Role of Mediastinoscopy in Pretreatment Staging of Patients with Primary Lung Cancer

Coughlin, Michael J.; Deslauriers, Jean; Beaulieu, M; Fournier, Brigitte; Piraux, Michel; Rouleau, Jacques R.; Tardif, André

doi:10.1016/s0003-4975(10)60348-7

Cited by 181 publications

(79 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These studies describe metastatic lymph nodes to be present at the time of surgery in 15-20% of CT-negative patients [4][5][6].…”

Section: Discussionmentioning

confidence: 99%

“…The inferior mediastinum may be evaluated by thoracoscopy. However, all these more aggressive staging procedures require general anaesthesia, surgical incision, and, therefore, are associated with considerable costs [5,6]. Positron emission tomography (PET) was expected to increase the accuracy of mediastinal staging in nonsmall cell lung cancer (NSCLC), and indeed, a meta-analysis has confirmed its superiority [7].…”

mentioning

confidence: 99%

See 1 more Smart Citation

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

Herth

Ernst²,

Eberhardt³

et al. 2006

European Respiratory Journal

278

161

View full text Add to dashboard Cite

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.

show abstract

“…These studies describe metastatic lymph nodes to be present at the time of surgery in 15-20% of CT-negative patients [4][5][6].…”

Section: Discussionmentioning

confidence: 99%

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

278

161

View full text Add to dashboard Cite

show abstract

“…While a standard cervical mediastinoscopy permits access to paratracheal lymph node stations (levels 2 right (R), 2 left (L), 3, 4R and 4L) and usually the anterior subcarinal lymph node station (level 7), access to the posterior and inferior mediastinum is limited and requires either extended cervical mediastinoscopy or a thoracoscopy. Furthermore, the sensitivity for mediastinoscopy is still only 80-90%, and, in 10-15% of cases, the technique returns a false-negative diagnosis [2,3]. Failure to identify mediastinal disease pre-operatively contributes to tumour relapse rates, despite apparently successful resection.…”

mentioning

confidence: 99%

Endobronchial and endoscopic ultrasound-guided real-time fine-needle aspiration for mediastinal staging

Rintoul

Skwarski²,

Murchison³

et al. 2005

European Respiratory Journal

265

154

View full text Add to dashboard Cite

Accurate staging of the mediastinum in lung cancer is essential for optimising treatment strategies. Conventional transbronchial needle aspiration (TBNA) is a blind procedure, reliant upon prior computed tomography (CT) or ultrasound imaging, but has low sensitivity. The current study reports the initial experience of using a prototype endobronchial ultrasound (EBUS) probe that allows TBNA under real-time imaging.In 20 patients selected by CT scanning, a linear-array ultrasound bronchoscope was used to visualise paratracheal and hilar lymph nodes, and TBNA was performed under direct ultrasonic control. In seven cases, sequential endoscopic ultrasound (EUS) was used to assess posteroinferior mediastinal lymph nodes. All procedures were performed under conscious sedation.EBUS-TBNA was undertaken in 18 out of 20 cases and EUS-guided fine-needle aspiration in six out of seven cases. Cytology showed node (N)2/N3 disease in 11 out of 18 EBUS-TBNA cases and provided a primary diagnosis for eight patients. EBUS-TBNA cytology was negative in six cases, which was confirmed by mediastinoscopy or clinical follow-up in four. EUS provided additional information in all cases. There were no procedural complications. Sensitivity, specificity and accuracy for EBUS-TBNA were 85%, 100% and 89%, respectively.In conclusion, endobronchial ultrasound with real-time transbronchial needle aspiration offers improved sensitivity and accuracy for staging of the middle mediastinum, and, combined with endoscopic ultrasound, should allow investigation of the majority of the mediastinum.

show abstract

“…13,14) It can only sample nodal stations 1-4 and 7, cannot access hilar nodal stations and has a morbidity of 1% and mortality of 0.05% which increases with inexperienced hands. 4,15) In contrast, the EBUS-TBNA procedure is safe and minimally invasive, and does not require general anesthesia or hospitalization.…”

Section: Discussionmentioning

confidence: 99%

The Diagnostic Utility of Real-Time EBUS-TBNA for Hilar and Mediastinal Lymph Nodes in Conventional TBNA Negative Patients

Çetınkaya

Özgül

Tutar

et al. 2014

ATCS

View full text Add to dashboard Cite

Background: There are many causes of mediastinal and hilar lymphadenopathy, such as neoplasms, granulomatous diseases, infections and reactive hyperplasia. Nowadays, the popularity of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is increasing in the diagnosis of mediastinal and hilar lymphadenopathy. We aimed to investigate the diagnostic value of EBUS-TBNA in patients with mediastinal and/or hilar lymphadenopathy and previously conventional TBNA-negative or inadequate results. Methods: Retrospective analysis was performed in 64 patients with previously conventional TBNA-negative or inadequate results and consequently undergoing EBUS-TBNA between July 2007 and August 2011. Results: One hundred and twenty three lymph nodes were sampled by EBUS-TBNA in 64 patients with no complications. In the 63 (98.4%) cases with adequate results, the sensitivity, diagnostic accuracy, and NPV of EBUS-TBNA per patient was 90.5%, 90.6%, and 66.6%, respectively. In a total of 122 (99.1%) adequately sampled lymph nodes, the diagnostic sensitivity, accuracy, and NPV of EBUS-TBNA per nodal station were 87.8%, 90.1%, and 65.7%, respectively. Non-small cell lung cancer (NSCLC) (n = 21, 33.3%) and sarcoidosis (n = 16, 25.3%) were the most common malignant and benign diseases in the patients with adequate samples by EBUS-TBNA. The relationships of diagnostic accuracy with the number of lymph nodes sampled, number of passes per node, or size of lymph nodes were both insignifi cant ( p >0.05). Conclusion: EBUS-TBNA is a sensitive and accurate method for the assessment of mediastinal and hilar lymph nodes in patients with conventional TBNA negative results.

show abstract

Role of Mediastinoscopy in Pretreatment Staging of Patients with Primary Lung Cancer

Cited by 181 publications

References 25 publications

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

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

Endobronchial and endoscopic ultrasound-guided real-time fine-needle aspiration for mediastinal staging

The Diagnostic Utility of Real-Time EBUS-TBNA for Hilar and Mediastinal Lymph Nodes in Conventional TBNA Negative Patients

Contact Info

Product

Resources

About