Endoscopic mediastinal staging of lung cancer

Abstract

The advent of endoscopic ultrasound-guided sampling procedures such as endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has lead to significant advances in the mediastinal diagnosis and staging of lung cancer. These endoscopic techniques can be performed in the outpatient setting under conscious sedation and local anesthesia, in contrast to the surgical standard, mediastinoscopy (MS), which requires operating theatre time and general anesthesia. Proponents of mediastinoscopy have always emphasized the advantages of mediastinoscopy, namely its sensitivity even with a low prevalence of mediastinal metastases and its low false negative rate. Newer endoscopic techniques such as EBUS-TBNA are showing sensitivities exceeding that of mediastinoscopy, even in the setting of an equally low prevalence of mediastinal metastases. However, endoscopic techniques have double the false negative rate of mediastinoscopy. As the tracheobronchial route and esophageal route provide almost complete access to mediastinal lymph nodes, these endoscopic techniques are complementary rather than competing. When used in combination, it is possible mediastinoscopy may be superseded. The challenge however, is how best to select the appropriate endoscopic procedures to accurately stage lung cancer in the most cost-effective manner.

Surgical outcomes in patients with small cell lung cancer: comparative analysis of computed tomograpy-detected patients with others

“…Similar findings of mismatch with nodal involvements between pre- and post-surgery were also reported in other studies [7,9,23]. Real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and PET/CT are new diagnostic tools and have been shown to be useful for precise diagnosis and staging of lung cancer, especially N involvements [24,25]. As EBUS-TBNA and PET/CT are now available for routine use in our institutes, the time frame of this 20-year retrospective analysis could influence the current data, which may be a limitation of the present analysis.…”

Nodal Stations and Diagnostic Performances of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in Patients with Non-Small Cell Lung Cancer

“…Thus, visualizing and sampling at station 4L by EBUS-TBNA is relatively more difficult than at the others (14). Because of these difficulties, several studies have been performed to identify additional yield of the combined approach of EBUS-TBNA and EUS-FNA for nodal staging in NSCLC patients and have shown additional benefits (17, 18). …”

Invasive staging of the mediastinum

“…Cervical mediastinoscopy has a reported morbidity (e.g. arrhythmia, haemorrhage and recurrent laryngeal nerve injury) and mortality rate of 2% and 0.08% respectively (8,9). An advantage of mediastinoscopy over TBNA is the performing of a more complete mediastinal mapping, including contralateral LN stations (5).…”