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Błach J, Frąk M, Krawczyk P, Pankowski J, Pankowski A, Buczkowski J, Szlubowski A, Siwiec J, Krudyś P, Michnar M, Kieszko R, Milanowski J. Observational cross-sectional study of 5279 bronchoscopy results for the practical effectiveness of various biopsy techniques in the diagnosis of lung diseases with particular emphasis on lung cancer. BMJ Open 2021; 11:e043820. [PMID: 34373288 PMCID: PMC8354294 DOI: 10.1136/bmjopen-2020-043820] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Bronchoscopy is the main method in the diagnosis of various lung diseases. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the most modern bronchoscopic technique useful in diagnosis and staging of lung cancer (LC). OBJECTIVE The aim of the study was to assess the yield of bronchoscopy in patients with suspected various respiratory diseases including LC. In particular, we examined the efficiency of different biopsy techniques in the diagnosis of LC in correlation with its localisation and pathomorphological type. PATIENTS AND METHODS The results of pathomorphological examinations from 5279 bronchoscopies performed in 2016-2018 were analysed. The material was collected with EBUS-TBNA, endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and endobronchial forceps biopsy. Clinical and demographic factors were analysed using the Fisher χ2 test. RESULTS 5279 patients were diagnosed due to various respiratory symptoms. LC was confirmed in 36.42% of patients. 40.81% of patients had no definitive pathomorphological diagnosis. Among patients with LC, the most frequent diagnosis was non-small cell LC: squamous cell lung cancer (SCC)-32.07% and adenocarcinoma (AC)-30.61%, then small cell LC-25.83% and not otherwise specified non-small cell lung cancer (NSCLC-NOS)-11.49%. Diagnosis of SCC was obtained significantly more often (χ2=43.143, p<0.000001) by forceps biopsy (41.09%) than by EBUS-TBNA/EUS-FNA (26.62%). On the contrary, diagnosis of AC or NSCLC-NOS was significantly more often (χ2=20.394, p<0.000007, and χ2=3.902, p<0.05, respectively) observed in EBUS-TBNA/EUS-FNA (34.31% and 12.6%) than in endobronchial biopsies (24.52% and 9.64%). CONCLUSIONS The use of bronchoscopy in the diagnosis of various lung diseases is vital but also has many limitations. Effectiveness of EBUS-TBNA and endobronchial forceps biopsy in the diagnosis of lung cancer is strongly affected by tumour localisation and type of cancer.
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Affiliation(s)
- Justyna Błach
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
- Department of Clinical Immunology, Medical University of Lublin, Lublin, Poland
| | - Małgorzata Frąk
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
| | - Pawel Krawczyk
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
| | - Juliusz Pankowski
- Specialist Hospital for Lung Diseases "Rebirth" Klara Jelska, Zakopane, Poland
| | | | - Jarosław Buczkowski
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
| | - Artur Szlubowski
- Specialist Hospital for Lung Diseases "Rebirth" Klara Jelska, Zakopane, Poland
| | - Jan Siwiec
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
| | | | - Marek Michnar
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
| | - Robert Kieszko
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
| | - Janusz Milanowski
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
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Mullins BT, Moore DT, Rivera MP, Marks LB, Akulian J, Pearlstein KA, Wang K, Burks AC, Weiner AA. The impact of pathologic staging of the hilar/mediastinal nodes on outcomes in patients with early-stage NSCLC receiving stereotactic body radiotherapy. J Thorac Dis 2021; 13:1045-1054. [PMID: 33717577 PMCID: PMC7947488 DOI: 10.21037/jtd-20-2808] [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] [Indexed: 11/06/2022]
Abstract
Background The importance of invasive mediastinal nodal staging in early-stage non-small cell lung cancer (NSCLC) in the PET/CT era is dependent on tumor factors that increase risk of nodal metastasis. At our institution, patients undergo biopsy via either CT-guidance (without nodal staging) or navigational bronchoscopy with endobronchial ultrasound transbronchial needle aspiration for nodal staging. This study aims to compare outcomes after stereotactic body radiotherapy (SBRT) stratified by receipt of invasive mediastinal nodal staging. Methods In this retrospective study, records of all consecutive patients undergoing SBRT for early-stage NSCLC between 2010 and 2017 were analyzed. The association between time-to event outcomes (recurrence and survival) were evaluated with covariates of interest including tumor size, location, histology, smoking history, prior lung cancer history, radiation dose and receipt of nodal staging. Both univariable and multivariable analyses were used to examine these comparisons. Results Overall, 158 patients were treated with SBRT. One hundred forty-nine out of one hundred fifty-eight patients (94%) underwent PET/CT staging, and all patients underwent tumor-directed biopsy. Seventy-nine patients underwent navigational bronchoscopy with nodal staging and 79 patients underwent CT-guided biopsy without nodal staging. Receipt of nodal staging was not associated with tumor size (P=0.35), yet was associated with central tumor location (P<0.001). There was no statistically significant association between receipt of nodal staging and time-to-event recurrence or survival outcomes; for example 3-year overall survival (OS) was 65% vs. 67% (P=0.65) and 3-year freedom from nodal failure was 84% vs. 69% (P=0.1) for those with and without nodal staging, respectively. Conclusions Similar recurrence and survival outcomes were observed after SBRT regardless of receipt of invasive mediastinal nodal staging. Further prospective evaluation can help identify which patients might derive greatest benefit from invasive staging of the mediastinum in the PET/CT era.
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Affiliation(s)
- Brandon T Mullins
- Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Dominic T Moore
- Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M Patricia Rivera
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lawrence B Marks
- Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jason Akulian
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kevin A Pearlstein
- Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kyle Wang
- Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Allen C Burks
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ashley A Weiner
- Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Sawabata N. Mediastinal lymph node staging for lung cancer. MEDIASTINUM (HONG KONG, CHINA) 2019; 3:33. [PMID: 35118261 PMCID: PMC8794439 DOI: 10.21037/med.2019.07.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 07/22/2019] [Indexed: 12/13/2022]
Abstract
Mediastinal lymph node staging is crucial in deciding the treatment strategy for lung carcinoma. The diagnosis rate of computed tomography is not high; however, it is a standard examination. Although the contrast computed tomography is necessary for an accurate diagnosis, images from the positron emission tomography are excellent, and these two technologies are independent and complementary. Positron emission tomography has a disadvantage of false positives and false negatives, but it should also be used in cases where lymph node diameters are 1 cm or more. However, image-based diagnostic methods are not an alternative to histological examination. The results of a transbronchial needle biopsy are extremely dependent on the inspection method, the diagnostic ability of the physician, and the staging of the case. The transesophageal ultrasound endoscope is useful for reaching parts inaccessible by a mediastinoscope. Although its employment requires technical training, it is becoming popular as a minimally invasive method of obtaining cell and the tissue samples. A thoracoscopic biopsy is considered as a last resort for mediastinal lymph node diagnosis. Carefully-chosen invasive procedures are necessary to diagnose swollen lymph nodes. Although mediastinoscopy is still considered as the gold standard, most procedures will be replaced by a comparatively minimally invasive method in the future.
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Affiliation(s)
- Noriyoshi Sawabata
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Nara, Japan
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Ozturk A, Demirci NY, Aktas Z, Demirag F, Alagoz A, Alici İO, Yilmaz A. EBUS may arise as an initial time saving procedure in patients who are suspected to have small cell lung cancer. CLINICAL RESPIRATORY JOURNAL 2016; 12:517-523. [PMID: 27704696 DOI: 10.1111/crj.12556] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/12/2016] [Accepted: 08/29/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Small cell lung cancer (SCLC) commonly presents as hilar/mediastinal masses. In some occasions, conventional flexible bronchoscopy fails and a substantial amount of time is lost until establishing the diagnosis. OBJECTIVE The aim of the study was to demonstrate the superiority of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) compared to conventional methods in establishing the diagnosis as an initial modality as well as to point out the saved time until the diagnosis. METHODS We retrospectively reviewed the patients who were diagnosed as SCLC by EBUS-TBNA between April 2010 and January 2016. The demographics of the patients, smoking history were all recorded. We also compared the time between the first computed tomography (1stCT) and first diagnostic procedure (1stDP), 1stDP and final diagnosis (FDx), 1stCT and FDx, and 1stDP and EBUS procedure were also compared. RESULTS One hundred and thirty-three patients were included in the study. The diagnostic yield of EBUS-TBNA was 98.5%. The mean time between the 1stCT and 1stDP; 1stDP and FDx; 1stCT and FDx; 1stDP and EBUS procedure were 7.0 ± 9.0; 11.8 ± 16.1; 18.8 ± 17.9; and 10.8 ± 16.0 days, respectively. The time between 1stCT to 1stDP was not significantly different in patients with or without previous diagnostic procedures. However, the time between 1stDP to FDx and 1stCT to FDx were significantly higher in the patients with previous procedures (P < .001). The difference in time between 1stDP to FDx and 1stCT to FDx was also similar in patients with only hilar and/or mediastinal lesions (P = .001, P = .006, respectively). CONCLUSION EBUS-TBNA may be an initial diagnostic procedure in SCLC. Patients with only hilar/mediastinal masses without any endobronchial lesion could be directed to centers with the capability for performing EBUS-TBNA to have a rapid diagnosis without any time loss.
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Affiliation(s)
- Ayperi Ozturk
- Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Nilgun Yilmaz Demirci
- Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Zafer Aktas
- Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Funda Demirag
- Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Ali Alagoz
- Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - İbrahim Onur Alici
- Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Aydın Yilmaz
- Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
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Hsu LH, Liu CC, Ko JS, Feng AC, Chu NM. Comparison of 19-gauge eXcelon and WANG MW-319 transbronchial aspiration needles. Thorac Cancer 2015; 7:264-70. [PMID: 27042234 PMCID: PMC4773310 DOI: 10.1111/1759-7714.12301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 06/30/2015] [Indexed: 12/25/2022] Open
Abstract
Conventional transbronchial needle aspiration (TBNA) using 19‐gauge needles can obtain larger histological specimens for hilar‐mediastinal diagnosis. A new 19‐gauge eXcelon needle was introduced in Taiwan in July 2012. We prospectively enrolled patients with hilar‐mediastinal lesions and pathology results of suspected benign origin or lymphoproliferative processes, to perform TBNA using a 19‐gauge eXcelon needle, between July 2012 and December 2012. The results were compared with historical control of TBNA using a WANG MW‐319 needle between January 2011 and June 2012. The procedure was performed by the same pulmonologist, and rapid on‐site cytologic evaluation was used. The 19‐gauge eXcelon needle was used in nine patients with 15 lymph nodes aspirated, with a mean diameter of 23.3 ± 10.7 mm. The mean number of needle passes was 2.7 ± 1.4, with a diagnostic accuracy of 77.8%. The MW‐319 needle was used in 12 patients with 18 lymph nodes aspirated, with a mean diameter of 21.3 ± 5.7 mm. The mean number of needle passes was 2.2 ± 0.4, with a diagnostic accuracy of 75.0%. Neither technical nor major clinical complications were noted in either group. We concluded that the 19‐gauge eXcelon needle was as safe and effective as the MW‐319 needle. A more adequate specimen could be obtained and fewer needle passes were required with the MW‐319 needle, although the difference did not reach significance.
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Affiliation(s)
- Li-Han Hsu
- School of Medical Laboratory Science and Biotechnology College of Medical Science and Technology Taipei Medical University Taipei Taiwan; Department of Medicine National Yang-Ming University Medical School Taipei Taiwan; Division of Pulmonary and Critical Care Medicine Sun Yat-Sen Cancer Center Taipei Taiwan
| | - Chia-Chuan Liu
- Division of Thoracic Surgery Sun Yat-Sen Cancer Center Taipei Taiwan
| | - Jen-Sheng Ko
- Department of Pathology Sun Yat-Sen Cancer Center Taipei Taiwan
| | - An-Chen Feng
- Department of Research Sun Yat-Sen Cancer Center Taipei Taiwan
| | - Nei-Min Chu
- Department of Medical Oncology Sun Yat-Sen Cancer Center Taipei Taiwan
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Murakami Y, Oki M, Saka H, Kitagawa C, Kogure Y, Ryuge M, Tsuboi R, Oka S, Nakahata M, Funahashi Y, Hori K, Ise Y, Ichihara S, Moritani S. Endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of small cell lung cancer. Respir Investig 2014; 52:173-178. [PMID: 24853017 DOI: 10.1016/j.resinv.2013.11.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 08/26/2013] [Accepted: 11/15/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND Massive lymphadenopathy and direct mediastinal invasion are well-recognized phenomena in patients with small cell lung cancer (SCLC). The aim of this study was to assess the utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of SCLC. METHODS We retrospectively reviewed the records of 780 patients who underwent EBUS-TBNA at our institution from March 2004 to June 2012. Of these, 101 had a final diagnosis of SCLC. Excluding 3 patients with known SCLC who underwent EBUS-TBNA for staging purposes and including 2 patients who underwent EBUS-TBNA twice for the diagnosis of recurrence after achieving complete response by chemoradiation therapy during the study period, a total of 100 EBUS-TBNA procedures in 98 patients were analyzed. RESULTS Other diagnostic tests prior to the initial EBUS-TBNA had failed to yield a diagnosis in 41 patients. The overall diagnostic yield of EBUS-TBNA for SCLC was 97% (97 of 100). Rapid on-site cytologic evaluation (ROSE) was performed at the operator's discretion in 77 procedures. ROSE did not have any impact on diagnostic yield (99% with ROSE vs. 90% without ROSE, p=0.1), but the use of ROSE was associated with fewer lesions (mean 1.1 with ROSE vs. 1.6 without ROSE, p<0.01) or aspirates (mean 2.3 with ROSE vs. 4.0 without ROSE, p<0.01). CONCLUSIONS EBUS-TBNA provided a high diagnostic yield in SCLC with or without ROSE. EBUS-TBNA can be recommended for patients suspected to have SCLC, even if other diagnostic tests have failed.
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Affiliation(s)
- Yasushi Murakami
- Department of Respiratory Medicine, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya 460-0001, Japan.
| | - Masahide Oki
- Department of Respiratory Medicine, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya 460-0001, Japan.
| | - Hideo Saka
- Department of Respiratory Medicine, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya 460-0001, Japan.
| | - Chiyoe Kitagawa
- Department of Respiratory Medicine, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya 460-0001, Japan.
| | - Yoshihito Kogure
- Department of Respiratory Medicine, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya 460-0001, Japan.
| | - Misaki Ryuge
- Department of Respiratory Medicine, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya 460-0001, Japan.
| | - Rie Tsuboi
- Department of Respiratory Medicine, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya 460-0001, Japan.
| | - Saori Oka
- Department of Respiratory Medicine, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya 460-0001, Japan.
| | - Masashi Nakahata
- Department of Respiratory Medicine, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya 460-0001, Japan.
| | - Yoriko Funahashi
- Department of Respiratory Medicine, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya 460-0001, Japan.
| | - Kazumi Hori
- Department of Respiratory Medicine, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya 460-0001, Japan.
| | - Yuko Ise
- Department of Respiratory Medicine, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya 460-0001, Japan.
| | - Shu Ichihara
- Department of Pathology, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya 460-0001, Japan.
| | - Suzuko Moritani
- Department of Pathology, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya 460-0001, Japan.
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Tutar N, Büyükoğlan H, Yılmaz İ, Kanbay A, Önal Ö, Bilgin M, Canöz Ö, Demir R, Oyak FS, Gülmez İ, Çetinkaya E. Learning curve of conventional transbronchial needle aspiration. CLINICAL RESPIRATORY JOURNAL 2013; 8:79-85. [DOI: 10.1111/crj.12041] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 06/12/2013] [Accepted: 07/09/2013] [Indexed: 02/02/2023]
Affiliation(s)
- Nuri Tutar
- Department of Pulmonary Medicine; School of Medicine; Erciyes University; Kayseri Turkey
| | - Hakan Büyükoğlan
- Department of Pulmonary Medicine; School of Medicine; Erciyes University; Kayseri Turkey
| | - İnsu Yılmaz
- Department of Pulmonary Medicine; School of Medicine; Erciyes University; Kayseri Turkey
| | - Asiye Kanbay
- Department of Pulmonary Medicine; School of Medicine; Medeniyet University; İstanbul Turkey
| | - Ömer Önal
- Department of Thoracic Surgery; School of Medicine; Erciyes University; Kayseri Turkey
| | - Mehmet Bilgin
- Department of Thoracic Surgery; School of Medicine; Erciyes University; Kayseri Turkey
| | - Özlem Canöz
- Department of Pathology; School of Medicine; Erciyes University; Kayseri Turkey
| | - Ramazan Demir
- Department of Pulmonary Medicine; School of Medicine; Erciyes University; Kayseri Turkey
| | - Fatma Sema Oyak
- Department of Pulmonary Medicine; School of Medicine; Erciyes University; Kayseri Turkey
| | - İnci Gülmez
- Department of Pulmonary Medicine; School of Medicine; Erciyes University; Kayseri Turkey
| | - Erdoğan Çetinkaya
- Department of Pulmonary Medicine; School of Medicine; Karabük University; Karabük Turkey
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Silvestri GA, Gonzalez AV, Jantz MA, Margolis ML, Gould MK, Tanoue LT, Harris LJ, Detterbeck FC. Methods for staging non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143:e211S-e250S. [PMID: 23649440 DOI: 10.1378/chest.12-2355] [Citation(s) in RCA: 945] [Impact Index Per Article: 85.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Correctly staging lung cancer is important because the treatment options and prognosis differ significantly by stage. Several noninvasive imaging studies and invasive tests are available. Understanding the accuracy, advantages, and disadvantages of the available methods for staging non-small cell lung cancer is critical to decision-making. METHODS Test accuracies for the available staging studies were updated from the second iteration of the American College of Chest Physicians Lung Cancer Guidelines. Systematic searches of the MEDLINE database were performed up to June 2012 with the inclusion of selected meta-analyses, practice guidelines, and reviews. Study designs and results are summarized in evidence tables. RESULTS The sensitivity and specificity of CT scanning for identifying mediastinal lymph node metastasis were approximately 55% and 81%, respectively, confirming that CT scanning has limited ability either to rule in or exclude mediastinal metastasis. For PET scanning, estimates of sensitivity and specificity for identifying mediastinal metastasis were approximately 77% and 86%, respectively. These findings demonstrate that PET scanning is more accurate than CT scanning, but tissue biopsy is still required to confirm PET scan findings. The needle techniques endobronchial ultrasound-needle aspiration, endoscopic ultrasound-needle aspiration, and combined endobronchial ultrasound/endoscopic ultrasound-needle aspiration have sensitivities of approximately 89%, 89%, and 91%, respectively. In direct comparison with surgical staging, needle techniques have emerged as the best first diagnostic tools to obtain tissue. Based on randomized controlled trials, PET or PET-CT scanning is recommended for staging and to detect unsuspected metastatic disease and avoid noncurative resections. CONCLUSIONS Since the last iteration of the staging guidelines, PET scanning has assumed a more prominent role both in its use prior to surgery and when evaluating for metastatic disease. Minimally invasive needle techniques to stage the mediastinum have become increasingly accepted and are the tests of first choice to confirm mediastinal disease in accessible lymph node stations. If negative, these needle techniques should be followed by surgical biopsy. All abnormal scans should be confirmed by tissue biopsy (by whatever method is available) to ensure accurate staging. Evidence suggests that more complete staging improves patient outcomes.
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Affiliation(s)
| | - Anne V Gonzalez
- Montreal Chest Institute, McGill University Health Centre, Montreal, QC, Canada
| | - Michael A Jantz
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, FL
| | | | - Michael K Gould
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Lynn T Tanoue
- Section of Pulmonary and Critical Care Medicine, New Haven, CT
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Schmidt RL, Factor RE, Witt BL, Layfield LJ. Quality Appraisal of Diagnostic Accuracy Studies in Fine-Needle Aspiration Cytology: A Survey of Risk of Bias and Comparability. Arch Pathol Lab Med 2013; 137:566-575. [DOI: 10.5858/arpa.2012-0199-ra] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Context.—The quality of diagnostic accuracy studies is determined by 2 key factors: risk of bias and comparability. Bias can distort accuracy estimates and poor reporting impairs comparability. While diagnostic accuracy studies for fine-needle aspiration cytology (FNAC) are frequently published, the methodologic issues associated with this body of literature have never been reviewed.Objective.—To assess the quality of design and reporting of diagnostic test accuracy studies in FNAC.Data Sources.—Diagnostic accuracy studies were identified by a Medline (US National Library of Medicine) search. Sixty-four FNAC diagnostic test accuracy studies were randomly selected for structured review with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) survey. Studies were divided between 2 time periods: 2000-2001 and 2009-2011.Conclusions.—Diagnostic test accuracy studies of FNAC suffer from numerous deficiencies in study design, which negatively affect the reliability of accuracy estimates.
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Affiliation(s)
- Robert L. Schmidt
- From the Department of Pathology, University of Utah School of Medicine and ARUP Laboratories, Salt Lake City, Utah
| | - Rachel E. Factor
- From the Department of Pathology, University of Utah School of Medicine and ARUP Laboratories, Salt Lake City, Utah
| | - Benjamin L. Witt
- From the Department of Pathology, University of Utah School of Medicine and ARUP Laboratories, Salt Lake City, Utah
| | - Lester J. Layfield
- From the Department of Pathology, University of Utah School of Medicine and ARUP Laboratories, Salt Lake City, Utah
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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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Bonifazi M, Zuccatosta L, Trisolini R, Moja L, Gasparini S. Transbronchial Needle Aspiration: A Systematic Review on Predictors of a Successful Aspirate. Respiration 2013; 86:123-34. [DOI: 10.1159/000350466] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Accepted: 02/28/2013] [Indexed: 11/19/2022] Open
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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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Darjani HRJ, Kiani A, Bakhtiar M, Sheikhi N. Diagnostic Yield of Transbronchial Needle Aspiration (TBNA) for Cases with Intra-Thoracic Lymphadenopathies. TANAFFOS 2011; 10:43-48. [PMID: 25191387 PMCID: PMC4153173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 08/13/2011] [Indexed: 06/03/2023]
Abstract
BACKGROUND Evaluation of the lymph nodes in cases with lung cancer for diagnosis or staging has been considered since many years ago. Various methods have been developed for obtaining a sample from lymph nodes. This study was conducted in a research institute with high patient turnover and aimed at evaluating the diagnostic yield of TBNA and effective factors on diagnosis and related complications in patients with pulmonary lesions. MATERIALS AND METHODS Our understudy population included all patients suffering from undiagnosed intrathoracic lymphadenopathies with no accompanying pulmonary lesions on chest CT scan who had been hospitalized in Masih Daneshvari Hospital or referred to its bronchoscopy unit. After determining the anatomic location of lymphadenopathy (LAP), patients underwent fiberoptic bronchoscopy (FOB) and TBNA using 19-gauge eXcelon aspiration needle. Four samples were taken from each patient from the same LAP location. In this study, 39 patients were evaluated. RESULTS The most common anatomic location of lymph node involvement among our understudy patients was the paratracheal area which was involved in 14 (45.2%) patients followed by subcarinal area in 12 cases (38.7%) and hilar involvement also in 12 cases (38.7%). Five patients (15.6%) had lymphadenopathies in other anatomical locations. Evaluation of the aspirates obtained by TBNA showed that the sample was adequate and diagnostic in 21 patients (55.26%), adequate but non-diagnostic in 9 patients (23.68%) and inadequate in 8 cases (21.06%). Definite diagnosis was made in 22 patients among which the most common diagnosis was atypical and malignant lesions in 11 cases (50%) followed by sarcoidosis in 8 (36.36%), tuberculosis (TB) in 2 (9.09%) and other diagnoses in 1 (4.55%) case. CONCLUSION Based on our study results, TBNA was diagnostic in more than half the cases. Various studies have reported a wide range of results in this respect but all of them including ours emphasize on the acceptable diagnostic yield of this technique.
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Affiliation(s)
- Hamid Reza Jabbar Darjani
- Tracheal Disease Research Center, NRITLD, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran- Iran
| | - Arda Kiani
- Tracheal Disease Research Center, NRITLD, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran- Iran
| | - Mehdi Bakhtiar
- Tracheal Disease Research Center, NRITLD, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran- Iran
| | - Negar Sheikhi
- Tracheal Disease Research Center, NRITLD, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran- Iran
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