Endobronchial Ultrasound–guided Transbronchial Needle Aspiration for Non–Small Cell Lung Cancer Staging

Abstract

Real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an established technique for invasive mediastinal staging of non-small cell lung cancer (NSCLC). Needle-based techniques are now recommended as a first-line diagnostic modality for mediastinal staging. Accurate performance of systematic staging with EBUS-TBNA requires a detailed knowledge of mediastinal anatomy. This examination begins at the N3 lymph nodes, progressing through the N2 and N1 lymph node stations, unless a higher station lymph node is positive for malignant cells by rapid on-site cytologic examination. Objective methods of identifying EBUS-TBNA targets include sampling any lymph node station with a visible lymph node or with a lymph node greater than 5 mm in short axis. Three passes per station or the use of rapid on-site cytologic examination with identification of diagnostic material (tumor or lymphocytes) up to five passes are well-established techniques. Obtaining sufficient tissue for molecular profiling may require performing more than three passes. The operating characteristics of EBUS-TBNA are similar to mediastinoscopy. However, mediastinoscopy should be considered in the setting of a negative EBUS-TBNA and a high posterior probability of N2 or N3 involvement.

Endobronchial ultrasound-transbronchial needle aspiration for mediastinal staging of non-small cell lung cancer: variability of results and perspectives

“…In patients undergoing EBUS-TBNA for diagnosis and/or staging of suspect/known NSCLC, more than three needle passes may be necessary to obtain sufficient material for molecular testing (18,30); it is therefore recommended that additional samples be obtained for EGFR and ALK testing (41).…”

Endobronchial ultrasound-guided transbronchial needle aspiration under conscious sedation with meperidine and midazolam

“…Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive well-established technique for mediastinal and hilar lymph node or mass diagnosis [1][2][3] and for lung cancer staging [4] that allows a tissue sampling more accurate than blind transbronchial needle aspiration (TBNA) [5].…”

Guideline for the Acquisition and Preparation of Conventional and Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration Specimens for the Diagnosis and Molecular Testing of Patients with Known or Suspected Lung Cancer

“…Early EBUS studies have focused on assessing the accuracy and safety of the technique. The highly convincing results have led to incorporating this technique as a first step in the diagnosis and staging of patients with (suspected) lung cancer [1,2]. Surgical staging procedures such as cervical mediastinoscopy can thus be reserved for cases with highly suspicious mediastinal nodes (pathologic by either CT and/or PET scan) after a negative endosonographic staging and for restaging procedures after induction therapy.…”