Role of the Endobronchial Landmarks Guiding TBNA and EBUS-TBNA in Lung Cancer Staging

Abstract

Background. Lung cancer is the leading cause of malignancy related mortality in the United States. Accurate staging of NSCLC influences therapeutic decisions. Transbronchial needle aspiration (TBNA) and endobronchial ultrasound-guided TBNA (EBUS-TBNA) has been accepted as a procedure for the diagnosis and staging of lung cancer. The aim of this study is to evaluate the efficacy and adequacy of TBNA and EBUS-TBNA for sampling of mediastinal adenopathy using the Wang's eleven lymph node map stations. Methods. We retrospectively reviewed 99 consecutive cases diagnosed with malignancy by EBUS-TBNA and a series 74 patients evaluated for mediastinal adenopathy or a pulmonary lesion using conventional transbronchial needle aspiration. The IASLC lymph node map was correlated with Wang's map. Results. A total of 182 lymph node stations were sampled using EBUS-TBNA. 96 were positive for nodal metastasis. A total of four cases of samples taken from station 2R showed malignant cells. From the 74 cases series using cTBNA 167 nodes were sampled in 222 passes. Lymphoid or malignant tissue was obtained in 67 (91.8%) cases; 55.1% of the nodes were 1 cm or less. Conclusions. The use of the eleven stations described in Wang's map to guide TBNA of the mediastinal nodes allows sampling of radiologically considered nonpathological nodes. These data suggest that Wang's map covers the most frequent IASLC nodal stations compromised with metastasis.

Comparison of the SuperARMS and ARMS for detecting EGFR mutations in liquid-based cytology specimens from NSCLC patients

“…Small biopsy or cytological specimens may be a good choice in these patients, while they have no surgical options. The types of non-surgical cytological samples include fine-needle aspiration (FNA), endobronchial ultrasound-guided (EBUS) biopsy, transbronchial needle aspiration (TBNA), bronchoscopic brush (BB) and pleural effusion (PLE), which are reliable for the diagnosis and staging of thoracic malignancy, especially of NSCLC [2][3][4][5][6].…”

Demarcated by bronchial or vascular landmarks? a study on the lower borders of the lower paratracheal lymph nodes

“…We have found that some parts of mediastinal LNs would be downgraded to hilar LNs, very few would be upgraded to mediastinal LNs on the right side, while many mediastinal LNs would be downgraded on the left. Although Wang's map was originally used to guide the biopsy of mediastinal and hilar adenopathy, it's bronchial landmarks can be helpful to complement the problem of IASLC using vessels as the boundaries [15,16].…”

Anesthesia for interventional pulmonology procedures: a review of advanced diagnostic and therapeutic bronchoscopy

“…70 Nevertheless, it is important to highlight the close anatomical relation that exists between major vascular structures and mediastinal lymph nodesi.e., stations in the left lower paratracheal region (4 L, 5, and 6) with the aortic arch and the pulmonary artery; stations in the right lower paratracheal region (4R) with the superior vena cava; and upper paratracheal stations (2R and 2L) with the innominate artery, left common carotid artery, and bilateral innominate veins. 71 The use of colour Doppler ultrasound during EBUS procedures allows for proper identification of vascular structures. 72 Aspirin use does not increase the bleeding risk during biopsies and should not preclude bronchoscopy from taking place.…”