Endobronchial ultrasound in real life: primary diagnosis and mediastinal staging of lung cancer in patients submitted to thoracic surgery

Abstract

BackgroundSince the first articles published for over 10 years ago, endobronchial ultrasound (EBUS) has gained a strong scientific backing and has been incorporated into routine medical practice in pulmonology and thoracic surgery centers. How is EBUS performing outside the scientific environment, as a diagnostic and mediastinal staging tool in a subset of patients that undergo thoracic surgery, is an interesting question.MethodsThis study evaluated consecutive patients who, during the period from January 2010 to August 2012, were submitted to EBUS and later to thoracic surgery. The samples obtained by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) were compared to surgical samples. The primary endpoint was the proportion of patients with a final diagnosis of non-small cell lung cancer (NSCLC) by EBUS-TBNA correctly subtyped. The secondary endpoint was the negative predictive value (NPV) of EBUS-TBNA for mediastinal staging of lung cancer.ResultsTwo hundred eighty seven patients were studied. Considering 84 patients with a final diagnosis of NSCLC by EBUS-TBNA, 79 % (CI 95 % 70.1–87.3) were correctly subclassified. The NPV of EBUS-TBNA for mediastinal staging was 89 % (IC 95 % 84.9–92.7). From a total of 21 false negative cases of mediastinal staging, 16 (76 %) did not undergo positron emission tomography-computed tomography (PET-CT) before the EBUS and in 15 (71 %) the affected lymph node chain was not punctured by EBUS-TBNA. Ten (47 %) patients had only lymph node metastases not directly accessible by the EBUS.ConclusionsPerformed in hospital routine and in patients submitted to thoracic surgery, EBUS-TBNA proved to be a good tool for proper pathological diagnosis of lung cancer. The negative predictive value of 89 % for mediastinal staging of lung cancer is comparable to that reported in previous studies, but the relatively high number of 21 false negative cases points to the need for standardization of routine strategies before, during and after EBUS.

Improved diagnostic yield of transbronchial lung biopsy in peripheral pulmonary lesions using a combination of endobronchial ultrasound and rapid on-site evaluation

“…The relationship between the rpEBUS probe position and focus also affects the diagnostic yield of rpEBUS-TBLB. [11][12][13][14][15] Uchimura et al 16 reported that the diagnostic yield when the EBUS probe was within the lesion was as high as 90%, but that diagnostic yield may be reduced to 52% to 55% when the ultrasound probe was adjacent to the lesion. Our study showed similar results.…”

Evolution in the management of non-small cell lung cancer in Brazil

“…Recent studies have evaluated the introduction of new surgical techniques, such as video-assisted thoracic surgery, video-assisted thoracoscopy, 8 , 9 , and robotics 10 in our country. Improvements in early diagnosis have also been described in our setting, with the use of endoscopic ultrasonography for mediastinal staging, 11 , 12 as well as for the management of more peripheral suspicious lesions 13 that were not previously amenable to a minimally invasive approach. Health care in thoracic oncology referral centers has also been shown to have a positive impact on the prognosis of patients with NSCLC in Brazil, when compared with that in general hospitals.…”

Diagnostic Patterns of Non-Small-Cell Lung Cancer at Princess Margaret Cancer Centre

“…For instance, all patients with nonsquamous histology should routinely undergo profiling 11 . However, those diagnosed with pure squamous, small-cell, or neuroendocrine subtypes have a lower likelihood of EGFR, ALK, or ROS1 aberration.Multiple sampling methods are available for lung cancer diagnosis [12][13][14] . Although minimally invasive procedures are often preferred to minimize the risk to patients, their use must be balanced against successful acquisition of sufficient material for pathologic and molecular evaluation.…”

“…Multiple sampling methods are available for lung cancer diagnosis [12][13][14] . Although minimally invasive procedures are often preferred to minimize the risk to patients, their use must be balanced against successful acquisition of sufficient material for pathologic and molecular evaluation.…”