The diagnosis of lung cancer in the era of interventional pulmonology

2021 ◽  
Vol 25 (1) ◽  
pp. 6-15
Author(s):  
C-K. Liam ◽  
P. Lee ◽  
C-J. Yu ◽  
C. Bai ◽  
K. Yasufuku
Keyword(s):  
Lung Cancer ◽  
Mediastinal Lymph Node ◽  
Needle Aspiration ◽  
Sampling Procedure ◽  
Endobronchial Ultrasound ◽  
Lymph Node Staging ◽  
Ultrasound Guided ◽  
Interventional Pulmonology ◽  
Diagnosis Of Lung Cancer ◽  
Sampling Procedures

Advances in bronchoscopic and other interventional pulmonology technologies have expanded the sampling procedures pulmonologist can use to diagnose lung cancer and accurately stage the mediastinum. Among the modalities available to the interventional pulmonologist are endobronchial ultrasound-guided transbronchial needles aspiration (EBUS-TBNA) and transoesophageal bronchoscopic ultrasound-guided fine-needle aspiration (EUS-B-FNA) for sampling peribronchial/perioesophageal central lesions and for mediastinal lymph node staging, as well as navigational bronchoscopy and radial probe endobronchial ultrasound (RP-EBUS) for the diagnosis of peripheral lung cancer. The role of the interventional pulmonologist in this setting is to apply these procedures based on the correct interpretation of clinical and radiological findings in order to maximise the chances of achieving the diagnosis and obtaining sufficient tissue for molecular biomarker testing to guide targeted therapies for advanced non-small cell lung cancer. The safest and the highest diagnosis-yielding modality should be chosen to avoid a repeat sampling procedure if the first one is non-diagnostic. The choice of site and biopsy modality are influenced by tumour location, patient comorbidities, availability of equipment and local expertise. This review provides a concise state-of-the art account of the interventional pulmonology procedures in the diagnosis and staging of lung cancer.

scholarly journals Diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration for mediastinal staging in lung cancer

2015 ◽  
Vol 41 (3) ◽  
pp. 219-224 ◽  
Author(s):  
Sebastián Fernández-Bussy ◽  
Gonzalo Labarca ◽  
Sofia Canals ◽  
Iván Caviedes ◽  
Erik Folch ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Lymph Node ◽  
Diagnostic Yield ◽  
Mediastinal Lymph Node ◽  
Needle Aspiration ◽  
Endobronchial Ultrasound ◽  
Lymph Node Staging ◽  
Ultrasound Guided ◽  
Transbronchial Needle Aspiration ◽  
The Mean

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.

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 Effectiveness of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in Patients With Undiagnosed Lung Cancer

Acta Medica ◽  
2021 ◽  
Vol 52 (3) ◽  
pp. 180-188
Author(s):  
Şule Gül ◽  
Elif Yelda Niksarlıoğlu ◽  
Ayşe Yeter
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Lymph Node ◽  
Needle Aspiration ◽  
Small Cell ◽  
Endobronchial Ultrasound ◽  
Small Cell Lung ◽  
Ultrasound Guided ◽  
Transbronchial Needle Aspiration ◽  
Diagnosis Of Lung Cancer

Objectives: Conventional bronchoscopic techniques and computed tomography-guided transthoracic needle aspiration are widely used in the diagnosis of lung cancer. In some patients diagnosis can be challenging. Endobronchial ultrasound-guided transbronchial needle aspiration can be used in the diagnosis of lung cancer after procedures have failed to provide a diagnosis. We aimed to show the effectiveness of Endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of lung cancer in view of the literature and to share the experience from Turkey. Material and Methods: This was a retrospective study conducted between 2014 and 2019. Forty-five patients who were suspected of having lung cancer and underwent Endobronchial ultrasound because diagnosis was not confirmed using methods such as bronchoscopy, computed tomography transthoracic needle aspiration, and peripheral lymph node excision, were included in the study. Results: Three hundred sixty-eight Endobronchial ultrasound procedures were performed. Forty-five patients met the inclusion criteria and were included in the study. Using Endobronchial ultrasound, samples were taken from only mass in eight patients (17.8%), lymph nodes in 30 patients (66.7%), and mass + lymph node in seven (15.5%) patients. Minor complications were seen in five (11.1%) patients and no major complications were seen. Definitive diagnosis was obtained in 35 (77.7%) patients with Endobronchial ultrasound guided transbronchial needle aspiration. Non-small cell lung cancer was identified in 16 patients (45.7%), small cell lung cancer was seen in 15 (42.8%) patients. Seven of ten undiagnosed patients underwent surgical procedures. Conclusion: Endobronchial ultrasound, is an effective and safe method for diagnosing lung cancer after undiagnosed procedures. In selected cases, it can be the first choice for the diagnosis of lung cancer.

scholarly journals Values of different specimen preparation methods for the diagnosis of lung cancer by endobronchial ultrasound guided transbronchial needle aspiration

2019 ◽  
Author(s):  
YouZu Xu ◽  
Jian Lin ◽  
meifang chen ◽  
HaiHong Zheng ◽  
JiaXi Feng
Keyword(s):  
Lung Cancer ◽  
Needle Aspiration ◽  
Endobronchial Ultrasound ◽  
Ultrasound Guided ◽  
Transbronchial Needle Aspiration ◽  
Hilar Lymph Node ◽  
Treatment Type ◽  
Significant Difference ◽  
Positive Rate ◽  
Diagnosis Of Lung Cancer

Abstract Background: Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) has been become an important procedure for the diagnosis and staging of lung cancer. Our research identified the effects of different pathological preparation on the diagnosis of lung cancer for specimens obtained by biopsy. Methods: Patients were clinically considered if lung cancer was accompanied by mediastinal or hilar lymph node enlargement between March 2014 and November 2017. Specimens obtained by EBUS-TBNA were treated by three methods: traditional smear cytology, liquid-based cytology (LBC) and histopathology. Results: Of a total of 154 puncture sites from 153 patients, the total positive rate of combination for the three pathological treatment types (histopathology, direct traditional smear, and LBC) was 77.3%. The diagnostic positive rate for histopathology was 68.6%, direct traditional smear was 65.6%, and LBC was 60.4%; there was no significant differences among the three single pathological treatment types (P=0.29), but there was a statistically significant difference between the combination of three treatments and any single pathological treatment type (P=0.01). The diagnostic sensitivities of histopathology combined with traditional smear and histopathology combined LBC were 94.4% and 92.8%, respectively, the specificities and PPVs were both 100%, and the diagnostic accuracies were 95.5% and 94.2%, respectively; the sensitivities, specificities and diagnostic accuracies above were all higher than those of single specimen treatment and lower than those of the three combined. Conclusion: When EBUS-TBNA is used for the diagnosis and staging of lung cancer, the use of histopathological sections combined with direct cytological smear should be sufficient and is the most economical choice.

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

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. 

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

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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