The Challenge of Mediastinal Staging

2011 ◽  
Vol 07 (01) ◽  
pp. 31 ◽  
Author(s):  
Loris Ceron ◽  
Lucio Michieletto ◽  
Andrea Zamperlin ◽  
Laura Mancino ◽  
◽  
...  
Keyword(s):  
Imaging Techniques ◽  
Diagnostic Procedures ◽  
Cancer Staging ◽  
Needle Aspiration ◽  
Nodal Metastasis ◽  
Endobronchial Ultrasound ◽  
Transbronchial Needle Aspiration ◽  
Predictive Values ◽  
Mediastinal Staging ◽  
Positron Emission

Lung cancer staging is a crucial step in both correct prognosis and therapy. Mediastinal staging in particular is usually accomplished using imaging techniques such as computed tomography and 18F–glucose positron-emission tomography, minimally invasive techniques, i.e. transbronchial needle aspiration with or without ultrasound guidance (endobronchial ultrasound) and transoesophageal ultrasound-guided fine needle aspiration and surgical procedures, i.e. mediastinoscopy, thoracoscopy. Each of these techniques has its own sensitivities, specificities and predictive values that must be thoroughly considered within the staging route, with the aim of achieving the best result with the least resource consumption and the least discomfort to the patient; the correct evaluation of a negative result on the basis of its predictive value is essential as well. In this article we suggest a mathematical model that can predict the probability of nodal metastasis after a certain number of diagnostic procedures has been performed, providing an objective way of evaluating whether a patient is fit for surgery or, conversely, whether further investigations are required.

scholarly journals Role of the Endobronchial Landmarks Guiding TBNA and EBUS-TBNA in Lung Cancer Staging

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
S. Arias ◽  
Q. H. Liu ◽  
B. Frimpong ◽  
H. Lee ◽  
D. Feller-Kopman ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Lymph Node ◽  
Cancer Staging ◽  
The United States ◽  
Needle Aspiration ◽  
Nodal Metastasis ◽  
Endobronchial Ultrasound ◽  
Transbronchial Needle Aspiration ◽  
Therapeutic Decisions ◽  
Mediastinal Adenopathy

Background. Lung cancer is the leading cause of malignancy related mortality in the United States. Accurate staging of NSCLC influences therapeutic decisions. Transbronchial needle aspiration (TBNA) and endobronchial ultrasound-guided TBNA (EBUS-TBNA) has been accepted as a procedure for the diagnosis and staging of lung cancer. The aim of this study is to evaluate the efficacy and adequacy of TBNA and EBUS-TBNA for sampling of mediastinal adenopathy using the Wang’s eleven lymph node map stations. Methods. We retrospectively reviewed 99 consecutive cases diagnosed with malignancy by EBUS-TBNA and a series 74 patients evaluated for mediastinal adenopathy or a pulmonary lesion using conventional transbronchial needle aspiration. The IASLC lymph node map was correlated with Wang’s map. Results. A total of 182 lymph node stations were sampled using EBUS-TBNA. 96 were positive for nodal metastasis. A total of four cases of samples taken from station 2R showed malignant cells. From the 74 cases series using cTBNA 167 nodes were sampled in 222 passes. Lymphoid or malignant tissue was obtained in 67 (91.8%) cases; 55.1% of the nodes were 1 cm or less. Conclusions. The use of the eleven stations described in Wang’s map to guide TBNA of the mediastinal nodes allows sampling of radiologically considered nonpathological nodes. These data suggest that Wang’s map covers the most frequent IASLC nodal stations compromised with metastasis.

Mediastinal Nodular Lymphocyte Predominant Hodgkin Lymphoma Achieved by Endoscopic Transesophageal Cryobiopsy

Respiration ◽  
2021 ◽  
pp. 1-5
Author(s):  
Zan-Sheng Huang ◽  
Dong Zhou ◽  
Jing Zhang ◽  
Wan-Lei Fu ◽  
Jing Wang ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Diagnostic Yield ◽  
Cancer Staging ◽  
Needle Aspiration ◽  
Sample Volume ◽  
Small Sample ◽  
Endobronchial Ultrasound ◽  
Ultrasound Guided ◽  
Transbronchial Needle Aspiration ◽  
Initial Sampling

Guidelines have recommended endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound-guided fine-needle aspiration biopsy as initial sampling approaches of mediastinal lymph nodes for lung cancer staging. However, the small sample volume might restrict the diagnostic utility of needle aspiration in certain mediastinal diseases. We have recently shown that transbronchial mediastinal cryobiopsy, which is capable of providing larger amounts of intact tissue, improves diagnostic yield in rare tumors and benign diseases compared to EBUS-TBNA. Here, we present a case of mediastinal nodular lymphocyte predominant Hodgkin lymphoma successfully diagnosed by endoscopic transesophageal cryobiopsy.

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

2015 ◽  
Vol 41 (1) ◽  
pp. 23-30 ◽  
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.

scholarly journals The role of sonographic patterns during endobronchial ultrasound-transbronchial needle aspiration for lung cancer staging: a narrative review

Mediastinum ◽  
2021 ◽  
Vol 5 ◽  
pp. 8-8
Author(s):  
Mario Nosotti ◽  
Michele Ferrari ◽  
Ilaria Righi ◽  
Paolo Mendogni ◽  
Francesco Damarco ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Staging ◽  
Needle Aspiration ◽  
Narrative Review ◽  
Endobronchial Ultrasound ◽  
Transbronchial Needle Aspiration ◽  
Sonographic Patterns

Concordance Between Rapid On-Site Evaluation and Final Cytologic Diagnosis in Patients Undergoing Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Non-Small Cell Lung Cancer Staging

2019 ◽  
Author(s):  
Cristina Caupena ◽  
Lluis Esteban ◽  
Angels Jaen ◽  
Bienvenido Barreiro ◽  
Raquel Albero ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Staging ◽  
Final Diagnosis ◽  
Needle Aspiration ◽  
Concordance Rate ◽  
Endobronchial Ultrasound ◽  
Ultrasound Guided ◽  
Transbronchial Needle Aspiration ◽  
Site Evaluation ◽  
A Prospective Study

Abstract Objectives In patients with lung cancer undergoing mediastinal staging through endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), decisions are based on rapid on-site evaluation (ROSE) findings. We aimed to analyze the concordance rate between ROSE diagnosis and final diagnosis. Methods A prospective study was carried out in patients undergoing EBUS-TBNA for lung cancer staging. Diagnosis concordance was defined as cases where lymph nodes (LNs) presented the same diagnosis in ROSE and final diagnosis. Determinants of concordance were analyzed. Results Sixty-four patients were included and 637 LNs sampled. ROSE diagnosis was concordant with final diagnosis in 612 (96.1%) LNs and nonconcordant in 25 (3.9%). Differences in the concordance rate were found between pathologists, ROSE diagnoses, presence of cell block, number of passes, and number of slides. The staging status was changed between ROSE and the final diagnosis in three (4.6%) patients. Conclusions ROSE diagnosis has a high concordance with the final diagnosis.

New advances in the management of pulmonary sarcoidosis

BMJ ◽  
2019 ◽  
pp. l5553 ◽  
Author(s):  
Daniel A Culver ◽  
Marc A Judson
Keyword(s):  
New Technologies ◽  
Granulomatous Inflammation ◽  
Needle Aspiration ◽  
Pulmonary Sarcoidosis ◽  
Endobronchial Ultrasound ◽  
Transbronchial Needle Aspiration ◽  
Optimal Outcomes ◽  
Disease States ◽  
Positron Emission ◽  
Immunosuppressive Medications

AbstractSarcoidosis is a highly variable granulomatous multisystem syndrome. It affects individuals in the prime years of life; both the frequency and severity of sarcoidosis are greater in economically disadvantaged populations. The diagnosis, assessment, and management of pulmonary sarcoidosis have evolved as new technologies and therapies have been adopted. Transbronchial needle aspiration guided by endobronchial ultrasound has replaced mediastinoscopy in many centers. Advanced imaging modalities, such as fluorodeoxyglucose positron emission tomography scanning, and the widespread availability of magnetic resonance imaging have led to more sensitive assessment of organ involvement and disease activity. Although several new insights about the pathogenesis of sarcoidosis exist, no new therapies have been specifically developed for use in the disease. The current or proposed use of immunosuppressive medications for sarcoidosis has been extrapolated from other disease states; various novel pathways are currently under investigation as therapeutic targets. Coupled with the growing recognition of corticosteroid toxicities for managing sarcoidosis, the use of corticosteroid sparing anti-sarcoidosis medications is likely to increase. Besides treatment of granulomatous inflammation, recognition and management of the non-granulomatous complications of pulmonary sarcoidosis are needed for optimal outcomes in patients with advanced disease.

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