Mediastinal restaging: EUS-FNA offers a new perspective

Annema, Jouke T.; Veselic, Maud; Versteegh, Michel I.M.; Willems, L. N. A.; Rabe, Klaus F.

doi:10.1016/s0169-5002(03)00364-7

Cited by 125 publications

(62 citation statements)

References 23 publications

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“…The decreased accuracy in small nodes may be due to sampling error, technical difficulty in sampling small nodes or the fact that nodes with a normal sonographic appearance are just not biopsied [88]. EUS-FNA has been suggested as a restaging method after induction chemoradiotherapy, for which accuracies of 83% and 86% were reported [89,90].…”

Section: Indications and Resultsmentioning

confidence: 99%

Transbronchial and transoesophageal (ultrasound-guided) needle aspirations for the analysis of mediastinal lesions

Herth

Rabe²,

Gasparini³

et al. 2006

Eur Respir J

138

103

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A tissue diagnosis of mediastinal nodes is frequently needed for accurate lung cancer staging as well as the assessment of mediastinal masses. Transbronchial needle aspiration (TBNA) is a safe procedure that is performed during routine bronchoscopy. Provided mediastinal metastases are confirmed, TBNA has a high impact on patient management. Unfortunately, TBNA remains underused in current daily practice, mainly due to the lack of realtime needle visualisation. The introduction of echo-endoscopes has overcome this problem.Endobronchial ultrasound-guided TBNA (EBUS-TBNA) allows real-time controlled tissue sampling of paratracheal, subcarinal and hilar lymph nodes. Mediastinal lymph nodes located adjacent to the oesophagus can be assessed by transoesophageal ultrasound-guided fine needle aspiration (EUS-FNA). Owing to the complementary reach of EBUS-TBNA and EUS-FNA in assessing different regions of the mediastinum, recent studies suggest that complete and accurate mediastinal staging can be achieved by the combination of both procedures.It is expected that implementation of minimally invasive endoscopic methods of endobronchial ultrasound-guided transbronchial needle aspiration and transoesophageal ultrasound-guided fine needle aspiration will reduce the need for surgical staging of lung cancer significantly.

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Section: Indications and Resultsmentioning

confidence: 99%

Transbronchial and transoesophageal (ultrasound-guided) needle aspirations for the analysis of mediastinal lesions

Herth

Rabe²,

Gasparini³

et al. 2006

Eur Respir J

138

103

View full text Add to dashboard Cite

show abstract

“…Endoscopic EBUS-TBNA and EUS-FNA techniques for restaging showed different results in relation to the NPV, due to the different prevalence of N2 disease and the selective approach only of a small number of nodal stations per patient (average of one to two nodal stations per patient). The reported NPV varied between 20% and 78%, indicating that in the case of negative endoscopic needle aspiration results, invasive surgical mediastinal restaging should be confirmed [83][84][85].…”

Section: Diagnosis For Mediastinal Nodes (N-status)mentioning

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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“…In 2003, ANNEMA et al [55] published the first case study with EUS-FNA for mediastinal restaging in 19 NSCLC patients with N2 disease who had been treated with induction chemotherapy. In the absence of regional lymph node metastasis (N0) at EUS-FNA, surgical resection of the tumour with lymph node sampling or dissection was performed.…”

Section: Review Of the Studies Eus Studiesmentioning

confidence: 99%

Combined endobronchial and oesophageal endosonography for the diagnosis and staging of lung cancer

et al. 2015

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Mediastinal restaging: EUS-FNA offers a new perspective

Cited by 125 publications

References 23 publications

Transbronchial and transoesophageal (ultrasound-guided) needle aspirations for the analysis of mediastinal lesions

Transbronchial and transoesophageal (ultrasound-guided) needle aspirations for the analysis of mediastinal lesions

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

Combined endobronchial and oesophageal endosonography for the diagnosis and staging of lung cancer

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