Priority of PET-CT vs CT Thorax for EBUS-TBNA 22G vs 19G: Mesothorax Lymphadenopathy

Abstract

Introduction: Lung lesions and undiagnosed mesothorax lymphadenopathy is an issue that several doctors face in the everyday clinical practice. PET-CT and CT of the thorax are usually the first examinations to identify characteristics of the lesions before biopsy. Patients and Methods: We performed a retrospective study with 450 patients that had EBUS-TBNA with 22G, Upgraded 22G and 19G needles with and without PET-CT in order to identify the cost effeteness of performing EBUS-TBNA before or after PET-CT. All centers used the same PET-CT equipment and EBUS-TBNA system. Three types of needle were used for the endoscopy in order to identify similarities and differences for the cost-effectiveness. The costs in every center for every examination and materials were the same. Results: There were more block slices for 19G>22Gupgraded>21G>22G and there was cost-effectiveness when in general PET-CT was performed prior to biopsy of any lesion. 19G needle was more effective for lymphomas, while 22Gupgraded and 21G needles were more cost-effective when used for smaller lesions for primary lung cancer of metastatic disease. Conclusions: We have been using PET-CT and EBUS-TBNA in the everyday clinical practice according to the current guidelines for initial disease staging and re-staging. However; we can also use both in a cost effective method based on the initial radiologic findings.

Cryo-Biopsy versus 19G needle versus 22G needle with EBUS-TBNA endoscopy

“…It has been previously presented that indifferent of the needle size the sample is enough for diagnosis and molecular next generation sequencing (NGS) investigation for lung cancer and other metastatic cancers in the lung parenchyma 5 , 15 , 18 . In a recent study it was observed that the 19G needle when compared to 22G needle has a larger sample size and it has a higher diagnostic sensitivity for lymphoma 19 , 20 . This information is in accordance with previous publications with the esophageal ultrasound (EUS) where the gastroenterologists used larger 19G needles 21 , 22 .…”

Endobronchial Radiofrequency Ablation for pulmonary nodules with Radial-Ebus and Navigation: Pros and Cons

“…In the case of nodules ≥1cm in diameter we can perform positron emission tomography (PET-CT) as a method to acquire information regarding the metabolic rate and evaluate the lymphnode stations in the thorax and check for distant metastasis. [8] In the case of pulmonary nodules less than 1cm the PET-CT usually cannot provide us with information regarding the metabolic rate due to the technical limitations of the method. However; we should not forget that even large nodules, large lymphnode stations can be false negative due to the low metabolic rate of the cancer disease.…”

Cryobiopsy for pneumonitis diagnosis in NSCLC immunotherapy

“…Non-small cell lung cancer is still diagnosed at advanced stage and systemic treatment administration is required. We have nowadays novel tools for the diagnosis and staging of lung cancer like radial-ebus, electromagnetic navigation and convex probe-ebus [ [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] ]. However; we still need a successful lung cancer screening program for early lung cancer diagnosis [ 9 ].…”