Endobronchial Ultrasound versus Mediastinoscopy for Mediastinal Nodal Staging of Non–Small-Cell Lung Cancer

Um, Sang‐Won; Kim, Hong Kwan; Jung, Sin‐Ho; Han, Joungho; Lee, Kyung Jong; Park, Hye Yun; Choi, Yong Soo; Shim, Young Mog; Ahn, Myung‐Ju; Park, Keunchil; Ahn, Yong Chan; Choi, Joon Young; Lee, Kyung Soo; Suh, Gee Young; Chung, Man Pyo; Kwon, O Jung; Kim, Young Tae

doi:10.1097/jto.0000000000000388

Cited by 172 publications

(148 citation statements)

References 30 publications

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“…This rapidly growing body of literature has, in fact, led to the publication of two sets of EBUS clinical guidelines (3,5). Clinical trials with head to head comparisons of EBUS-TBNA vs. cervical mediastinoscopy (CM) for mediastinal staging of lung cancer have shown comparable accuracy and, not surprisingly, a more favorable safety profile in favor of EBUS-TBNA (6)(7)(8). Moreover, a more recent prospective comparison performed by Um and coworkers showed EBUS to be superior to CM with a sensitivity of 88% vs. 81% and negative predictive value of 85% vs. 79% (P<0.05) (7).…”

Section: Introductionmentioning

confidence: 99%

“…Clinical trials with head to head comparisons of EBUS-TBNA vs. cervical mediastinoscopy (CM) for mediastinal staging of lung cancer have shown comparable accuracy and, not surprisingly, a more favorable safety profile in favor of EBUS-TBNA (6)(7)(8). Moreover, a more recent prospective comparison performed by Um and coworkers showed EBUS to be superior to CM with a sensitivity of 88% vs. 81% and negative predictive value of 85% vs. 79% (P<0.05) (7). The cost effectiveness of EBUS-TBNA over mediastinoscopy has also been shown in several studies (9,10).…”

Section: Introductionmentioning

confidence: 99%

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Recent advances in diagnostic bronchoscopy

2016

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EBUSConvex-Probe EBUS is a technique that allows real-time sonographic visualization of peri-bronchial structures during bronchoscopy using an ultrasound transducer which is mounted at the tip of the bronchoscope (3). Its advent at the beginning of the 21st century dramatically changed Abstract: The field of diagnostic bronchoscopy has been revolutionized in the last decade primarily with the advent of endobronchial ultrasound (EBUS) but also with the addition of multiple different techniques for "guided-bronchoscopy". These advances have had a substantial impact in the management of lung cancer with bronchoscopy now providing both diagnosis and mediastinal staging in a single procedure.EBUS has, in fact, become the first choice for staging of the mediastinum over cervical mediastinoscopy (CM). Although EBUS is now a well-established technique, there are continuous efforts from the scientific community to improve its diagnostic performance, and these will be reviewed in this manuscript. The term "guided-bronchoscopy" was recently coined to describe a myriad of techniques that guide our bronchoscopes or bronchoscopic tools into the periphery of the lungs in addition to our conventional fluoroscopy.Electromagnetic and non-electromagnetic navigation, thin and ultrathin scopes, as well as radial-probe EBUS have collectively increased our yield for smaller peripheral lung lesions and continue to evolve.Despite this improved diagnostic yield, there is still ample room for improvement and newer techniques are under way. With new therapies available for patients with interstitial lung disease, achieving a specific histologic diagnosis is now of paramount importance. Given the high morbidity and mortality of surgical biopsies, bronchoscopic cryobiopsy is being rapidly adopted as a safer and effective alternative, and it is likely going to play a major role in the management of these diseases in the near future. This manuscript we will focus on recent advances in EBUS, guided-bronchoscopy, and the use of cryobiopsy.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Recent advances in diagnostic bronchoscopy

2016

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“…After one large randomized control trial compared surgical staging or combined EBUS-TBNA and transesophageal ultrasound fine needle aspiration (EUS-FNA) followed by surgical staging (41), EBUS CP guided TBNA (EBUS-TBNA) is now the first choice for mediastinal LN staging (9,42). Another single arm study also supports that EBUS TBNA is better than mediastinoscopy (43). EBUS TBNA is not only a minimally invasive procedure that can be performed repeatedly, but also has higher sensitivity and specificity in specific lymph node stations (9,44).…”

Section: Ebus Cpmentioning

confidence: 78%

Current advances of endobronchial ultrasonography in the diagnosis and staging of lung cancer

Lin

Yang

et al. 2016

J. Thorac. Dis.

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The diagnosis and staging of patients with lung cancer has relied on tissue sampling.Endobronchial ultrasound (EBUS) is a minimally invasive procedure for the rapid and safe acquisition of tissue and can be done easily and repeatedly. EBUS transbronchial needle aspiration (TBNA) is now the standard for diagnosis of mediastinal and hilar lymphadenopathy and should be considered in patients who have a high probability of lymph node metastases without systemic involvement. EBUS also provides guidance for biopsy of peripheral lung lesions. Recent advances of EBUS with new techniques help to improve the diagnostic yield and decrease the complication rate and total procedure time.

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“…However, it can be limited with the small size of the sampled specimens, lack of access to the posterior lymph node stations and variable operator efficiency. If EBUS guided biopsy is negative for malignancy, additional biopsy usually with mediastinoscopy might be needed [10,11].…”

Section: Discussionmentioning

confidence: 99%

Lung cancer or sarcoidosis: A diagnostic dilemma

Ramadas¹,

Krishnan²,

Pandita³

et al. 2016

J Cancer Ther Res

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Background: Small cell lung cancer is a neuroendocrine neoplasm representing about 15 percent of all lung cancers. Sarcoidosis is a multisystem granulomatous disease. The involvement of mediastinal lymph nodes is common in both and makes the diagnosis challenging when these conditions coexist. We report a rare case of a patient with history of sarcoidosis who was diagnosed with small cell lung cancer. Case presentation: 65-year-old African American female with history of sarcoidosis, who presented with right sided shoulder pain for two months. CT thorax showed right upper lobe nodule with mediastinal and bilateral hilar lymphadenopathy. FDG-PET scan showed increased uptake in the right upper lobe and in mediastinal and hilar lymph nodes. She subsequently underwent an EBUS with biopsies of multiple lymph node stations. Pathology of these lymph nodes revealed non-necrotizing granulomas without evidence of malignancy. She underwent a CT guided biopsy of the right upper lobe lesion and pathology was consistent with small cell carcinoma. It was unclear whether the enlarged and active mediastinal and hilar lymph nodes were related to sarcoidosis or small cell cancer. A multidisciplinary meeting was conducted and decided to treat the patient presumably as small cell cancer with nodal disease. She was given 2 cycles of carboplatin and etoposide. Follow-up CT thorax after the second cycle showed decrease in size of the nodule along with mediastinal and hilar lymph nodes. She also underwent radiation therapy including mediastinum in the field of radiation. Discussion: Sarcoid-like reactions have been noted either in the vicinity of the tumor or within the regional lymph nodes draining that particular tumor. This has been described in less than 1 percent of lung cancers and mostly in squamous cell lung cancers. True sarcoidosis may be confused with a sarcoid-like reaction in cancer patients. It was not possible to definitively differentiate if the nodal involvement was from sarcoidosis or small cell cancer metastasis or a sarcoid like reaction in our patient. Given the diagnostic dilemma, we treated her nodal involvement as small cell lung cancer metastasis since under treatment could lead to relapse and compromise survival.

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Endobronchial Ultrasound versus Mediastinoscopy for Mediastinal Nodal Staging of Non–Small-Cell Lung Cancer

Abstract: EBUS-TBNA was superior to mediastinoscopy in terms of its diagnostic performance for mediastinal staging of cN1-3 NSCLC. Because EBUS-TBNA is both less invasive and affords superior diagnostic sensitivity, it should be the first-line procedure performed in patients with NSCLC.

Cited by 172 publications

References 30 publications

Recent advances in diagnostic bronchoscopy

Recent advances in diagnostic bronchoscopy

Current advances of endobronchial ultrasonography in the diagnosis and staging of lung cancer

Lung cancer or sarcoidosis: A diagnostic dilemma

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