The role of endobronchial ultrasound/esophageal ultrasound for evaluation of the mediastinum in lung cancer

Abstract

The introduction: of ultrasound-based, minimally invasive techniques (Endobronchial Ultrasound guided Transbronchial Needle Aspiration (EBUS-TBNA) and Esophageal Ultrasound guided Fine Needle Aspiration) has revolutionized care of patients with lung cancer needing mediastinal lymph node sampling. When combined, the techniques offer safe and accurate assessment of mediastinum, with accuracy surpassing that of the pervious gold standard - cervical mediastinoscopy. EBUS-TBNA can be used for mediastinal restaging in both, patients with suspected recurrence following treatment for primary lung cancer and followingneoadjuvant therapy in preparation for definitive surgical intervention. Both EBUS-TBNA and esophageal ultrasound guided fine needle aspiration techniques have been shown to provide sufficient material for molecular and DNA testing, extending their role beyond initial evaluation of the mediastinum to help direct and personalize medical treatment and predict response to therapy. In the future, assessing sonographic features of lymph nodesmay become useful in predicting nodal metastasis, further increasing the sensitivity of these techniques for detection of metastatic disease.

Concomitant Mediastinoscopy Increases the Risk of Postoperative Pneumonia After Pulmonary Lobectomy

“…The first paradigm developed by proponents of mediastinoscopy have increased the scope and aggressiveness of this procedure to perform a full mediastinal lymph node dissection using either the mediastinoscopy alone (video assisted mediastinal lymphadenectomy or VAMLA) or combined with a transcervical incision (transcervical extended mediastinal lymphadenectomy or TEMLA)[11–13]. The second paradigm is to avoid mediastinoscopy altogether and rely on endobronchial ultrasound fine needle aspiration (EBUS-FNA) for staging the mediastinum [14]. Discussions of using one modality over the other have included accuracy of staging, invasiveness, adequacy of specimens for molecular testing, recurrent laryngeal nerve injury rate, clinical context and operator dependence [15–17].…”

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

“…Generally, Med is a safe procedure, performed in outpatient setting. Reported Introduction of radial probe endobronchial ultrasound (RP-EBUS) in the early 1990's, has introduced the idea of less invasive mediastinal LN staging in lung cancer (24)(25)(26)(27). Besides its role in diagnosis of peribronchial lesions (28,29) RP-EBUS has been used to guide TBNA in patients with mediastinal lymphadenopathy and in lung cancer mediastinal LN staging.…”

A novel, stepwise approach combining conventional and endobronchial ultrasound needle aspiration for mediastinal lymph node sampling

“…It has superior sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV),[3] and it is expected to continue to reduce the need for mediastinoscopy for evaluation and staging of abnormal mediastinal LNs. [4] However, along with its distinct advantages, this technique bears some limitations. Samples obtained by EBUS-TBNA have often been claimed to be insufficient for the diagnosis of diseases where histological samples are required as with lymphomas (in particular Hodgkin's disease).…”