The accuracy of EUS-FNA in assessing mediastinal lymphadenopathy and staging patients with NSCLC

Caddy, Grant R.; Conron, Matthew; Wright, Gavin; Desmond, Paul; Hart, David; Chen, R Y

doi:10.1183/09031936.05.00092104

Cited by 55 publications

(31 citation statements)

References 30 publications

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“…The results from this study showing 92% sensitivity and 93% accuracy for PNB of hilar lesions are comparable to the sensitivity and accuracy rates of EUS-guided FNAB (92%-97%) and endobronchial ultrasound-guided FNAB (92%-98%). 22,[30][31][32][33][34] The reported complication rates associated with EUS-guided and endobronchial ultrasound-guided FNAB are very low overall, and complications relating to pneumothorax and thoracostomy tube placement have not been encountered for sampling of mediastinal and hilar lesions. 35,36 When endobronchial ultrasound-guided FNAB is used for sampling of peripheral lung lesions, the reported pneumothorax rate can be up to 8%.…”

Section: Discussionmentioning

confidence: 99%

Accuracy and sensitivity of computed tomography‐guided percutaneous needle biopsy of pulmonary hilar lymph nodes

Avritscher

Krishnamurthy

Ensor

et al. 2010

Cancer

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BACKGROUND: Because of their proximity to the pulmonary artery or vein, hilar lymph nodes are routinely biopsied with endobronchial or endoscopic ultrasonography (EUS)-guided fine-needle aspiration biopsy (FNAB). Computed tomography (CT)-guided percutaneous needle biopsy (PNB) allows the operator to acquire a larger core needle biopsy (CNB) when initial samples are inconclusive, when the suspected disease is not optimally diagnosed with FNAB, or when biomarkers are required. The purpose of this study was to retrospectively evaluate the sensitivity and accuracy of CT-guided PNB in patients with hilar adenopathy. METHODS: The authors identified 80 patients who underwent 81 CT-guided PNBs of pulmonary hilar lesions from October 2002 through December 2006 and retrospectively reviewed their medical and imaging records. The PNB sensitivity and accuracy were calculated in each case, and each case was reviewed for complications, including pneumothorax and subsequent thoracostomy tube insertion. RESULTS: PNB included FNAB and CNB in 81 (100%) and 14 (17%) procedures, respectively. Data on 69 PNB specimens (67 FNAB specimens and 13 CNB specimens) were available for statistical analysis. Overall, PNB had a sensitivity of 91.4% (95% confidence interval [CI], 81.0%-97.1%) and an accuracy rate of 92.8% (95% CI, 83.9%-97.1%). Pneumothoraxes occurred in 39 patients (48%), 26 (32%) of whom required thoracostomy tube insertion. CONCLU-SIONS: CT-guided PNB of pulmonary hilar lesions has high sensitivity and accuracy and represents a viable alternative for endobronchial ultrasound-or EUS-guided FNAB when larger biopsy samples are required for diagnosis or biomarker analysis. However, the procedure can result in high rates of pneumothorax.

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Section: Discussionmentioning

confidence: 99%

Accuracy and sensitivity of computed tomography‐guided percutaneous needle biopsy of pulmonary hilar lymph nodes

Avritscher

Krishnamurthy

Ensor

et al. 2010

Cancer

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“…The probability of performing endoscopic ultrasound for the analysis of the posterior lymph nodes or even preferring this method over video-assisted thoracoscopy is a reality in many countries (8,9,29,30) and a near-future perspective in Brazil.…”

Section: Discussionmentioning

confidence: 99%

Utilização conjunta de mediastinoscopia cervical e videotoracoscopia para a avaliação linfática mediastinal em pacientes com carcinoma de pulmão não-pequenas células

et al. 2009

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OBJETIVO: Avaliar a eficácia da utilização conjunta de mediastinoscopia cervical e videotoracoscopia para a amostragem linfonodal mediastinal em pacientes com câncer de pulmão não-pequenas células (CPNPC) candidatos à ressecção pulmonar. MÉTODOS: Uma amostra de 62 pacientes com diagnóstico de CPNPC foi submetida à mediastinoscopia cervical e à videotoracoscopia. As amostras obtidas (das cadeias paratraqueais, cadeia subcarinal anterior e posterior, cadeias paraesofágicas e ligamento pulmonar) foram submetidas a exame de congelação. Foram também avaliadas as seguintes variáveis: idade, sexo, perda ponderal, método diagnóstico, achados tomográficos, tipo histológico, estadiamento, localização e tamanho do tumor primário. RESULTADOS: Em 11 pacientes, a mediastinoscopia não apresentou comprometimento da cadeia subcarinal, enquanto esse envolvimento foi detectado na videotoracoscopia: valor preditivo positivo = 88,89% (IC95%: 51,75-99,72); valor preditivo negativo = 94,34% (IC95%: 84,34-98,82); prevalência = 17,74% (IC95%: 9,2-29,53); sensibilidade = 72,73% (IC95%: 39,03-93,98); e especificidade = 98,77% (IC95%: 93,31-99,97). Em 60% dos pacientes com comprometimento da porção posterior da cadeia subcarinal, o tumor primário estava no lobo inferior direito (p = 0,029). CONCLUSÕES: A utilização conjunta da mediastinoscopia cervical e videotoracoscopia para avaliação linfática mediastinal posterior se mostrou um método eficaz. Quando o acesso às cadeias posteriores não for possível através de ultrassom com biópsia transbrônquica ou transesofágica, que prescinde de anestesia geral, esse deve ser o método de escolha para a correta avaliação linfática mediastinal em pacientes com CPNPC.

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“…In contrast, both TBNA and EUS-FNA are minimally invasive and can be performed in the outpatient setting under local anesthesia and sedation. EUS-FNA permits real-time visualization of needle sampling and has been shown to be highly accurate in the mediastinal staging of lung cancer, as well as in the diagnosis of mediastinal lymphadenopathy of unknown etiology [6,[12][13][14][15][16][17][18] . The development of EBUS-TBNA for mediastinal lymph nodes has lagged behind EUS-FNA by more than a decade [19,20] .…”

Section: Discussionmentioning

confidence: 99%

First endoscopic procedure for diagnosis and staging ofmediastinal lymphadenopathy

Khoo¹,

Ho²,

Khor³

et al. 2009

WJG

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AIM:To compare a first diagnostic procedure of trans bronchial needle aspiration (TBNA) with selection of endoscopic ultrasoundguided fineneedle aspiration (EUSFNA) or TBNA for mediastinal lymphadenopathy. METHODS:Sixty-eight consecutive patients with mediastinal lymphadenopathy on computed tomography (CT), who required cytopathological diagnosis, were recruited. The first 34 underwent a sequential approach in which TBNA was performed first, followed by EUS FNA if TBNA was unrevealing. The next 34 underwent a selective approach where either TBNA or EUS-FNA was selected as the first procedure based on the CT findings. RESULTS:The diagnostic yield of TBNA as the first diagnostic procedure in the sequential approach was 62%. In the selective approach, the diagnostic yield of the first procedure was 71%. There was no significant difference in the overall diagnostic yield, but there were significantly fewer combined procedures with the selective approach. CONCLUSION:Selecting either EUS-FNA or TBNA as the first diagnostic procedure achieved a comparable diagnostic yield with significantly fewer procedures than performing TBNA first in all patients.

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The accuracy of EUS-FNA in assessing mediastinal lymphadenopathy and staging patients with NSCLC

Cited by 55 publications

References 30 publications

Accuracy and sensitivity of computed tomography‐guided percutaneous needle biopsy of pulmonary hilar lymph nodes

Accuracy and sensitivity of computed tomography‐guided percutaneous needle biopsy of pulmonary hilar lymph nodes

Utilização conjunta de mediastinoscopia cervical e videotoracoscopia para a avaliação linfática mediastinal em pacientes com carcinoma de pulmão não-pequenas células

First endoscopic procedure for diagnosis and staging ofmediastinal lymphadenopathy

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