostic information. Other studies reported similar performance characteristics for Med with sensitivity of 61-83%, diagnostic accuracy of 84-91% and NPV of 85% (96)(97)(98)100). One, study however, showed very low sensitivity and diagnostic accuracy of Med, 29% and 60%, respectively, which was presumed to be due to inadequate sampling of station 7 LN in majority of patients (99).…”

Section: Ebus-tbna and Med-role In Lung Cancer Diagnosismentioning

confidence: 78%

“…Both Med and EBUS-TBNA have been used for mediastinal restaging (41,(96)(97)(98)(99)(100)(101)(102). However, performance of both Med and EBUS-TBNA in restaging is worse than in original staging.…”

Section: Ebus-tbna and Med-role In Lung Cancer Diagnosismentioning

confidence: 99%

The role of endobronchial ultrasound versus mediastinoscopy for non-small cell lung cancer

Czarnecka‐Kujawa¹,

Yasufuku²

2017

J. Thorac. Dis.

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This review provides an update on the current role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and mediastinoscopy (Med) in assessment of patients with non-small cell lung cancer (NSCLC). Invasive mediastinal lymph node (LN) staging is the major application for both of these techniques. Up until recently, Med was the gold standard for invasive mediastinal LN staging in NSCLC. However, EBUS-TBNA has shown to be equivalent, and in some studies better than Med for invasive staging of lung cancer. EBUS-TBNA offers access to N1 LNs and development of the thin convex probe EBUS (TCP-EBUS) will expand EBUS-TBNA access from the paratracheal region and central airways to more distal parabronchial regions allowing for more extensive N1 LN assessment and sampling more distal lung tumors. EBUS-TBNA is more cost-effective than Med and it is currently recommended as the test of first choice for invasive mediastinal LN staging in lung cancer. ConfirmatoryMed should be performed selectively in patients with high pretest probability of metastatic disease. Addition of esophageal ultrasound fine needle aspiration (EUS-FNA) may increase diagnostic yield of EBUS-TBNA mediastinal staging. Both Med and EBUS-TBNA can be used in primary lung cancer diagnosis, restaging of the mediastinum following neoadjuvant therapy and in diagnosis of lung cancer recurrence. In the future, a combination of EBUS-TBNA with or without EUS-FNA and Med is most likely going to provide the most optimal invasive assessment of the mediastinum in patients with lung cancer. The decision on test choice and sequence should be made on a case-by-case basis and factoring in local resources and expertise.

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“…The number of removed or biopsied lymph nodes varied in the published series, but was significantly higher, than in the endoscopic needle aspiration techniques. Persisting nodal disease at repeat mediastinoscopy carries a poor survival in the majority of cases because of occult metastases; therefore, indication for surgical intervention in such an unfavourable group of patients should be evaluated very carefully [80,[87][88][89][90].…”

Section: Diagnosis For Mediastinal Nodes (N-status)mentioning

confidence: 99%

Staging of lung cancer: the role of noninvasive, minimally invasive and invasive techniques

Stamatis

2015

Eur Respir J

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Accurate staging and restaging of primary tumour and mediastinal nodes in patients with lung cancer is of significant importance. For primary tumours, computed tomography (CT) scans of the chest are recommended. Positron emission tomography (PET) imaging should be used in patients with curative intent treatment to evaluate metastatic disease. Diagnosis of the primary tumour should be performed using bronchoscopy or CT-guided transthoracic needle aspiration. In patients with enlarged mediastinal nodes and no distant metastasis, invasive staging of the mediastinum is required. For suspicious N2 or N3 disease, endoscopic needle techniques, such as endobronchial ultrasound and transbronchial needle aspiration, oesophageal ultrasound and fine needle aspiration, or a combination of both, are preferred to any surgical staging technique. In cases of suspicious nodes and negative results using needle aspiration techniques, invasive surgical staging using mediastinoscopy or video-assisted thoracic surgery should be performed. In central tumours or N1 nodes, preoperative invasive staging is indicated.Restaging after induction therapy remains a controversial topic. Today, neither CT, PET nor PET/CT scans are accurate enough to make final further therapeutic decisions for mediastinal nodal involvement. An invasive technique providing cytohistological information is still recommended.

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Remediastinoscopy in restaging of lung cancer after induction therapy

Cited by 72 publications

References 26 publications

The Role of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration in the Diagnosis of Recurrent Non-small Cell Lung Cancer after Surgery

The Role of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration in the Diagnosis of Recurrent Non-small Cell Lung Cancer after Surgery

The role of endobronchial ultrasound versus mediastinoscopy for non-small cell lung cancer

Staging of lung cancer: the role of noninvasive, minimally invasive and invasive techniques

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