Transbronchial and transesophageal fine-needle aspiration using a single ultrasound bronchoscope in the diagnosis of locoregional recurrence of surgically-treated lung cancer

Abstract

BackgroundThe present study sought to evaluate the usefulness of EBUS-TBNA in the diagnosis of locoregional recurrence of lung cancer in a cohort of lung cancer patients who were previously treated surgically, and describe our initial experience of EUS-B-FNA in this clinical scenario.MethodsWe retrospectively studied the clinical records of all patients with a previous surgically-treated lung cancer who were referred to our bronchoscopy unit after suspicion of locoregional recurrence. The diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy of EBUS-TBNA for the diagnosis of locoregional recurrence were evaluated.ResultsSeventy-three patients were included. EBUS-TBNA confirmed malignancy in 40 patients: 34 confirmed to have locoregional recurrence, six had metachronous tumours. Of the 33 patients with non-malignant EBUS-TBNA; 2 had specific non-malignant diseases, 26 underwent radiological follow up and 5 patients underwent surgery. Of the 26 patients who had radiological follow up; 18 remained stable, three presented thoracic radiological progression and 5 presented extrathoracic progression. Of the 5 patients who underwent surgery; 3 had metachronous tumours, one confirmed to be a true negative and one presented nodal invasion. Seven patients underwent EUS-B-FNA, four of them confirmed to have recurrence. The sensitivity, specificity, NPV, PPV and overall accuracy of EBUS-TBNA for the diagnosis of locoregional recurrence were 80.9, 100, 69.2, 100 and 86.6% respectively.ConclusionsEBUS-TBNA is an accurate procedure for the diagnosis of locoregional recurrence of surgically-treated lung cancer. EUS-B-FNA combined with EBUS-TBNA broads the diagnostic yield of EBUS-TBNA alone.

Unusual Periaortic Mediastinal Recurrence of Pulmonary Adenocarcinoma: When Making Diagnosis Is Really Necessary

“…Over the last years, EBUS-TBNA is currently proposed as the first choice in the diagnosis of loco-regional relapse of lung cancer since in such instances, the mediastinal area and altered postoperative fibrotic mediastinum make other invasive diagnostic procedures as transcervical extended mediastinal lymphadenectomy and video-assisted mediastinal lymphadenectomy, challenging and unsafe [4, 7, 8]. “Xiauhi” comparing diagnostic yield of EBUS-TBNA and VAM in mediastinal LN staging in lung cancer confirmed that both techniques have similar performance, with EBUS-TBNA being less invasive, better tolerated, and with fewer complications [9].…”

Prognostic Impact of EBUS TBNA for Lung Adenocarcinoma Patients with Postoperative Recurrences

“…According to a literature review, Kim J. et al [ 28 ] showed high diagnostic value and high suitability for EGFR mutation analysis with regard to re-biopsy in patients with previously treated lung cancer. Sanz-Santos J. et al [ 29 ] proved EBUS-TBNA is an accurate procedure for the diagnosis of locoregional recurrence of surgically treated lung cancer. Although they all investigated the role of EBUS TBNA in recurrent lung cancer, no associated outcomes were discussed.…”

Esophageal ultrasound with ultrasound bronchoscope (EUS-B) guided left adrenal biopsy: Case report with review of literature

“…Benign adrenal adenomas are also common [8]. PET scan is not very useful in differentiating benign from malignant lesion [9]. The cytology is thus important for patients with carcinoma of lung and adrenal lesions.…”