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Santhakumar S, Deshmukh K, Mehta SS, Muthusamy RK, Venugopal J, Deepak TH, Karthi N, Sharmila S, Joseph A, Kurdula T. EBUS guided trans-esophgeal cryobiopsy-two case reports. Lung India 2025; 42:252-255. [PMID: 40296398 PMCID: PMC12097670 DOI: 10.4103/lungindia.lungindia_531_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 05/20/2024] [Accepted: 10/21/2024] [Indexed: 04/30/2025] Open
Abstract
ABSTRACT Endobronchial ultrasound (EBUS) guided mediastinal cryobiopsy is a novel technique which can be combined with EBUS -TBNA to improve the diagnostic yield. Recent studies report, this technique is safe and superior to EBUS TBNA alone in terms of acquisition of larger tissue samples and thereby a better diagnostic yield and adequacy of tissue for molecular studies. However, safety of this technique in patients do not tolerate a bronchoscopic procedure due to hypoxia or respiratory distress is not clarified yet. Alternatively, EBUS guided FNA via trans-esophageal route(EUS-B-FNA) is a proven technique with a similar diagnostic yield as EBUS TBNA with a better tolerance and a more patient comfort. We report two patients here, in whom EUS- B guided cryobiopsy was successfully done via trans-esophageal route, due to intolerance for bronchoscopic procedure and inconclusive ROSE reports.
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Affiliation(s)
- S. Santhakumar
- Department of Pulmonology, KMCH, Coimbatore, Tamil Nadu, India
| | - Karan Deshmukh
- Department of Pulmonology, KMCH, Coimbatore, Tamil Nadu, India
| | | | | | - J. Venugopal
- Department of Pulmonology, KMCH, Coimbatore, Tamil Nadu, India
| | - T. H Deepak
- Department of Pulmonology, KMCH, Coimbatore, Tamil Nadu, India
| | - N. Karthi
- Department of Anesthesia, KMCH, Coimbatore, Tamil Nadu, India
| | - S Sharmila
- Department of Anesthesia, KMCH, Coimbatore, Tamil Nadu, India
| | - Ananthu Joseph
- Department of Pulmonology, KMCH, Coimbatore, Tamil Nadu, India
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Nakajima T. An update on the role of endobronchial ultrasound-guided transbronchial needle aspiration in lung cancer management. Expert Rev Respir Med 2025; 19:423-434. [PMID: 40159145 DOI: 10.1080/17476348.2025.2486349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2025] [Accepted: 03/26/2025] [Indexed: 04/02/2025]
Abstract
INTRODUCTION Accurate diagnosis and staging are essential for optimizing lung cancer management. The 9th edition of the TNM classification emphasizes distinguishing between single-station and multi-station N2 disease, highlighting the necessity of comprehensive mediastinal node assessment for clinical staging. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive modality used for nodal staging and diagnosis of lung cancer, offering a diagnostic yield comparable to that of mediastinoscopy when performed by experts. Additionally, EBUS-TBNA facilitates essential ancillary testing, including next-generation sequencing (NGS)-based biomarker panels and PD-L1 immunohistochemistry, which are critical for evaluating the suitability of targeted therapies and immune checkpoint inhibitors. Notably, advancements in perioperative management, such as neoadjuvant and adjuvant therapies with immunotherapy and targeted agents, have improved the outcomes of locally advanced diseases. EBUS-TBNA helps identify patients with early-stage lung cancer who are candidates for perioperative therapy. AREAS COVERED This review discusses lung cancer diagnosis, nodal staging, the 9th TNM classification, biomarker testing, PD-L1 immunohistochemistry, and precision medicine. EXPERT OPINION Lung cancer management requires pathological diagnosis, including histological subtyping, accurate nodal staging of the hilum and mediastinum, and NGS-based biomarker and PD-L1 testing. EBUS-TBNA achieves all three in a single session, making it indispensable in modern lung cancer care.
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Affiliation(s)
- Takahiro Nakajima
- Department of General Thoracic Surgery, Dokkyo Medical University, Tochigi, Japan
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3
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Zhang L, Zhang F, Li G, Xiang X, Liang H, Zhang Y. Predicting lymph node metastasis of clinical T1 non-small cell lung cancer: a brief review of possible methodologies and controversies. Front Oncol 2024; 14:1422623. [PMID: 39720561 PMCID: PMC11667114 DOI: 10.3389/fonc.2024.1422623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 11/25/2024] [Indexed: 12/26/2024] Open
Abstract
Non-small cell lung cancer (NSCLC) is a major subtype of lung cancer and poses a serious threat to human health. Due to the advances in lung cancer screening, more and more clinical T1 NSCLC defined as a tumor with a maximum diameter of 3cm surrounded by lung tissue or visceral pleura have been detected and have achieved favorable treatment outcomes, greatly improving the prognosis of NSCLC patients. However, the preoperative lymph node staging and intraoperative lymph node dissection patterns of operable clinical T1 NSCLC are still subject to much disagreement, as well as the heterogeneity between primary tumors and metastatic lymph nodes poses a challenge in designing effective treatment strategies. This article comprehensively describes the clinical risk factors of clinical T1 NSCLC lymph node metastasis, and its invasive and non-invasive prediction, focusing on the genetic heterogeneity between the primary tumor and the metastatic lymph nodes, which is significant for a thoroughly understanding of the biological behavior of early-stage NSCLC.
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Affiliation(s)
- Li Zhang
- Department of Oncology, the Fifth Affiliated Hospital of Kunming Medical University, Gejiu, China
| | - Feiyue Zhang
- Department of Thoracic Surgery, Yunnan Cancer Center, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
- Department of Oncology, Yuxi City People’s Hospital, The Sixth Affiliated Hospital of Kunming Medical University, Yuxi, China
| | - Gaofeng Li
- Department of Thoracic Surgery, Yunnan Cancer Center, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xudong Xiang
- Department of Thoracic Surgery, Yunnan Cancer Center, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Haifeng Liang
- Department of Oncology, the Fifth Affiliated Hospital of Kunming Medical University, Gejiu, China
| | - Yan Zhang
- Department of Oncology, the Fifth Affiliated Hospital of Kunming Medical University, Gejiu, China
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4
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Matsuoka S, Takigawa Y, Sato K, Inoue T, Watanabe H, Kudo K, Sato A, Fujiwara K, Shibayama T. Convex endobronchial ultrasound bronchoscope may enhance visualization and diagnosis by respiratory physicians: Clinical image of an endoscopic ultrasound with bronchoscope. Respirol Case Rep 2024; 12:e70072. [PMID: 39588326 PMCID: PMC11586573 DOI: 10.1002/rcr2.70072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Accepted: 11/19/2024] [Indexed: 11/27/2024] Open
Abstract
Herein, we present the detection of two cystic lesions via the transesophageal route using endobronchial ultrasound and emphasize the fact that understanding the anatomy may enhance the diagnostic yield.
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Affiliation(s)
- Suzuka Matsuoka
- Department of Respiratory MedicineNHO Okayama Medical CenterTamasu Kita‐kuJapan
| | - Yuki Takigawa
- Department of Respiratory MedicineNHO Okayama Medical CenterTamasu Kita‐kuJapan
| | - Ken Sato
- Department of Respiratory MedicineNHO Okayama Medical CenterTamasu Kita‐kuJapan
| | - Tomoyoshi Inoue
- Department of Respiratory MedicineNHO Okayama Medical CenterTamasu Kita‐kuJapan
| | - Hiromi Watanabe
- Department of Respiratory MedicineNHO Okayama Medical CenterTamasu Kita‐kuJapan
| | - Kenichiro Kudo
- Department of Respiratory MedicineNHO Okayama Medical CenterTamasu Kita‐kuJapan
| | - Akiko Sato
- Department of Respiratory MedicineNHO Okayama Medical CenterTamasu Kita‐kuJapan
| | - Keiichi Fujiwara
- Department of Respiratory MedicineNHO Okayama Medical CenterTamasu Kita‐kuJapan
| | - Takuo Shibayama
- Department of Respiratory MedicineNHO Okayama Medical CenterTamasu Kita‐kuJapan
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Griffiths S, Power L, Breen D. Pulmonary endoscopy - central to an interventional pulmonology program. Expert Rev Respir Med 2024; 18:843-860. [PMID: 39370862 DOI: 10.1080/17476348.2024.2413561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 09/12/2024] [Accepted: 10/03/2024] [Indexed: 10/08/2024]
Abstract
INTRODUCTION Pulmonary endoscopy occupies a central role in Interventional Pulmonology and is frequently the mainstay of diagnosis of respiratory disease, in particular lung malignancy. Older techniques such as rigid bronchoscopy maintain an important role in central airway obstruction. Renewed interest in the peripheral pulmonary nodule is driving major advances in technologies to increase the diagnostic accuracy and advance new potential endoscopic therapeutic options. AREAS COVERED This paper describes the role of pulmonary endoscopy, in particular ultrasound in the diagnosis and staging of lung malignancy. We will explore the recent expansion of ultrasound to include endoscopic ultrasound - bronchoscopy (EUS-B) and combined ultrasound (CUS) techniques. We will discuss in detail the advances in the workup of the peripheral pulmonary nodule.We performed a non-systematic, narrative review of the literature to summarize the evidence regarding the indications, diagnostic yield, and safety of current bronchoscopic sampling techniques. EXPERT OPINION EBUS/EUS-B has revolutionized the diagnosis and staging of thoracic malignancy resulting in more accurate assessment of the mediastinum compared to mediastinoscopy alone, thus reducing the rate of futile thoracotomies. Although major advances in the assessment of the peripheral pulmonary nodule have been made, the role of endoscopy in this area requires further clarification and investigation.
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Affiliation(s)
- Sally Griffiths
- Interventional Respiratory Unit, Galway University Hospitals, Galway, Ireland
| | - Lucy Power
- Interventional Respiratory Unit, Galway University Hospitals, Galway, Ireland
| | - David Breen
- Interventional Respiratory Unit, Galway University Hospitals, Galway, Ireland
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Fantin A, Castaldo N, Crisafulli E, Sartori G, Villa A, Felici E, Kette S, Patrucco F, van der Heijden EHFM, Vailati P, Morana G, Patruno V. Minimally Invasive Sampling of Mediastinal Lesions. Life (Basel) 2024; 14:1291. [PMID: 39459591 PMCID: PMC11509195 DOI: 10.3390/life14101291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 09/03/2024] [Accepted: 10/07/2024] [Indexed: 10/28/2024] Open
Abstract
This narrative review examines the existing literature on minimally invasive image-guided sampling techniques of mediastinal lesions gathered from international databases (Medline, PubMed, Scopus, and Google Scholar). Original studies, systematic reviews with meta-analyses, randomized controlled trials, and case reports published between January 2009 and November 2023 were included. Four authors independently conducted the search to minimize bias, removed duplicates, and selected and evaluated the studies. The review focuses on the recent advancements in mediastinal sampling techniques, including EBUS-TBNA, EUS-FNA and FNB, IFB, and nodal cryobiopsy. The review highlights the advantages of an integrated approach using these techniques for diagnosing and staging mediastinal diseases, which, when used competently, significantly increase diagnostic yield and accuracy.
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Affiliation(s)
- Alberto Fantin
- Department of Pulmonology, S. Maria della Misericordia University Hospital, 33100 Udine, Italy
- Department of Medicine, Respiratory Medicine Unit, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, 37134 Verona, Italy
| | - Nadia Castaldo
- Department of Pulmonology, S. Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Ernesto Crisafulli
- Department of Medicine, Respiratory Medicine Unit, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, 37134 Verona, Italy
| | - Giulia Sartori
- Department of Medicine, Respiratory Medicine Unit, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, 37134 Verona, Italy
| | - Alice Villa
- Department of Medicine, Respiratory Medicine Unit, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, 37134 Verona, Italy
| | - Elide Felici
- Department of Medicine, Respiratory Medicine Unit, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, 37134 Verona, Italy
| | - Stefano Kette
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Filippo Patrucco
- Division of Respiratory Diseases, Department of Medicine, Maggiore della Carità University Hospital, 28100 Novara, Italy
| | | | - Paolo Vailati
- Department of Pulmonology, S. Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Giuseppe Morana
- Department of Pulmonology, S. Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Vincenzo Patruno
- Department of Pulmonology, S. Maria della Misericordia University Hospital, 33100 Udine, Italy
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Doğan D, Doğan D, Taşçı C. Safety and effectivity of endoscopic ultrasound with bronchoscope-guided fine-needle aspiration in elderly patients. J Investig Med 2024; 72:730-736. [PMID: 38869154 DOI: 10.1177/10815589241262005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) is a well-established technique for assessing lesions near the central airway. While EBUS is typically used via the airway, the esophageal approach known as endoscopic ultrasound with bronchoscope-guided fine needle aspiration (EUS-B-FNA) has gained popularity for evaluating previously inaccessible lesions. This study aimed to assess the safety and diagnostic contribution of EUS-B-FNA in elderly patients. This retrospective study included elderly patients (≥65 years) who underwent EUS-B-FNA with concurrent convex probe-EBUS (C-EBUS) between June 2019 and December 2022. Inclusion criteria were age >64, having chest computed tomography (CT) or FDG-PET/CT, and undergoing C-EBUS, with the exclusion of patients with prior malignancy diagnoses and undergoing EBUS-TBNA. Among 68 patients who underwent combined EBUS and EUS-B-FNA, 31 met the inclusion criteria. The mean age was 71.7 years and 74.2% were male. All EUS-B-FNA material provided adequate material for histopathological analysis. Among patients, 67.7% received a malignancy diagnosis. Samples were obtained from mass lesions (58.1%) and lymph nodes (41.9%), primarily from the subcarinal (station 7) and left paratracheal (station 4L) regions. The mean number of needle passes was 2.83, with an average procedure duration of 9.4 min. No significant complications occurred. EUS-B-FNA is a safe and effective diagnostic method in elderly patients, offering an alternative when the transbronchial approach is not feasible. This underscores the importance of bronchoscopists' training in the transesophageal approach via EBUS scope.
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Affiliation(s)
- Deniz Doğan
- Gulhane Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | | | - Cantürk Taşçı
- Gulhane Faculty of Medicine, University of Health Sciences, Ankara, Turkey
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Liu L, Zhang J, Wood S, Newell F, Leonard C, Koufariotis LT, Nones K, Dalley AJ, Chittoory H, Bashirzadeh F, Son JH, Steinfort D, Williamson JP, Bint M, Pahoff C, Nguyen PT, Twaddell S, Arnold D, Grainge C, Simpson PT, Fielding D, Waddell N, Pearson JV. Performance of somatic structural variant calling in lung cancer using Oxford Nanopore sequencing technology. BMC Genomics 2024; 25:898. [PMID: 39350042 PMCID: PMC11441263 DOI: 10.1186/s12864-024-10792-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 09/11/2024] [Indexed: 10/04/2024] Open
Abstract
BACKGROUND Lung cancer is a heterogeneous disease and the primary cause of cancer-related mortality worldwide. Somatic mutations, including large structural variants, are important biomarkers in lung cancer for selecting targeted therapy. Genomic studies in lung cancer have been conducted using short-read sequencing. Emerging long-read sequencing technologies are a promising alternative to study somatic structural variants, however there is no current consensus on how to process data and call somatic events. In this study, we preformed whole genome sequencing of lung cancer and matched non-tumour samples using long and short read sequencing to comprehensively benchmark three sequence aligners and seven structural variant callers comprised of generic callers (SVIM, Sniffles2, DELLY in generic mode and cuteSV) and somatic callers (Severus, SAVANA, nanomonsv and DELLY in somatic modes). RESULTS Different combinations of aligners and variant callers influenced somatic structural variant detection. The choice of caller had a significant influence on somatic structural variant detection in terms of variant type, size, sensitivity, and accuracy. The performance of each variant caller was assessed by comparing to somatic structural variants identified by short-read sequencing. When compared to somatic structural variants detected with short-read sequencing, more events were detected with long-read sequencing. The mean recall of somatic variant events identified by long-read sequencing was higher for the somatic callers (72%) than generic callers (53%). Among the somatic callers when using the minimap2 aligner, SAVANA and Severus achieved the highest recall at 79.5% and 79.25% respectively, followed by nanomonsv with a recall of 72.5%. CONCLUSION Long-read sequencing can identify somatic structural variants in clincal samples. The longer reads have the potential to improve our understanding of cancer development and inform personalized cancer treatment.
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Affiliation(s)
- Lingchen Liu
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Jia Zhang
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Scott Wood
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Felicity Newell
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Conrad Leonard
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | | | - Katia Nones
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Andrew J Dalley
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Haarika Chittoory
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Farzad Bashirzadeh
- Department of Thoracic Medicine, The Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - Jung Hwa Son
- Department of Thoracic Medicine, The Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - Daniel Steinfort
- Department of Thoracic Medicine, Royal Melbourne Hospital, Melbourne, Australia
| | | | - Michael Bint
- Department of Thoracic Medicine, Sunshine Coast University Hospital, Birtinya, Australia
| | - Carl Pahoff
- Department of Thoracic Medicine, Gold Coast University Hospital, Southport, Australia
| | - Phan T Nguyen
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia
| | - Scott Twaddell
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia
| | - David Arnold
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia
| | - Christopher Grainge
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia
| | - Peter T Simpson
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - David Fielding
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Thoracic Medicine, The Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - Nicola Waddell
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.
| | - John V Pearson
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Yamamoto S, Nakayama M. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA): revolutionizing the landscape of lung disease diagnostics. J Med Ultrason (2001) 2024; 51:245-251. [PMID: 38114815 DOI: 10.1007/s10396-023-01391-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/19/2023] [Indexed: 12/21/2023]
Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has emerged as a revolutionary diagnostic tool for lung diseases, including lung cancer, sarcoidosis, and lymphoproliferative diseases. This minimally invasive procedure offers a superior diagnostic yield while ensuring maximum patient safety when compared to traditional invasive techniques such as mediastinoscopy and thoracoscopy. By enabling real-time imaging and sampling of mediastinal and hilar lymph nodes and masses directly from the bronchoscope, EBUS-TBNA has redefined the precision of diagnostic bronchoscopy. This comprehensive review explores the origins, development, and current status of EBUS-TBNA, highlighting its successes and identifying potential areas for improvement. Technological advancements have continuously enhanced the reliability and efficacy of EBUS-TBNA over time. The mechanisms underlying the superior diagnostic yield of EBUS-TBNA are thoroughly discussed, further solidifying its position as the gold standard for lung cancer staging and diagnosis. Furthermore, this review delves into the crucial role of EBUS-TBNA in lung cancer diagnosis, supported by studies comparing its accuracy, safety, and cost-effectiveness to other diagnostic tools. Looking ahead, ongoing research aims to expand the applications of EBUS-TBNA and improve its diagnostic performance. Notable advancements in needle design and sampling techniques hold promise for further enhancing its efficacy. Maximizing its potential through comprehensive training and continuous technological developments will enable broader clinical applications, ultimately leading to improved patient outcomes. As EBUS-TBNA continues to evolve, its diagnostic impact is expected to increase, solidifying its position as an indispensable tool in the diagnosis and management of lung diseases.
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Affiliation(s)
- Shinichi Yamamoto
- Department of Endoscopy, Jichi Medical University Hospital, Tochigi, Japan.
| | - Masayuki Nakayama
- Department of Endoscopy, Jichi Medical University Hospital, Tochigi, Japan
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Schwalk AJ, Niroula A, Schimmel M. What is new in mediastinal staging? Curr Opin Pulm Med 2024; 30:25-34. [PMID: 37851368 DOI: 10.1097/mcp.0000000000001022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
PURPOSE OF REVIEW Appropriate staging is of utmost importance in nonsmall cell lung cancer (NSCLC), as the pathologic stage dictates both overall prognosis and appropriate therapeutic pathways. This article seeks to review the current recommendations for mediastinal staging of NSCLC and available modalities to achieve this. Landmark publications pertaining to recent advancements in NSCLC treatments are also highlighted and the role of specific bronchoscopic modalities for tissue acquisition are reviewed. RECENT FINDINGS Recent advancements in the treatment of NSCLC have made accurate mediastinal staging more important than ever. Guidelines and recommendations outlining patients that warrant invasive mediastinal staging are available and a systematic approach should be utilized when sampling is performed. Ensuring the adequacy of tissue for the growing number of molecular biomarkers that must be tested has been the focus of many recent studies. SUMMARY Appropriate mediastinal staging is crucial for the management of patients with NSCLC as is obtaining adequate tissue for diagnostic and therapeutic purposes. EBUS-TBNA is sufficient for the diagnosis of nonsmall cell and small cell lung carcinomas, but EBUS-guided intranodal forceps and cryobiopsy may provide more optimal specimen for patients with benign disease, such as sarcoidosis, or in cases of lymphoma. Further studies are necessary to better delineate the role of these techniques in the diagnosis and staging of mediastinal diseases before they become the primary diagnostic modalities.
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Affiliation(s)
- Audra J Schwalk
- University of Texas Southwestern Medical Center, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Dallas, Texas
| | - Abesh Niroula
- Emory University School of Medicine, Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Atlanta, Georgia, USA
| | - Matthew Schimmel
- Emory University School of Medicine, Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Atlanta, Georgia, USA
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Mishra DR, Bhatta N, Shahi R, Verma A, Acharya AB. Letter from Nepal: From bench to bronchus: Setting up EBUS services in an academic centre in Nepal. Respirology 2023; 28:964-965. [PMID: 37526216 DOI: 10.1111/resp.14564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/19/2023] [Indexed: 08/02/2023]
Affiliation(s)
- Deebya Raj Mishra
- Department of Pulmonary, Critical Care and Sleep Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Narendra Bhatta
- Department of Pulmonary, Critical Care and Sleep Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Rejina Shahi
- Department of Pulmonary, Critical Care and Sleep Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Avatar Verma
- Department of Pulmonary, Critical Care and Sleep Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Achyut Bhakta Acharya
- Department of Pulmonary, Critical Care and Sleep Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal
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12
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Mankidy BJ, Mohammad G, Trinh K, Ayyappan AP, Huang Q, Bujarski S, Jafferji MS, Ghanta R, Hanania AN, Lazarus DR. High risk lung nodule: A multidisciplinary approach to diagnosis and management. Respir Med 2023; 214:107277. [PMID: 37187432 DOI: 10.1016/j.rmed.2023.107277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 04/28/2023] [Accepted: 05/04/2023] [Indexed: 05/17/2023]
Abstract
Pulmonary nodules are often discovered incidentally during CT scans performed for other reasons. While the vast majority of nodules are benign, a small percentage may represent early-stage lung cancer with the potential for curative treatments. With the growing use of CT for both clinical purposes and lung cancer screening, the number of pulmonary nodules detected is expected to increase substantially. Despite well-established guidelines, many nodules do not receive proper evaluation due to a variety of factors, including inadequate coordination of care and financial and social barriers. To address this quality gap, novel approaches such as multidisciplinary nodule clinics and multidisciplinary boards may be necessary. As pulmonary nodules may indicate early-stage lung cancer, it is crucial to adopt a risk-stratified approach to identify potential lung cancers at an early stage, while minimizing the risk of harm and expense associated with over investigation of low-risk nodules. This article, authored by multiple specialists involved in nodule management, delves into the diagnostic approach to lung nodules. It covers the process of determining whether a patient requires tissue sampling or continued surveillance. Additionally, the article provides an in-depth examination of the various biopsy and therapeutic options available for malignant lung nodules. The article also emphasizes the significance of early detection in reducing lung cancer mortality, especially among high-risk populations. Furthermore, it addresses the creation of a comprehensive lung nodule program, which involves smoking cessation, lung cancer screening, and systematic evaluation and follow-up of both incidental and screen-detected nodules.
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Affiliation(s)
- Babith J Mankidy
- Division of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, 1Baylor Plaza, Houston, TX, 77030, USA.
| | - GhasemiRad Mohammad
- Department of Radiology, Division of Vascular and Interventional Radiology, Baylor College of Medicine, USA.
| | - Kelly Trinh
- Texas Tech University Health Sciences Center, School of Medicine, USA.
| | - Anoop P Ayyappan
- Department of Radiology, Division of Thoracic Radiology, Baylor College of Medicine, USA.
| | - Quillan Huang
- Department of Oncology, Baylor College of Medicine, USA.
| | - Steven Bujarski
- Division of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, 1Baylor Plaza, Houston, TX, 77030, USA.
| | | | - Ravi Ghanta
- Department of Cardiothoracic Surgery, Baylor College of Medicine, USA.
| | | | - Donald R Lazarus
- Division of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, 1Baylor Plaza, Houston, TX, 77030, USA.
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Fielding D, Dalley AJ, Singh M, Nandakumar L, Lakis V, Chittoory H, Fairbairn D, Ferguson K, Bashirzadeh F, Bint M, Pahoff C, Son JH, Hodgson A, Pearson JV, Waddell N, Lakhani SR, Hartel G, Nones K, Simpson PT. Whole Genome Sequencing in Advanced Lung Cancer can be Performed Using Diff-Quik Cytology Smears Derived from Endobronchial Ultrasound, Transbronchial Needle Aspiration (EBUS TBNA). Lung 2023; 201:407-413. [PMID: 37405466 PMCID: PMC10444633 DOI: 10.1007/s00408-023-00631-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/25/2023] [Indexed: 07/06/2023]
Abstract
INTRODUCTION Maximising alternative sample types for genomics in advanced lung cancer is important because bronchoscopic samples may sometimes be insufficient for this purpose. Further, the clinical applications of comprehensive molecular analysis such as whole genome sequencing (WGS) are rapidly developing. Diff-Quik cytology smears from EBUS TBNA is an alternative source of DNA, but its feasibility for WGS has not been previously demonstrated. METHODS Diff-Quik smears were collected along with research cell pellets. RESULTS Tumour content of smears were compared to research cell pellets from 42 patients, which showed good correlation (Spearman correlation 0.85, P < 0.0001). A subset of eight smears underwent WGS, which presented similar mutation profiles to WGS of the matched cell pellet. DNA yield was predicted using a regression equation of the smears cytology features, which correctly predicted DNA yield > 1500 ng in 7 out of 8 smears. CONCLUSIONS WGS of commonly collected Diff-Quik slides is feasible and their DNA yield can be predicted.
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Affiliation(s)
- David Fielding
- Department of Thoracic Medicine, The Royal Brisbane & Women's Hospital, Brisbane, Australia.
- Faculty of Medicine, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia.
| | - Andrew J Dalley
- Faculty of Medicine, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - Mahendra Singh
- Faculty of Medicine, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
- Pathology Queensland, The Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - Lakshmy Nandakumar
- Pathology Queensland, The Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - Vanessa Lakis
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Haarika Chittoory
- Faculty of Medicine, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - David Fairbairn
- Pathology Queensland, The Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - Kaltin Ferguson
- Faculty of Medicine, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - Farzad Bashirzadeh
- Department of Thoracic Medicine, The Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - Michael Bint
- Department of Thoracic Medicine, Sunshine Coast University Hospital, Birtinya, Australia
| | - Carl Pahoff
- Department of Respiratory Medicine, Gold Coast University Hospital, Southport, Australia
| | - Jung Hwa Son
- Department of Thoracic Medicine, The Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - Alan Hodgson
- Pathology Queensland, The Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - John V Pearson
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Nicola Waddell
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Sunil R Lakhani
- Faculty of Medicine, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
- Pathology Queensland, The Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - Gunter Hartel
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Katia Nones
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
- School of Biomedical Sciences, The University of Queensland, Brisbane, Australia
| | - Peter T Simpson
- Faculty of Medicine, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
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Hartert M, Huertgen M. Portrayal of video-assisted mediastinoscopic lymphadenectomy's range subsequent to its simultaneous use with uniportal VAT-lobectomy for left-sided NSCLC: a case-based perspective. J Cardiothorac Surg 2023; 18:152. [PMID: 37069572 PMCID: PMC10111845 DOI: 10.1186/s13019-023-02277-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/05/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Video-assisted mediastinoscopic lymphadenectomy (VAMLA) is the most precise approach combining staging and therapeutic interventions in non-small cell lung cancer (NSCLC). In the case of left-sided NSCLC, the likelihood of mediastinal lymph node metastases depends on the involvement of the left lung regional lymphatic network. As such, it appears obvious - at least for selected patients with mediastinal staging by either PET-CT or EBUS-TBNA ± EUS-FNA and with cN ≤ 2 - to merge VAMLA and left-sided video-assisted thoracoscopic (VAT) lobectomy for a single-stage therapeutical procedure. CASE PRESENTATION We present the clinical course of an 83-year-old patient following simultaneous VAMLA and VAT-lobectomy for invasive mucinous adenocarcinoma of the left upper lobe with a provisional cT3cN0cM0 stage. The patient developed a clinically relevant postoperative pneumothorax due to a persistent parenchymal air leak. CT scan revealed a substantial pneumomediastinum and showed the capability of VAMLAs range for mediastinal lymph node dissection in a unique way. Following the prompt insertion of a second chest tube, the situation was stabilized with an unremarkable further in-hospital stay. The patient remains free of tumor recurrence or distant metastases at a one-year follow-up. CONCLUSION Presenting this aperçu, we encourage reviving the debate on (1) precise mediastinal staging in general and (2) VAMLA's important role as a diagnostic and therapeutic tool.
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Affiliation(s)
- Marc Hartert
- Department of Thoracic Surgery, Katholisches Klinikum Koblenz-Montabaur, Rudolf-Virchow-Str. 7-9, 56073, Koblenz, Germany.
| | - Martin Huertgen
- Department of Thoracic Surgery, Katholisches Klinikum Koblenz-Montabaur, Rudolf-Virchow-Str. 7-9, 56073, Koblenz, Germany
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Affiliation(s)
- Peter V Dicpinigaitis
- Albert Einstein College of Medicine and Montefiore Medical Center/Einstein Division, 1825 Eastchester Road, Bronx, NY, 10461, USA.
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