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Fiorelli A, Rambaldi P, Vicidomini G, di Serio U, Accardo M, Rotondo A, Santini M. Combined transbronchial needle aspiration and (99m)Tc-2-methoxy-isobutyl-isonitrile single photon emission computed tomography for diagnosing enlarged mediastinal lymph nodes. Arch Bronconeumol 2013; 50:3-9. [PMID: 24291006 DOI: 10.1016/j.arbres.2013.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 06/26/2013] [Accepted: 06/29/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND To demonstrate the diagnostic accuracy of an integrated approach of blind trans-bronchial needle aspiration (TBNA) and (99m)Tc-2-methoxy-isobutyl-isonitrile single photon emission computed tomography ((99m)Tc-MIBI-SPECT) in diagnosing mediastinal lymph adenopathy. METHODS Sixty one consecutive patients with mediastinal lymph adenopathy undergoing both TBNA and (99m)Tc-MIBI-SPECT were prospectively enrolled. Mediastinoscopy was attended in case of negative TBNA. RESULTS Eighty three adenopathies were sampled (73 malignant and 10 benign). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of TBNA was 74%, 100%, 100%, and 34%, respectively; and of (99m)Tc-MIBI-SPECT was 96%, 80%, 97%, and 73%, respectively. Combining TBNA and (99m)Tc-MIBI-SPECT results sensitivity, specificity, PPV, NPV of 97%, 100%, 100%, and 83%, respectively, was obtained. TBNA alone avoided medistianoscopy in 65% of cases, while an integrated approach could have potentially obviated mediastinoscopy in 76%. CONCLUSIONS (99m)Tc-MIBI-SPECT improved the sensitivity and the NPV of TBNA, reducing the need of mediastinoscopy.
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Affiliation(s)
- Alfonso Fiorelli
- Unidad de Cirugía Torácica, Segunda Universidad de Nápoles, Nápoles, Italia
| | - Pierfrancesco Rambaldi
- Departamento de Radiología, Unidad de Medicina Nuclear, Segunda Universidad de Nápoles, Nápoles, Italia
| | | | - Umberto di Serio
- Unidad de Cirugía Torácica, Segunda Universidad de Nápoles, Nápoles, Italia
| | - Marina Accardo
- Departamento de Salud Pública, Sección de Anatomía Patológica, Segunda Universidad de Nápoles, Nápoles, Italia
| | - Antonio Rotondo
- Departamento de Radiología, Unidad de Radiología, Segunda Universidad de Nápoles, Nápoles, Italia
| | - Mario Santini
- Unidad de Cirugía Torácica, Segunda Universidad de Nápoles, Nápoles, Italia.
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Castelao Naval J, Izquierdo Alonso JL, Gallardo Carrasco J, Sánchez Hernández I, Almonacid Sánchez C, Fernández Francés J, Resano Barrio P, Mediano San Andrés O. Utilidad clínica e impacto económico de la punción transbronquial convencional de adenopatías mediastínicas en el carcinoma broncogénico. Arch Bronconeumol 2013; 49:41-6. [DOI: 10.1016/j.arbres.2012.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 09/20/2012] [Accepted: 09/20/2012] [Indexed: 12/25/2022]
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Lucena CM, Agustí C, Martínez-Olondris P, Cano-Jiménez E, Marrades RM, Ramírez J, Sánchez M, Arguis P, Xaubet A. Significance of the presence of lymphocytes in the cytological analysis of transbronchial needle aspiration. Arch Bronconeumol 2011; 47:122-7. [PMID: 21277665 DOI: 10.1016/j.arbres.2010.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Revised: 10/18/2010] [Accepted: 10/19/2010] [Indexed: 11/17/2022]
Abstract
AIM To evaluate the clinical relevance of the presence of lymphocytes in transbronchial needle aspiration (TBNA) samples from pathological mediastinal lymph nodes in patients with suspected lung cancer. METHODS Retrospective observational study evaluating the negative predictive value (NPV) of TBNA samples containing lymphocytes but not malignant cells. RESULTS A total of 266 TBNA were performed in 252 patients with pathological lymph nodes. One hundred and fifteen TBNA samples had evidence of malignant cells (43%), and 94 (35%) samples were considered as inadequate (absence of adequate cytological material or exclusive presence of bronchial epithelial cells). Out of the 57 TBNA samples remaining (21%), 15 could not be confirmed; in 32, TBNA samples were confirmed with alternative diagnostic techniques and in 10, they were confirmed after clinical and radiological follow-up. The NPV of the 32 samples that were confirmed with alternative diagnostic techniques was 84% decreasing down to 76% when the 10 TBNA samples confirmed after clinical and radiological follow-up were included. CONCLUSIONS The presence of lymphocytes in the TBNA sample does not exclude the neoplasic invasion of the specific lymph node analyzed.
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Affiliation(s)
- Carmen M Lucena
- Servicio de Neumología, Instituto Clínico del Tórax, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Ciber de Enfermedades Respiratorias 2009 SGR 911, Barcelona, España.
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Computed Tomography-Bronchoscopic Simulation for Guiding Transbronchial Fine Needle Aspiration of Extramural Targets: A Phantom Study. Invest Radiol 2007; 42:807-14. [DOI: 10.1097/rli.0b013e3181142bf2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Monsó E, Andreo F, Rosell A, Cuellar P, Castellà E, Llatjós M. Utilidad de la ultrasonografía endobronquial con punción-aspiración en tiempo real para la estadificación de la neoplasia broncopulmonar. Med Clin (Barc) 2007; 128:481-5. [PMID: 17419909 DOI: 10.1157/13100934] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE To determine the usefulness of endobronchial ultrasonography (EBUS) with real-time needle aspiration (NA) for lung cancer staging. PATIENTS AND METHOD All patients examined with EBUS and real-time NA to measure and sample mediastinal and lobar nodes for lung cancer staging during one year were included, independently of the size of the mediastinal nodes at computed tomography (CT). RESULTS Eighty two nodes > 5 mm were sampled using EBUS-NA (16.0 [7.2] mm; 23 cases <or= 10 mm, 28.0%), from 67 patients were examined for staging (64.0 [12.4] years). NA from 72 nodes was adequate (87.8%) (38 normal node, 46.3%; 31 neoplasia, 37.8%; 3 granuloma, 3.7%), and EBUS-NA found neoplasia in 4/23 nodes <or= 10 mm (17.4%). EBUS-NA showed neoplasic nodes in 5 out of 24 patients with a normal mediastinum at CT (20.8%). The use of EBUS-NA avoided mediastinoscopy in 62 of the 67 patients included in the study (92.5%). CONCLUSIONS The use of EBUS with real-time NA on mediastinal and lobar nodes obtain representative pathological samples and allow the avoidance of mediastinoscopy in over 90% of the patients referred for lung cancer staging.
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Affiliation(s)
- Eduard Monsó
- Servicio de Neumología, Hospital Germans Trias i Pujol, Badalona, Barcelona, España.
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Fernández-Villar A, Iglesias F, Mosteiro M, Corbacho D, González A, Blanco P, Paz-Esquete J, Bandrés R, Piñeiro L. Factores predictores del resultado de la punción-aspiración transtraqueal de adenopatías mediastínicas neoplásicas. Arch Bronconeumol 2005. [DOI: 10.1157/13077955] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Fernández-Villar A, Iglesias F, Mosteiro M, Corbacho D, González A, Blanco P, Paz-Esquete J, Bandrés R, Piñeiro L. Transbronchial Needle Aspiration of Diseased Mediastinal Lymph Nodes: Predictors of Positive Findings. ACTA ACUST UNITED AC 2005; 41:434-8. [PMID: 16117949 DOI: 10.1016/s1579-2129(06)60259-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To assess the factors that may determine the effectiveness of transbronchial needle aspiration through a flexible bronchoscope in the diagnosis of diseased mediastinal lymph nodes in patients with lung or extrapulmonary tumors. METHODS Prospective study carried out at 2 hospitals between 1998 and 2004 that included all transbronchial needle aspirations performed on patients who had diseased mediastinal lymph nodes larger than 10 mm and nonlymphoid neoplasms. Univariate and multivariate analysis of the diagnostic results of transbronchial needle aspiration were performed according to the type and location of the primary neoplasm and the lymph node station biopsied, the diameter of the affected node, endoscopic findings, and the results of other bronchoscopic techniques. RESULTS The study evaluated the transbronchial needle aspiration of 230 lymph node stations in 207 patients. Histologic examination revealed 151 cases (72.9%) of non-small cell lung cancer, 42 cases (20.3%) of small cell lung cancer, and 14 cases (6.8%) of extrapulmonary cancer. The best predictors of obtaining a diagnostic sample were a diameter of the diseased node greater than 20 mm in diameter (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.2-4.7; P=.01) and a histologic diagnosis of small cell lung cancer (OR, 2.7; 95% CI, 0.9-8.2; P=.07). CONCLUSIONS The size of the diseased node and the tumor type are the best predictors of obtaining a diagnostic sample with transbronchial needle aspiration of diseased mediastinal lymph nodes in patients with lung or extrapulmonary tumors.
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Affiliation(s)
- A Fernández-Villar
- Servicio de Neumología, Hospital Xeral-Cíes, Complexo Hospitalario Universitario de Vigo, Pontevedra, España.
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Holty JEC, Kuschner WG, Gould MK. Accuracy of transbronchial needle aspiration for mediastinal staging of non-small cell lung cancer: a meta-analysis. Thorax 2005; 60:949-55. [PMID: 15994251 PMCID: PMC1747236 DOI: 10.1136/thx.2005.041525] [Citation(s) in RCA: 190] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The reported accuracy of transbronchial needle aspiration (TBNA) for mediastinal staging in non-small cell lung cancer (NSCLC) varies widely. We performed a meta-analysis to estimate the accuracy of TBNA for mediastinal staging in NSCLC. METHODS Medline, Embase, and the bibliographies of retrieved articles were searched for studies evaluating TBNA accuracy with no language restriction. Meta-analytical methods were used to construct summary receiver-operating characteristic curves and to pool sensitivity and specificity. RESULTS Thirteen studies met inclusion criteria, including six studies that surgically confirmed all TBNA results and enrolled at least 10 patients with and without mediastinal metastasis (tier 1). Methodological quality varied but did not affect diagnostic accuracy. In tier 1 studies the median prevalence of mediastinal metastasis was 34%. Using a random effects model, the pooled sensitivity and specificity were 39% (95% CI 17 to 61) and 99% (95% CI 96 to 100), respectively. Compared with tier 1 studies, the median prevalence of mediastinal metastasis (81%; p = 0.002) and pooled sensitivity (78%; 95% CI 71 to 84; p = 0.009) were higher in non-tier 1 studies. Sensitivity analysis confirmed that the sensitivity of TBNA depends critically on the prevalence of mediastinal metastasis. The pooled major complication rate was 0.3% (95% CI 0.01 to 4). CONCLUSIONS When properly performed, TBNA is highly specific for identifying mediastinal metastasis in patients with NSCLC, but sensitivity depends critically on the study methods and patient population. In populations with a lower prevalence of mediastinal metastasis, the sensitivity of TBNA is much lower than reported in recent lung cancer guidelines.
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Rendimiento de la punción aspirativa transtraqueal y transbronquial para el diagnóstico anatomopatológico de la neoplasia broncopulmonar. Clin Transl Oncol 2004. [DOI: 10.1007/bf02712374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
OBJECTIVE To review the current concepts in the mediastinal staging of nonsmall cell lung cancer (NSCLC), evaluating traditional and modern staging modalities. SUMMARY BACKGROUND DATA Staging of NSCLC includes the assessment of mediastinal lymph nodes. Traditionally, computed tomography (CT) and mediastinoscopy are used. Modern staging modalities include magnetic resonance imaging (MRI), positron emission tomography (PET), and endoscopic ultrasound with fine-needle aspiration (EUS-FNA) METHODS: Literature was searched with PubMed and SUMSearch for original, peer-reviewed, full-length articles. Studies were evaluated on inclusion criteria, sample size, and operating characteristics. Endpoints were accuracy, safety, and applicability of the staging methods. RESULTS CT had moderate sensitivities and specificities. With few exceptions magnetic resonance imaging (MRI) offered no advantages when compared with CT, against higher costs. PET was significantly more accurate than CT. Mediastinoscopy and its variants were widely used as gold standard, although meta-analyses were absent. Percutaneous transthoracic needle biopsy (PTNB) and transbronchial needle biopsy (TBNA) were moderately sensitive and specific. EUS-FNA had high sensitivity and specificity, is a safe and fast procedure, and is cost-effective. EUS-FNA evaluates largely a nonoverlapping mediastinal area compared with mediastinoscopy. CONCLUSIONS PET has the highest accuracy in the mediastinal staging of NSCLC, but is not generally used yet. EUS-FNA has the potential to perform mediastinal tissue sampling more accurate than TBNA, PTNB, and mediastinoscopy, with fewer complications and costs. Although promising, EUS-FNA is still experimental. Mediastinoscopy is still considered as gold standard for mediastinal staging of NSCLC.
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Affiliation(s)
- Henk Kramer
- Department of Pulmonary Diseases, University Hospital Groningen, The Netherlands.
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Vázquez-Sequeiros E, Ginès A, Wiersema MJ. [Role of ultrasound-guided endoscopy in the evaluation of mediastinal lesions]. Med Clin (Barc) 2003; 121:231-7. [PMID: 12882736 DOI: 10.1016/s0025-7753(03)73914-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The evaluation of the mediastinum is still a challenge. In most cases, a pathologic study is mandatory for therapeutic decision-making. In this setting, endoscopic ultrasonography (EUS) without and with fine needle aspiration (FNA) is currently considered as a very useful and safe non-invasive technique since it overcomes most problems raising from standard radiologic techniques at the time of obtaining histologic confirmation. Moreover, it avoids the surgical approach for diagnosis in a significant number of patients. Thus, performance characteristics (sensitivity, specificity and accuracy) of EUS FNA in the diagnosis of mediastinal lymph nodes of unknown origin are higher than 90%. The place of EUS FNA in the staging of lung cancer is not well established yet, but available data suggest that it can play a major role in patients with negative transbronchial biopsy or even in the initial evaluation regardless of CT results. Finally, recent studies also suggest that EUS FNA is the most cost-effective non-surgical technique for the study of the mediastinum.
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Affiliation(s)
- Enrique Vázquez-Sequeiros
- Sección de Endoscopia Digestiva (ecoendoscopia). Servicio de Gastroenterología. Hospital Ramón y Cajal. Madrid. España
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Bronchoscopic Needle Aspiration and Biopsy of Paratracheal Tumors and Hilar and Mediastinal Lymph Nodes. ACTA ACUST UNITED AC 2003. [DOI: 10.1097/00128594-200307000-00004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Soria MT, Solé M, Pellisé M, Bordas JM, Ginès A. [Interventional diagnostic and therapeutic endoscopic ultrasonography]. GASTROENTEROLOGIA Y HEPATOLOGIA 2002; 25:467-74. [PMID: 12139843 DOI: 10.1016/s0210-5705(02)70290-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- M T Soria
- Unidad de Endoscopia Digestiva, Institut de Malalties Digestives, Hospital Clínic, Barcelona, Spain
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Wiersema MJ, Vazquez-Sequeiros E, Wiersema LM. Evaluation of mediastinal lymphadenopathy with endoscopic US-guided fine-needle aspiration biopsy. Radiology 2001; 219:252-7. [PMID: 11274566 DOI: 10.1148/radiology.219.1.r01ap44252] [Citation(s) in RCA: 140] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the safety and accuracy of endoscopic ultrasonography (US)-guided fine-needle aspiration biopsy (FNAB) of lymph nodes in the paratracheal, aortopulmonic, subcarinal, and posterior mediastinal regions. MATERIALS AND METHODS Eighty-six consecutive patients with mediastinal lymphadenopathy who did not have a primary gastrointestinal neoplasm were examined. In 29 patients, endoscopic US-guided FNAB of mediastinal lymphadenopathy was performed as a component of staging non-small cell lung cancer (NSCLC); in the remaining 57 patients, it was performed to obtain a primary diagnosis. Final diagnosis was based on clinical follow-up, cytologic, and/or surgical results. RESULTS In 82 patients in whom a final diagnosis was available, the sensitivity, specificity, accuracy, negative predictive value, and positive predictive value of endoscopic US-guided FNAB in distinguishing benign from malignant mediastinal lymph nodes were 96%, 100%, 98%, 94%, and 100%, respectively. In those patients who underwent staging of NSCLC, endoscopic US-guided FNAB had superior mediastinal lymph node staging accuracy compared with endoscopic US alone (79%) and CT alone (79%) (P =.01). The results of endoscopic US-guided FNAB prompted a change to nonsurgical management in 66 (80%) of 82 patients who underwent the procedure. One minor complication, postprocedural fever that resolved with oral antibiotics, occurred (1%; 95% CI: 0%, 6%). CONCLUSION Endoscopic US-guided FNAB is accurate and safe for biopsy of mediastinal lymph nodes to stage NSCLC, establish a primary diagnosis, or examine patients with prior inconclusive biopsy results.
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Affiliation(s)
- M J Wiersema
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St SW, Eisenberg 8A, Rochester, MN 55905, USA.
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Utilidad clínica y coste-efectividad de la punción-aspiración transbronquial en el diagnóstico de adenopatías mediastínicas. Rev Clin Esp 2001. [DOI: 10.1016/s0014-2565(01)70786-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Trueba IM, Viguera JL. La punción-aspiración transbronquial en el diagnóstico de adenopatías mediastínicas. Rev Clin Esp 2001. [DOI: 10.1016/s0014-2565(01)70785-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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