Ten-year experience with endobronchial ultrasound-guided transbronchial needle aspiration: single center results in mediastinal diagnostic and staging

Rosso, Lorenzo; Ferrero, Stefano; Mendogni, Paolo; Bonaparte, Eleonora; Palleschi, Alessandro; Righi, I.; Montoli, M.; Damarco, Francesco; Tosi, Davide

doi:10.21037/jtd.2017.03.115

Cited by 9 publications

(11 citation statements)

References 15 publications

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“…13,14 Our specificity, PPV, and NPV (100.0%, 100.0%, and 91.5%) were also close to values in other studies of 100.0%, 100.0%, and 78%-97.4%, respectively. [13][14][15][16] Our study further validates the high sensitivity of EBUS-TBNA in the diagnosis of lung cancer and demonstrates that even in smaller programs, EBUB-TBNA can be as effective as mediastinoscopy. Further evaluating our experience, it appears that EBUS-TBNA is rarely conformed with mediastinoscopy, and when mediastinoscopy was used as a confirmatory test, the two procedures gave the same results.…”

Section: Discussionsupporting

confidence: 87%

“…This number is slightly lower than the literature value of 15.33%. 13 We try to minimize non-diagnostic results by taking multiple samples from the same node, but even with good technique, this is one of the major limitations of EBUS-TBNA. In terms of sample quality, mediastinoscopy has the advantage of allowing direct visualization and sampling of the node.…”

Section: Discussionmentioning

confidence: 99%

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Endobronchial ultrasound-guided biopsy for evaluation of suspected lung cancer

Harris

Saha

2019

Asian Cardiovasc Thorac Ann

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Purpose Historically, mediastinoscopy has been the gold standard for lung cancer diagnosis and staging, but mediastinoscopy has many limitations including sensitivity, the limited number of lymph node levels that can be sampled, and safety. Endobronchial ultrasound-guided transbronchial needle aspiration is a relatively new and less-invasive technique being used for lung cancer screening. Many studies have reported that it has similar sensitivity and specificity compared to mediastinoscopy, with a significantly lower complication rate. We performed this review to determine our institution’s experience with endobronchial ultrasound-guided transbronchial needle aspiration in lung cancer diagnosis and staging. Methods We reviewed the last 150 patients with suspected lung cancer who underwent endobronchial ultrasound-guided transbronchial needle aspiration procedures in our institution from May 26, 2016 to August 31, 2017. Results Ninety-seven of the 150 patients had a confirmed diagnosis of malignancy. Forty patients had a diagnosis other than cancer, and 13 had incomplete information or were lost to follow-up. Endobronchial ultrasound-guided transbronchial needle aspiration was correct in diagnosing malignancy or excluding malignant lymph nodes in 92 of the 97 patients with malignancy. Overall, the sensitivity, specificity, positive-predictive value, and negative-predictive value was 94.0%, 100.0%, 100.0%, and 91.5%, respectively. Only 3 complications were reported: 2 patients suffered minor bleeding, and one suffered major bleeding that resulted in cardiac arrest. Conclusions Real-time endobronchial ultrasound-guided transbronchial needle aspiration has a similar sensitivity and specificity to mediastinoscopy in diagnosing malignancy, with fewer complications and more financial benefit.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Endobronchial ultrasound-guided biopsy for evaluation of suspected lung cancer

Harris

Saha

2019

Asian Cardiovasc Thorac Ann

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“…A randomized trial comparing two groups of NSCLC patients who underwent molecular analysis with or without ROSE found no significant difference in terms of sensitivity and adequacy rate ( 57 ). Further investigations confirmed that, if an adequate number of passes per sampled station is performed (usually 3 to 4), it is possible to obtain a full molecular diagnosis of NSCLC regardless of the availability of ROSE ( 37 , 41 , 48 , 53 ). Hence, the use of ROSE is not mandatory, but it should be tailored on the basis of Center experience ( 54 ).…”

Section: Technical Factors Affecting Accuracy Of Mutation Analysis On Ebus-tbna Samplesmentioning

confidence: 91%

“…Biopsy tissue resulted adequate in about 80% of cases. Other trials confirmed the possibility to perform multiple molecular analyses on EBUS-TBNA samples, some reporting a percentage of sample adequacy even superior to 90% ( 38 , 41 , 43 ).…”

Section: Adequacy Of Molecular Genotyping and Pd-l1 Assessment On Samples Obtained By Ebus-tbna: Review Of Literaturementioning

confidence: 92%

“…Jeyabalan et al . ( 39 ) and Rosso and colleagues ( 41 ) analyzed the potential effect produced by the choice of needles of different size; both Authors, however, concluded that, given the comparable results, selection should follow the individual preference of the operator, as suggested by CHEST guidelines ( 54 ).…”

Section: Technical Factors Affecting Accuracy Of Mutation Analysis On Ebus-tbna Samplesmentioning

confidence: 99%

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The role of EBUS-TBNA in lung cancer restaging and mutation analysis

Muriana¹,

Rossetti²

2020

Mediastinum

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In recent years, several molecules targeting specific genetic aberrations were released for the treatment of patients affected by locally advanced and metastatic non-small cell lung cancer (NSCLC), leading to an improvement in survival. Moreover, inhibitors of PD-1 and PD-L1 immune checkpoints showed to improve survival, and they are now indicated as first-line treatment in selected patients. Hence, the collection of adequate samples for diagnosis, staging, genotyping and immunohistochemical analysis is a fundamental step in NSCLC treatment planning. When feasible, EBUS-TBNA is suggested as the first-choice diagnostic tool by most of the guidelines. Several studies demonstrated that mutation analysis is viable with high levels of accuracy on both cytological and histological samples obtained by EBUS-TBNA. No technical factor (type of needle, number of passes, use of rapid-on-site-examination, material processing, detection method) has been identified as uniquely influencing the diagnostic yield of molecular analysis. EBUS-TBNA demonstrated to be useful for the restaging of patients affected by locally advanced NSCLC who underwent induction chemotherapy or chemo-radiotherapy, as well as in those who show acquired resistance to targeted therapy and immunotherapy. Nevertheless, most authors agree that a high number of false negative results should be expected due to the likely presence of necrosis and fibrosis induced by neoadjuvant treatments. Therefore, in case of EBUS-TBNA negative sample, pathologic confirmation by surgical biopsy is recommended for the planning of definitive treatment. As suggested by a few preliminary experiences, a wide application of next-generation sequencing (NGS) on EBUS-TBNA specimens will lead to the development of better tailored treatments with simultaneous identification of a large number of gene alterations on a single sample at the time of diagnosis.

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