EUS-FNA in the preoperative staging of non-small cell lung cancer

Talebian, M.; Bartheld, Martin B. von; Braun, Jerry; Versteegh, Michael I.; Dekkers, Olaf M.; Rabe, Klaus F.; Annema, Jouke T.

doi:10.1016/j.lungcan.2009.08.016

Cited by 25 publications

(13 citation statements)

References 13 publications

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“…The NPV of ECM was observed to be higher in all series, including our series, as compared to that of transbronchial needle aspiration biopsy (TBNA), endobronchial ultrasound‐guided fine needle aspiration (EBUS‐FNA), and esophageal endoscopic ultrasound‐guided fine needle aspiration (EUS‐FNA) . Furthermore, APW lymph node stations 5 and 6 are, even when visualized, difficult to target because of the intervening pulmonary artery (station 5) and aorta (station 6) . The accuracy of EUS–FNA for the subaortic station remains as low as 66%, as compared to ECM, even in patients selected by means of PET/CT and/or CT findings .…”

Section: Resultsmentioning

confidence: 61%

Impact of extended cervical mediastinoscopy in staging of left lung carcinoma

et al. 2013

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Background: Extended cervical mediastinoscopy (ECM) is a method for staging lung carcinoma. We aimed to demonstrate the impact of ECM in the staging of lung carcinoma. Methods: Between 1998 and 2011, 159 patients with left lung carcinoma who underwent ECM simultaneously with standard cervical mediastinoscopy (SCM), were retrospectively analyzed. Until 2006, ECM had been performed routinely (n = 90, routine ECM), however, after 2006 ECM was performed only in patients selected based on computed tomography and positron emission tomography scans (n = 69, selective ECM). Results: Mediastinal lymph node metastasis was present in 36 patients by mediastinoscopy. Aortopulmonary window (APW) lymph node metastasis was present in 26 patients (10 in the routine group, 16 in the selective group), whereas the 10 patients who had mediastinal lymph node metastasis that could only be accessed by SCM, but had no APW lymph node metastasis, were excluded. The remaining 123 patients (72 in the routine group, 51 in the selective group) were identified as cN0/N1 by SCM/ECM, and lobectomy, pneumonectomy, and exploratory thoracotomy were performed on 64, 43, and 16 of these patients, respectively. According to the lymphadenectomy, APW lymph node metastasis was determined in 11 patients (seven in the routine group, four in the selective group). Sensitivity, negative predictive value (NPV), and accuracy of ECM were calculated as 0.70, 0.90, and 0.92, respectively. Staging values of routine/selective ECM protocols were 0.58/0.80, 0.89/0.91 and 0.91/0.94, respectively. The complication rate was 5% (n = 8). Conclusions: ECM has an adequate NPV and accuracy in determining metastasis to the APW lymph nodes in patients with left lung carcinoma.

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Section: Resultsmentioning

confidence: 61%

Impact of extended cervical mediastinoscopy in staging of left lung carcinoma

et al. 2013

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“…This procedure requires skilled and experienced investigators. The overall prevalence in the published studies was 58%, the median sensitivity was 89% (range 50−100%), the median specificity was 100%, and the median NPV was 86% (range 68−100%) respectively [36,47,48]. Complications such as bleeding or infection are rare and no mortality for either ultrasound guided needle technique has been reported.…”

Section: Minimally Invasive Techniquesmentioning

confidence: 99%

Staging of lung cancer: the role of noninvasive, minimally invasive and invasive techniques

Stamatis

2015

Eur Respir J

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Accurate staging and restaging of primary tumour and mediastinal nodes in patients with lung cancer is of significant importance. For primary tumours, computed tomography (CT) scans of the chest are recommended. Positron emission tomography (PET) imaging should be used in patients with curative intent treatment to evaluate metastatic disease. Diagnosis of the primary tumour should be performed using bronchoscopy or CT-guided transthoracic needle aspiration. In patients with enlarged mediastinal nodes and no distant metastasis, invasive staging of the mediastinum is required. For suspicious N2 or N3 disease, endoscopic needle techniques, such as endobronchial ultrasound and transbronchial needle aspiration, oesophageal ultrasound and fine needle aspiration, or a combination of both, are preferred to any surgical staging technique. In cases of suspicious nodes and negative results using needle aspiration techniques, invasive surgical staging using mediastinoscopy or video-assisted thoracic surgery should be performed. In central tumours or N1 nodes, preoperative invasive staging is indicated.Restaging after induction therapy remains a controversial topic. Today, neither CT, PET nor PET/CT scans are accurate enough to make final further therapeutic decisions for mediastinal nodal involvement. An invasive technique providing cytohistological information is still recommended.

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“…The dedicated ultrasound scanner, mounted on a side viewing videogastroscope enables tissue visualization at a radius of 2-10 cm around the esophagus. The sensitivity of EUS-FNA has been reported to range between 74 and 92 % [29][30][31]. Two recent meta-analyses, combining more than 1000 patients have determined the sensitivity to be closer to 83-84 % [5,25].…”

Section: Eus-fnamentioning

confidence: 99%

Mediastinoscopy in the era of endobronchial ultrasound: when should it be performed?

Hanna

Yasufuku

2012

Curr Respir Care Rep

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Accurate mediastinal lymph node staging is critical for patients with non-small cell lung cancer (NSCLC). Although cervical mediastinoscopy has been regarded as the method of choice for mediastinal staging in NSCLC, emergence of minimally invasive sonography, for example endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound fine needle aspiration (EUS-FNA), has led to questions about the routine use of mediastinoscopy. EBUS-TBNA has access to all the mediastinal lymph nodes accessible by mediastinoscopy but also extends to the N1 nodes. EUS-FNA enables access to paraesophageal (station 8) and pulmonary ligament (station 9) lymph nodes, which are not accessible by either mediastinoscopy or EBUS-TBNA. On the basis of current evidence, sonographic staging is the recommended choice for patients with high pretest probability of lymph node metastatic involvement; all negative results should, however, be verified by mediastinoscopy, especially in centers with low expertise. For patients with low pretest probability, mediastinoscopy may be omitted.

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EUS-FNA in the preoperative staging of non-small cell lung cancer

Cited by 25 publications

References 13 publications

Impact of extended cervical mediastinoscopy in staging of left lung carcinoma

Impact of extended cervical mediastinoscopy in staging of left lung carcinoma

Staging of lung cancer: the role of noninvasive, minimally invasive and invasive techniques

Mediastinoscopy in the era of endobronchial ultrasound: when should it be performed?

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