Mediastinal staging procedures in lung cancer: EBUS, TBNA and mediastinoscopy

Medford, Andrew R L; Bennett, Jonathan; Free, C.M.; Agrawal, Sanjay

doi:10.1097/mcp.0b013e32832b8a45

Cited by 73 publications

(67 citation statements)

References 42 publications

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“…The obtained samples provide one cell block and are smaller compared with those obtained via mediastinoscopy (historically considered as the 'gold standard' mediastinal sampling technique). However, EBUS-TBNA has a number of advantages when compared with mediastinoscopy: This technique is routinely performed as a day case procedure under conscious sedation (although it may also performed under general anaesthesia) and, as such, the morbidity and mortality rates are lower (9). This is of particular relevance for patients with poorer Eastern Cooperative Oncology Group (ECOG) performance status (10) who may otherwise be deemed unfit for more invasive sampling diagnostic techniques.…”

Section: Introductionmentioning

confidence: 99%

Adequacy of endobronchial ultrasound-guided transbronchial needle aspiration samples processed as histopathological samples for genetic mutation analysis in lung adenocarcinoma

Jeyabalan

Bhatt

Plummeridge

et al. 2015

Molecular and Clinical Oncology

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Abstract. Phenotyping non-small-cell lung cancer is becoming increasingly important with the advent of molecular testing. Tumours harbouring somatic mutations in the gene that encodes for the tyrosine kinase domain of the epidermal growth factor receptor (EGFR) have been found to increase responsiveness to tyrosine kinase inhibitors. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive technique for mediastinal node sampling. The available prospective data on EBUS-TBNA sample suitability for molecular profiling are currently limited. The aim of this prospective study was to evaluate the adequacy of EBUS-TBNA samples for EGFR and anaplastic lymphoma kinase (ALK) genetic mutation analysis in confirmed primary lung adenocarcinomas. We conducted a prospective analysis of 410 consecutive patients referred for EBUS-TBNA between 2010 and 2014. Rapid on-site cytological evaluation was not used. The samples were obtained using 21-gauge (21G) or 22G needles and were prepared as histopathological samples. A total of 91 samples were confirmed as lung adenocarcinomas and 80 of these samples were sent for EGFR mutation analysis. EBUS-TBNA had a diagnostic accuracy of 98.3% for malignancy. EGFR mutation testing was possible in 79/80 cases (98.75%). EGFR mutations were detected in 5/80 (6.3%) samples. ALK gene analysis, which became available during the study period, was requested and successfully performed in 21̸21 samples (100%). The total combined genotyping success rate was 100/101 (99.0%). This UK study confirmed the high clinical utility of EBUS-TBNA samples processed as histopathological specimens for EGFR and ALK genotyping in primary lung adenocarcinoma. The needle gauge did not affect genotyping efficacy.

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Section: Introductionmentioning

confidence: 99%

Adequacy of endobronchial ultrasound-guided transbronchial needle aspiration samples processed as histopathological samples for genetic mutation analysis in lung adenocarcinoma

Jeyabalan

Bhatt

Plummeridge

et al. 2015

Molecular and Clinical Oncology

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“…In addition, an anterior approach is necessary for reaching stations 5 and 6: mediastinotomy or extended cervical mediastinoscopy [22,23]. Recently, the development of EBUS transbronchial needle aspiration or endooesophageal ultrasound-guided needle aspiration (EUS) has allowed for more accurate staging of proximal hilar and all mediastinal stations [24,25]. As chest CT, PET-CT or PET scan do not have a specificity, negative predictive value or accuracy of 100%, it is recommended that patients with negative lymph nodes on PET or PET-CT, but enlarged nodes on staging CT still undergo proper staging of mediastinal nodes through EBUS/EUS or mediastinoscopy, before thoracotomy [26,27].…”

Section: Clinical and Surgical Stagingmentioning

confidence: 99%

Surgery for nonsmall cell lung cancer

Lang-Lazdunski

2013

Eur Respir Rev

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Surgery remains the best curative option in patients with early stage lung cancer (stage I and II). Developments in minimally invasive techniques now allow surgeons to perform lung resections on elderly patients, patients with poor pulmonary function or significant cardiopulmonary comorbidities. New techniques, such as stereotactic radiotherapy and ablative procedures, are being evaluated in early-stage lung cancer and may represent an alternative to surgery in patients unfit for lung resection. Perioperative mortality rates have dropped significantly at most institutions in the past two decades and complications are managed more efficiently. Progress in imaging and staging techniques have helped cut futile thoracotomy rates and offer patients the most adequate treatment options. Large randomised trials have helped clarify the role of neoadjuvant, induction and adjuvant chemotherapy, as well as radiotherapy. Surgery remains an essential step in the multimodality therapy of selected patients with advanced-stage lung cancer (stage III and IV). Interventional and endoscopic techniques have reduced the role of surgery in the diagnosis and staging of nonsmall cell lung cancer, but surgery remains an important tool in the palliation of advanced-stage lung cancer. Large national/international surgical databases have been developed and predictive risk-models for surgical mortality/morbidity published by learned surgical societies. Nonetheless, lung cancer overall survival rates remain deceptively low and it is hoped that early detection/screening, better understanding of tumour biology and development of biomarkers, and development of efficient targeted therapies will help improve the prognosis of lung cancer patients in the next decade. @ERSpublications Despite progress in surgical techniques, radiotherapy techniques and targeted therapy, lung cancer prognosis remains poor

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“…EBUS-TBNA is safer, cheaper, quicker (2 hours 24 minutes in one tertiary UK centre versus an average of 30 minutes for EBUS-TBNA by experienced operators), access the hilar nodes 18 and is less invasive than mediastinoscopy (the latter with a 1.4-2.3% risk of important complications, 0.5% risk of major complications, including death). 19 Many centres use EBUS-TBNA to stage discrete or bulky mediastinal nodal disease, reserving mediastinoscopy for situations where radical treatment is intended although EBUS-TBNA may come to have a role in the radiologically 'normal' mediastinum. Currently, most centres corroborate negative EBUS-TBNA results with mediastinoscopy in cases where the probability of malignancy is high.…”

Section: Ebus-tbna Compared To Other Staging Techniquesmentioning

confidence: 99%

Endobronchial ultrasound: what is it and when should it be used?

Medford

2010

Clinical Medicine

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-Endobronchial ultrasound has become increasingly used in the UK as a lung cancer staging and diagnostic tool. It has many applications especially in the mediastinal lymph nodes but also the vascular structures as well as the airway wall itself. It is superior to conventional transbronchial needle aspiration in lung cancer staging and diagnosis of mediastinal lymphadenopathy. With time it may well replace mediastinoscopy completely for staging lung cancer. There are, however, training issues and revenuebased tariff systems have been slow to reflect this innovation. Future developments may include routine use in the assessment of central pulmonary vasculature and assessment of airway wall remodelling.

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Mediastinal staging procedures in lung cancer: EBUS, TBNA and mediastinoscopy

Cited by 73 publications

References 42 publications

Adequacy of endobronchial ultrasound-guided transbronchial needle aspiration samples processed as histopathological samples for genetic mutation analysis in lung adenocarcinoma

Adequacy of endobronchial ultrasound-guided transbronchial needle aspiration samples processed as histopathological samples for genetic mutation analysis in lung adenocarcinoma

Surgery for nonsmall cell lung cancer

Endobronchial ultrasound: what is it and when should it be used?

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