Endobronchial sonography: feasibility and preliminary results.

Hürter, T; Hanrath, P

doi:10.1136/thx.47.7.565

Cited by 226 publications

(133 citation statements)

References 7 publications

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“…13 EUS was developed in the 1980s to evaluate GI cancers. The fi rst EBUS was described in 1992 14 and led to the development of a linear EBUS scope that allows for direct guidance for transbronchial needle aspiration. 3 The usefulness of this procedure in the diagnosis and staging of lung cancer is beyond question, with a weighted sensitivity of 93% and virtually no complications.…”

Section: Resultsmentioning

confidence: 99%

Using Endobronchial Ultrasound Features to Predict Lymph Node Metastasis in Patients With Lung Cancer

Memoli

El-Bayoumi

Pastis

et al. 2011

Chest

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A ppropriate staging of lung cancer is critical, as it predicts prognosis and dictates treatment. Radiographic staging with CT scan and PET scan can offer clues to the extent of disease, but pathologic confi rmation of malignancy and determination of the TNM stage for non-small cell lung cancer (NSCLC) dictates the treatment choice. 1 In practice, mediastinal lymph node involvement most often differentiates those who are surgical candidates from those who are not. 2 The current methods available to adequately stage the mediastinum include mediastinoscopy, videoassisted thoracoscopy, endoscopic ultrasound (EUS), endobronchial ultrasound (EBUS), transthoracic needle aspiration, and transbronchial needle aspiration. The American College of Chest Physicians practice guidelines state that "tissue should be obtained by whatever method is easiest to perform" depending on the size and location of the lymph node, the availability of the technology, and expertise in the local facility. 1 EBUS and EUS have gained acceptance as dependable procedures to stage lung cancer with comparable accuracy to surgical methods. 1,[3][4][5] The use of ultrasound facilitates the direct visualization of the lymph node during biopsy and may offer information regarding nodal characteristics of malignant nodes.Purpose: Reliable staging of the mediastinum determines TNM classifi cation and directs therapy for non-small cell lung cancer (NSCLC). Our aim was to evaluate predictors of mediastinal lymph node metastasis in patients undergoing endobronchial ultrasound (EBUS). Methods: Patients with known or suspected lung cancer undergoing EBUS for staging were included. Lymph node radiographic characteristics on chest CT/PET scan and ultrasound characteristics of size, shape, border, echogenicity, and number were correlated with rapid on-site evaluation (ROSE) and fi nal pathology. Logistic regression (estimated with generalized estimating equations to account for correlation across nodes within patients) was used with cancer (vs normal pathology) as the outcome. ORs compare risks across groups, and testing was performed with two-sided a of 0.05. Results: Two hundred twenty-seven distinct lymph nodes (22.5% positive for malignancy) were evaluated in 100 patients. Lymph node size, by CT scan and EBUS measurements, and round and oval shape were predictive of mediastinal metastasis. Increasing size of lymph nodes on EBUS was associated with increasing malignancy risk ( P 5 .0002). When adjusted for CT scan size, hypermetabolic lymph nodes on PET scan did not predict malignancy. Echogenicity and border contour on EBUS and site of biopsy were not signifi cantly associated with cancer. In 94.8% of lymph nodes with a clear diagnosis, the ROSE of the fi rst pass correlated with subsequent passes. Conclusions: Lymph node size on CT scan and EBUS and round or oval shape by EBUS are predictors of malignancy, but no single characteristic can exclude a visualized lymph node from biopsy. Further, increasing the number of samples taken is unlikely to signifi cant...

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Section: Resultsmentioning

confidence: 99%

Using Endobronchial Ultrasound Features to Predict Lymph Node Metastasis in Patients With Lung Cancer

Memoli

El-Bayoumi

Pastis

et al. 2011

Chest

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“…This complex technique, which is currently performed only in a few highly specialized centers, includes (1) transesophageal US-endoscopy, which can reveal abnormalities (lymphadenopathy and neoplastic masses) between the aorta and the central pulmonary veins, eliminating the need for biopsy; (2) endobronchial US, which can be used to visualize intra-and subparietal lesions of the bronchi, as well as peribronchial extension of a bronchial mass, and to characterize the vascular pattern of these lesions [51]; (3) US during thoracoscopy, which can identify tiny nodules that are impossible to detect with others tools [52].…”

Section: Invasive Pleural and Pulmonary Proceduresmentioning

confidence: 99%

Role of thoracic ultrasound in the assessment of pleural and pulmonary diseases

Sperandeo

Filabozzi

Varriale

et al. 2008

Journal of Ultrasound

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Although numerous studies have been conducted on the use of ultrasonography (US) for the examination of thoracic structures, this procedure is not as widely accepted as abdominal US. The newer portable scanners can be used at the bedside to detect pleural malignancies and effusions, as well as peripheral lung nodules of the lung, even in seriously ill patients. Focal thickening of the pleura can be easily detected with US and further investigated with a US-guided biopsy. US guidance can also be used during percutaneous drainage of pleural effusion or transthoracic biopsy of peripheral lung lesions, thus reducing the incidence of procedure-related pneumothorax to almost zero. We review the current literature on thoracic US and present our clinical experience with the technique in large groups of patients with pleural and peripheral lung diseases.Sommario L'ecografia del torace non è ancora diffusa quanto quella addominale, nonostante una notevole quantità di studi ne attesti l'importanza. Le apparecchiature più recenti permettono di diagnosticare neoplasie, versamenti pleurici e noduli polmonari periferici al letto del paziente, anche nei casi più gravi. L'ispessimento pleurico focale è facilmente messo in luce dall'ecografia e può essere ulteriormente studiato tramite la biopsia ecoguidata. Questa può essere praticata anche su lesioni polmonari periferiche, riducendo quasi a zero il rischio di pneumotorace. In questo articolo esaminiamo la letteratura recente sull'ecografia del torace e presentiamo la nostra esperienza clinica su numerosi pazienti con patologia pleurica e della periferia polmonare. ª

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“…The development of EBUS started in the 1980s and was introduced into clinical practice in 1992 [Hurter and Hanrath, 1992]. The initial EBUS was the radial probe EBUS (RP-EBUS), which is used through the working channel of the flexible bronchoscope.…”

Section: Endobronchial Ultrasoundmentioning

confidence: 99%

Bronchoscopic staging of lung cancer

Hanna

Yasufuku

2012

Ther Adv Respir Dis

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Advances in bronchoscopy have contributed valuable tools to the diagnosis and staging of lung cancer. Detection of lesions at the premalignant microscopic stage has become possible with autofluorescence bronchoscopy and narrow band imaging. Bronchoscopy also allows for sampling of visible intra-bronchial lesions and for transbronchial needle aspiration of lesions in pulmonary parenchyma. With endobronchial ultrasound guidance, real-time evaluation and biopsy of mediastinal and pulmonary lesions can be achieved, enabling accurate clinical and pathological T-staging and N-staging without the need for surgery. In combination with advanced imaging techniques, Navigational bronchoscopy allows for the targeting and biopsy of the most peripheral lesions that are located in the smallest airways. For patients in whom tumor genetics are important, bronchoscopic-guided transbronchial biopsy can provide sufficient material for molecular analysis. As minimally invasive technology continues to evolve and improve, bronchoscopic techniques are poised to continue to be essential for the diagnosis and staging of lung cancer.

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Endobronchial sonography: feasibility and preliminary results.

Cited by 226 publications

References 7 publications

Using Endobronchial Ultrasound Features to Predict Lymph Node Metastasis in Patients With Lung Cancer

Using Endobronchial Ultrasound Features to Predict Lymph Node Metastasis in Patients With Lung Cancer

Role of thoracic ultrasound in the assessment of pleural and pulmonary diseases

Bronchoscopic staging of lung cancer

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