A prospective controlled trial of endobronchial ultrasound-guided transbronchial needle aspiration compared with mediastinoscopy for mediastinal lymph node staging of lung cancer

OBJECTIVE: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive diagnostic test with a high diagnostic yield for suspicious central pulmonary lesions and for mediastinal lymph node staging. The main objective of this study was to describe the diagnostic yield of EBUS-TBNA for mediastinal lymph node staging in patients with suspected lung cancer. METHODS: Prospective study of patients undergoing EBUS-TBNA for diagnosis. Patients ≥ 18 years of age were recruited between July of 2010 and August of 2013. We recorded demographic variables, radiological characteristics provided by axial CT of the chest, location of the lesion in the mediastinum as per the International Association for the Study of Lung Cancer classification, and definitive diagnostic result (EBUS with a diagnostic biopsy or a definitive diagnostic method). RESULTS: Our analysis included 354 biopsies, from 145 patients. Of those 145 patients, 54.48% were male. The mean age was 63.75 years. The mean lymph node size was 15.03 mm, and 90 lymph nodes were smaller than 10.0 mm. The EBUS-TBNA method showed a sensitivity of 91.17%, a specificity of 100.0%, and a negative predictive value of 92.9%. The most common histological diagnosis was adenocarcinoma. CONCLUSIONS: EBUS-TBNA is a diagnostic tool that yields satisfactory results in the staging of neoplastic mediastinal lesions.

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Role of endobronchial ultrasound-guided transbronchial needle aspiration for mediastinal lymph node staging of lung cancer

Thoracic Cancer ◽

10.1111/j.1759-7714.2010.00004.x ◽

2010 ◽

Vol 1 (1) ◽

pp. 2-3 ◽

Cited By ~ 5

Author(s):

Eric Lim ◽

Pallav L. Shah

Keyword(s):

Lung Cancer ◽

Lymph Node ◽

Mediastinal Lymph Node ◽

Needle Aspiration ◽

Endobronchial Ultrasound ◽

Lymph Node Staging ◽

Ultrasound Guided ◽

Transbronchial Needle Aspiration

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Endobronchial ultrasound-guided transbronchial needle aspiration for lung cancer staging: early experience in Brazil,

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37132015000100004 ◽

2015 ◽

Vol 41 (1) ◽

pp. 23-30 ◽

Cited By ~ 5

Author(s):

Viviane Rossi Figueiredo ◽

Paulo Francisco Guerreiro Cardoso ◽

Márcia Jacomelli ◽

Sérgio Eduardo Demarzo ◽

Addy Lidvina Mejia Palomino ◽

...

Keyword(s):

Lung Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Cancer Staging ◽

Accurate Method ◽

Needle Aspiration ◽

Endobronchial Ultrasound ◽

Lymph Node Staging ◽

Ultrasound Guided ◽

Transbronchial Needle Aspiration

Objective: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive, safe and accurate method for collecting samples from mediastinal and hilar lymph nodes. This study focused on the initial results obtained with EBUS-TBNA for lung cancer and lymph node staging at three teaching hospitals in Brazil. Methods: This was a retrospective analysis of patients diagnosed with lung cancer and submitted to EBUS-TBNA for mediastinal lymph node staging. The EBUS-TBNA procedures, which involved the use of an EBUS scope, an ultrasound processor, and a compatible, disposable 22 G needle, were performed while the patients were under general anesthesia. Results: Between January of 2011 and January of 2014, 149 patients underwent EBUS-TBNA for lymph node staging. The mean age was 66 ± 12 years, and 58% were male. A total of 407 lymph nodes were sampled by EBUS-TBNA. The most common types of lung neoplasm were adenocarcinoma (in 67%) and squamous cell carcinoma (in 24%). For lung cancer staging, EBUS-TBNA was found to have a sensitivity of 96%, a specificity of 100%, and a negative predictive value of 85%. Conclusions: We found EBUS-TBNA to be a safe and accurate method for lymph node staging in lung cancer patients.

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Mediastinal lymph node staging by EBUS-TBNA and CT: Characteristics of lymph node enlargement caused by anthracosis and other benign conditions

International Journal of Diagnostic Imaging ◽

10.5430/ijdi.v1n2p64 ◽

2014 ◽

Vol 1 (2) ◽

pp. 64

Author(s):

Johannes Kirchner ◽

Michael Broll ◽

Philipp Müller ◽

Esther Maria Kirchner ◽

Natalia Pomjanski ◽

...

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Mediastinal Lymph Node ◽

Needle Aspiration ◽

Endobronchial Ultrasound ◽

Control Group ◽

Lymph Node Staging ◽

Ultrasound Guided ◽

Transbronchial Needle Aspiration ◽

Lymph Node Enlargement

Objectives: Aim of this comparative study was to assess the accuracy of computed tomography (CT) and endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) for mediastinal lymph node staging in cases of lymph node enlargement due to anthracosis and other benign conditions. Methods: In a retrospective analysis we report on the MSCT findings of 39 patients (28 males, 11 females) with EBUS-TBNA confirmed diagnosis of 53 enlarged lymph nodes due to anthracosis. A control group comprised 20 consecutive patients with 27 enlarged lymph nodes (11 males, 9 females) due to chronic lymphadenopathy (n = 14) or sarcoidosis (n = 13). Results: No significant differences were observed between the two groups regarding size (mean short axis diameter 13.7mm vs. 14.5mm), shape (most often oval) or presence of lymph node confluence (32.1% vs. 33.3%), contrast enhancement (3.8% vs. 3.7%), and fatty involution (3.8% vs. 3.7%). In comparison with the control group anthracotic lymph nodes were significantly less often ill-defined in EBUS (5.7 vs. 25.9, p = 0.025) as well as in CT (1.9% vs. 18.5%, p = 0.01), but more often showed calcifications in CT (24.5% vs. 3.7%, p = 0.017). Lymph node colliquation was seen neither in anthracosis nor in other benign conditions. Conclusions: Mediastinal lymph node enlargement due to anthracosis, lymphadenopathy and sarcoidosis show some different findings in EBUS and CT but cannot definitely be differentiated. Advances in knowledge: Radiologists should be aware of mediastinal lymph node enlargement due to anthracosis.

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Mediastinal lymph node staging in patients with non-small cell lung cancer (NSCLC) with F18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT).

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e17503 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e17503-e17503

Author(s):

Miriam Mendez ◽

Constanza Maximiano ◽

Miriam Huelves ◽

Bernard Gaston Doger de Speville ◽

Patricia Ibeas ◽

...

Keyword(s):

Lung Cancer ◽

Lymph Node ◽

Mediastinal Lymph Node ◽

Tumor Resection ◽

Needle Aspiration ◽

Endobronchial Ultrasound ◽

Western World ◽

Lymph Node Staging ◽

Transbronchial Needle Aspiration ◽

The Relationship

e17503 Background: Lung cancer is the leading cause of cancer-related deaths in the Western world. CT and mediastinoscopy are the standard for staging modalities in recent years; PET has emerged as a complement to other techniques. Mediastinal lymph node (MLN) staging is important because it establishes subsequent treatment. The aim of the present study is to analyze the relationship between mediastinal staging by endobronchial ultrasound-guided transbronchial needle aspiration, mediastinoscopy, lymphadenectomy and PET. It also analyzes the patient characteristics like age, sex, histology. Methods: The study prospectively evaluated 42 patients from August 2009 to March 2011. All of them had MLN staging by PET and pathology (tumor resection with systematic lymph node dissection, transbronchial needle aspiration or mediastinoscopy). Univariable date analysis was conducted using Pearson's chi-square test. P values were considered statistically significant if <0.05. Results: The study group comprised 42 patients, 83% men and 17% female, mean age of 66 years. The primary tumor cell type: 45% squamous cell, 33% adenocarcinoma and 19% large cells. 40 patients were smoking. The most frequent location of tumor was upper lobes (58%). The most common stage found after surgery was stage I (42%), stage II (19%), stage III (A: 29%, B: 5%) and stage IV (5%). The kappa statistic for diagnostic agreement between CT and PET was 0.53 (p<0.001). About MLN staging, PET has a sensitivity of 61% and specificity of 53% , positive predictive value 61% and negative 53%. Conclusions: The present study attempts to find the relationship between tumor involvement found in PET and resected tumor specimens obtained from the mediastinum. Our sensitivity and specificity were not concordant with those previously reported; this may be due to the learning curve at our center or the shortness of our series. In contrast we conducted histological examination of all involved MLNs, supporting our data and shows that this confirmation can lead to a change of therapeutic strategy in some cases.

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The Techniques of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e31820c91a7 ◽

2011 ◽

Vol 6 (1) ◽

pp. 57-64 ◽

Cited By ~ 11

Author(s):

Takahiro Nakajima ◽

Kazuhiro Yasufuku

Keyword(s):

Lymph Node ◽

Diagnostic Yield ◽

Mediastinal Lymph Node ◽

Needle Aspiration ◽

Endobronchial Ultrasound ◽

Lymph Node Staging ◽

Ultrasound Guided ◽

Surgical Biopsy ◽

Transbronchial Needle Aspiration ◽

High Diagnostic Yield

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive modality for mediastinal lymph node staging in lung cancer patients as well as for the diagnosis of mediastinal and hilar adenopathy. The high diagnostic yield of EBUS-TBNA for lymph node staging has been shown in systematic reviews and meta-analysis. It has attracted physicians and surgeons as an alternative modality to surgical biopsy for the assessment of patients with enlarged mediastinal and/or hilar lymph nodes. Cell blocks obtained by EBUS-TBNA can be applicable not only for pathologic diagnosis but also for further investigations such as immunohistochemistry and fluorescence in situ hybridization. In addition, samples obtained by EBUS-TBNA can also be used for molecular analysis. Unlike regular bronchoscopy, EBUS-TBNA uses the convex probe EBUS with an ultrasound probe on the tip of a flexible bronchoscope. It is important for the bronchoscopist to fully understand the mediastinal anatomy and be able to correlate it with the ultrasound images for a successful EBUS-TBNA. The dedicated transbronchial needle used for EBUS-TBNA is somewhat different from an ordinary transbronchial biopsy forceps. Training is mandatory for achieving high diagnostic yield without complications. The learning curve of EBUS-TBNA is different from each physician, and continuous training program will be needed for impartiality. This article explains the detailed techniques of EBUS-TBNA to master this innovative procedure.

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