Use of Endobronchial Ultrasound and Endoscopic Ultrasound to Stage the Mediastinum in Early-Stage Lung Cancer

Abstract

Lung cancer remains the deadliest cancer, with more than 160,000 deaths and 226,000 newly diagnosed cases estimated in 2012. Because treatment and survival are directly linked to disease stage, accurate staging in all patients is crucial. The proper staging of early-stage lung cancer involves investigation for the presence of metastatic spread via lymph nodes within the thorax. Initial steps include CT and PET. Mediastinoscopy has previously been considered the gold standard for mediastinal lymph node sampling; however, over the past 10 years the use of ultrasound-guided lymph node sampling has been shown to be at least as sensitive, and has the added advantage of being able to access significantly more stations. This article reviews the current standards of lung cancer staging in 2012.

The use of convex probe endobronchial ultrasound-guided transbronchial needle aspiration in a pediatric population: A multicenter study

“…There remain numerous potential advantages for the use of EBUS‐TBNA in the evaluation of intrathoracic abnormalities within the pediatric population. Current pediatric literature often supports the early use of invasive surgical biopsy techniques in the evaluation of mediastinal masses and adenopathy, whereas EBUS‐TBNA remains the first diagnostic test often performed in the adult population . EBUS‐TBNA remains a minimally invasive procedure which can often be performed in an endoscopy suite as an outpatient procedure with less overall associated cost .…”

“…Current pediatric literature often supports the early use of invasive surgical biopsy techniques in the evaluation of mediastinal masses and adenopathy, whereas EBUS‐TBNA remains the first diagnostic test often performed in the adult population . EBUS‐TBNA remains a minimally invasive procedure which can often be performed in an endoscopy suite as an outpatient procedure with less overall associated cost . Invasive surgical procedures such as mediastinosopcy and thoracotomy have been identified as potentially costing 3–7 times more than outpatient endoscopic procedures (even when utilizing general anesthesia for endoscopy) .…”

“…Invasive surgical procedures such as mediastinosopcy and thoracotomy have been identified as potentially costing 3–7 times more than outpatient endoscopic procedures (even when utilizing general anesthesia for endoscopy) . EBUS‐TBNA can be utilized as a restaging procedure (after chemotherapy and/or radiation therapy) without significant concern for increased complication risk, which is in stark comparison to repeat mediastinoscopy or thoracotomy . EBUS‐TBNA has demonstrated an excellent overall sensitivity and diagnostic accuracy allowing for the avoidance of more invasive procedures such as mediastinoscopy or thoracotomy …”

“…In many centers, it has often replaced mediastinoscopy as the firstline diagnostic procedure of choice in the evaluation of intrathoracic lymphadenopathy. 9,11,23 The main potential limitations for widespread acceptance of EBUS-TBNA in the evaluation of mediastinal masses and lymphadenopathy in the pediatric population remain: diameter of the endoscope, need for lesion adjacent to an airway, the ability to perform a diagnostic and therapeutic procedure in one setting, as well as concern for yield from fine needle aspirate specimens to define certain diseases such as lymphoma. The use of adult bronchoscopic equipment in the pediatric population is often a concern as the limiting factor is almost always anatomic size of airways.…”

“…These advancements have led to improved specimen acquisition, decreased complications, and a favorable comparison to “gold standard” surgical biopsy techniques . This experience has led to a significant paradigm shift in how many adult patients with mediastinal and hilar abnormalities presenting to thoracic oncology centers are evaluated and managed . The use of minimally invasive procedures such as endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) have now become the initial diagnostic test for the evaluation of these abnormalities, oftentimes reserving more invasive surgical biopsy procedures such as mediastinoscopy and thoracoscopy for those patients with non‐diagnostic minimally invasive procedures.…”