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de Moura DTH, McCarty TR, Jirapinyo P, Ribeiro IB, Farias GFA, Ryou M, Lee LS, Thompson CC. Endoscopic Ultrasound Fine-Needle Aspiration versus Fine-Needle Biopsy for Lymph Node Diagnosis: A Large Multicenter Comparative Analysis. Clin Endosc 2019; 53:600-610. [PMID: 31794654 PMCID: PMC7548151 DOI: 10.5946/ce.2019.170] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 09/26/2019] [Indexed: 02/06/2023] Open
Abstract
Background/Aims Endoscopic ultrasound fine-needle aspiration (EUS-FNA) is preferred for sampling of lymph nodes (LNs) adjacent to the gastrointestinal wall; however, fine-needle biopsy (FNB) may provide improved diagnostic outcomes. This study aimed to evaluate the comparative efficacy and safety of FNA versus FNB for LN sampling.
Methods This was a multicenter retrospective study of prospectively collected data to evaluate outcomes of EUS-FNA and EUS-FNB for LN sampling. Characteristics analyzed included sensitivity, specificity, accuracy, the number of needle passes, diagnostic adequacy of rapid on-site evaluation (ROSE), cell-block analysis, and adverse events.
Results A total of 209 patients underwent EUS-guided LN sampling. The mean lesion size was 16.22±8.03 mm, with similar sensitivity and accuracy between FNA and FNB ([67.21% vs. 75.00%, respectively, p=0.216] and [78.80% vs. 83.17%, respectively, p=0.423]). The specificity of FNB was better than that of FNA (100.00% vs. 93.62%, p=0.01). The number of passes required for diagnosis was not different. Abdominal and peri-hepatic LN location demonstrated FNB to have a higher sensitivity (81.08% vs. 64.71%, p=0.031 and 80.95% vs. 58.33%, p=0.023) and accuracy (88.14% vs. 75.29%, p=0.053 and 88.89% vs. 70.49%, p=0.038), respectively. ROSE was a significant predictor for accuracy (odds ratio, 5.16; 95% confidence interval, 1.15–23.08; p=0.032). No adverse events were reported in either cohort.
Conclusions Both EUS-FNA and EUS-FNB are safe for the diagnosis of LNs. EUS-FNB is preferred for abdominal LN sampling. EUS-FNA+ ROSE was similar to EUS-FNB alone, showing better diagnosis for EUS-FNB than traditional FNA. While ROSE remained a significant predictor for accuracy, due to its poor availability in most centers, its use may be limited to cases with previous inconclusive diagnoses.
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Affiliation(s)
- Diogo Turiani Hourneaux de Moura
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Thomas R McCarty
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Pichamol Jirapinyo
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Igor Braga Ribeiro
- Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Galileu Ferreira Ayala Farias
- Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marvin Ryou
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Linda S Lee
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston MA, USA.,Harvard Medical School, Boston, MA, USA
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Cazacu IM, Luzuriaga Chavez AA, Saftoiu A, Vilmann P, Bhutani MS. A quarter century of EUS-FNA: Progress, milestones, and future directions. Endosc Ultrasound 2018; 7:141-160. [PMID: 29941723 PMCID: PMC6032705 DOI: 10.4103/eus.eus_19_18] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 03/21/2018] [Indexed: 12/11/2022] Open
Abstract
Tissue acquisition using EUS has considerably evolved since the first EUS-FNA was reported 25 years ago. Its introduction was an important breakthrough in the endoscopic field. EUS-FNA has now become a part of the diagnostic and staging algorithm for the evaluation of benign and malignant diseases of the gastrointestinal tract and of the organs in its proximity, including lung diseases. This review aims to present the history of EUS-FNA development and to provide a perspective on the recent developments in procedural techniques and needle technologies that have significantly extended the role of EUS and its clinical applications. There is a bright future ahead for EUS-FNA in the years to come as extensive research is conducted in this field and various technologies are continuously implemented into clinical practice.
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Affiliation(s)
- Irina Mihaela Cazacu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania
- Department of Gastroenterology, Hepatology, and Nutrition, University of Texas – MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Adrian Saftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania
| | - Peter Vilmann
- Gastrounit, Division of Surgery, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Manoop S. Bhutani
- Department of Gastroenterology, Hepatology, and Nutrition, University of Texas – MD Anderson Cancer Center, Houston, Texas, USA
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3
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Abstract
Endoscopic ultrasound (EUS)-guided tissue acquisition has greatly evolved since the first EUS-guided fine-needle aspiration was reported nearly 25 years ago. EUS-guided tissue acquisition has become the procedure of choice for sampling of the pancreas, subepithelial lesions, and other structures adjacent to the gastrointestinal tract. This review focuses on recent developments in procedural techniques and needle technologies for EUS-guided tissue acquisition.
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Bhatia S, Puri R. Role of endoscopic ultrasound in non-small cell lung cancer. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2016. [DOI: 10.18528/gii160014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Sumit Bhatia
- Institute of Digestive and Hepatobiliary Sciences, Medanta - The Medicity, Gurgaon, India
| | - Rajesh Puri
- Institute of Digestive and Hepatobiliary Sciences, Medanta - The Medicity, Gurgaon, India
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Han L, Liu P, Petrenko VA, Liu A. A Label-Free Electrochemical Impedance Cytosensor Based on Specific Peptide-Fused Phage Selected from Landscape Phage Library. Sci Rep 2016; 6:22199. [PMID: 26908277 PMCID: PMC4764921 DOI: 10.1038/srep22199] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 02/09/2016] [Indexed: 11/09/2022] Open
Abstract
One of the major challenges in the design of biosensors for cancer diagnosis is to introduce a low-cost and selective probe that can recognize cancer cells. In this paper, we combined the phage display technology and electrochemical impedance spectroscopy (EIS) to develop a label-free cytosensor for the detection of cancer cells, without complicated purification of recognition elements. Fabrication steps of the cytosensing interface were monitored by EIS. Due to the high specificity of the displayed octapeptides and avidity effect of their multicopy display on the phage scaffold, good biocompatibility of recombinant phage, the fibrous nanostructure of phage, and the inherent merits of EIS technology, the proposed cytosensor demonstrated a wide linear range (2.0 × 10(2) - 2.0 × 10(8) cells mL(-1)), a low limit of detection (79 cells mL(-1), S/N = 3), high specificity, good inter-and intra-assay reproducibility and satisfactory storage stability. This novel cytosensor designing strategy will open a new prospect for rapid and label-free electrochemical platform for tumor diagnosis.
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Affiliation(s)
- Lei Han
- Institute for Biosensing &In-Vitro Diagnostics, and College of Medicine, Qingdao University, 38 Dengzhou Road, Qingdao 266021, China.,Laboratory for Biosensing, Qingdao Institute of Bioenergy &Bioprocess Technology, Chinese Academy of Sciences, 189 Songling Road, Qingdao, 266101, China
| | - Pei Liu
- Laboratory for Biosensing, Qingdao Institute of Bioenergy &Bioprocess Technology, Chinese Academy of Sciences, 189 Songling Road, Qingdao, 266101, China
| | - Valery A Petrenko
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, 269 Greene Hall, Auburn, Alabama 36849-5519, United States
| | - Aihua Liu
- Institute for Biosensing &In-Vitro Diagnostics, and College of Medicine, Qingdao University, 38 Dengzhou Road, Qingdao 266021, China.,Laboratory for Biosensing, Qingdao Institute of Bioenergy &Bioprocess Technology, Chinese Academy of Sciences, 189 Songling Road, Qingdao, 266101, China
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Colella S, Vilmann P, Konge L, Clementsen PF. Endoscopic ultrasound in the diagnosis and staging of lung cancer. Endosc Ultrasound 2014; 3:205-12. [PMID: 25485267 PMCID: PMC4247527 DOI: 10.4103/2303-9027.144510] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 01/03/2014] [Indexed: 12/25/2022] Open
Abstract
We reviewed the role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and esophageal ultrasound guided fine needle aspiration (EUS-FNA) in the pretherapeutic assessment of patients with proven or suspected lung cancer. EUS-FNA and EBUS-TBNA have been shown to have a good diagnostic accuracy in the diagnosis and staging of lung cancer. In the future, these techniques in combination with positron emission tomography/computed tomographic may replace surgical staging in patients with suspected and proven lung cancer, but until then surgical staging remains the gold standard for adequate preoperative evaluation.
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Affiliation(s)
- Sara Colella
- Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark
| | - Peter Vilmann
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Herlev, Denmark
| | - Lars Konge
- Centre for Clinical Education, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
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Unno J, Kanno A, Masamune A, Kasajima A, Fujishima F, Ishida K, Hamada S, Kume K, Kikuta K, Hirota M, Motoi F, Unno M, Shimosegawa T. The usefulness of endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of pancreatic neuroendocrine tumors based on the World Health Organization classification. Scand J Gastroenterol 2014; 49:1367-74. [PMID: 25180490 DOI: 10.3109/00365521.2014.934909] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND We assessed the controversial topic of using 22-gauge needles in endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for the diagnosis and evaluation of Ki67 labeling indices (Ki67LI) of pancreatic neuroendocrine tumors (pNET). METHODS Thirty-eight patients with pNET who underwent EUS-FNA between January 1, 2008 and December 31, 2012 were enrolled in this study. When available, the Ki67LI and WHO classifications obtained by EUS-FNA and surgical resection were compared. RESULTS EUS-FNA with a 22-gauge needle acquired sufficient histological sample to correctly diagnose pNET in 35 cases (92.1%). Both EUS-FNA and surgical histological specimens were available for 19 cases, and grading classes of the 2 procedures were consistent in 17 cases (89.5%) according to the WHO classification based on the Ki67LI. Tumor size was associated with a difference in the Ki67LI between the 2 procedures, although the Ki67LI was almost completely consistent for tumors less than 18 mm in size. CONCLUSIONS EUS-FNA with a 22-gauge needle is a safe and highly accurate technique for the diagnosis of pNET. There was a clear correlation between the Ki67LI of histological specimens acquired by EUS-FNA and surgery. EUS-FNA with a 22-gauge needle is useful to predict the WHO classification of pNET.
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Affiliation(s)
- Jun Unno
- Division of Gastroenterology, Tohoku University Graduate School of Medicine , Sendai , Japan
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Colaiácovo R, Assef MS, Ganc RL, Carbonari APC, Silva FAOB, Bin FC, Rossini LGB. Rectal cancer staging: Correlation between the evaluation with radial echoendoscope and rigid linear probe. Endosc Ultrasound 2014; 3:161-6. [PMID: 25184122 PMCID: PMC4145476 DOI: 10.4103/2303-9027.138786] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 01/29/2014] [Indexed: 01/18/2023] Open
Abstract
Background and Objectives: The National Cancer Institute estimated 40,340 new cases of rectal cancer in the United States in 2013. The correct staging of rectal cancer is fundamental for appropriate treatment of this disease. Transrectal ultrasound is considered one of the best methods for locoregional staging of rectal tumors, both radial echoendoscope and rigid linear probes are used to perform these procedures. The objective of this study is to evaluate the correlation between radial echoendoscopy and rigid linear endosonography for staging rectal cancer. Patients and Methods: A prospective analysis of 48 patients who underwent both, radial echoendoscopy and rigid linear endosonography, between April 2009 and May 2011, was done. Patients were staged according to the degree of tumor invasion (T) and lymph node involvement (N), as classified by the American Joint Committee on Cancer. Anatomopathological staging of surgical specimen was the gold standard for discordant evaluations. The analysis of concordance was made using Kappa index. Results: The general Kappa index for T staging was 0.827, with general P < 0.001 (confidence interval [CI]: 95% 0.627-1). The general Kappa index for N staging was 0.423, with general P < 0.001 (CI: 95% 0.214-0.632). Conclusion: The agreement between methods for T staging was almost perfect, with a worse outcome for T2, but still with substantial agreement. The findings may indicate equivalence in the diagnostic value of both flexible and rigid devices. For lymph node staging, there was moderate agreement between the methods.
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Affiliation(s)
- Rogério Colaiácovo
- Department of Endoscopy and French-Brazilian Centre of Endoscopic Ultrasound (CFBEUS), Santa Casa de São Paulo Hospital, São Paulo, Brazil
| | - Maurício Saab Assef
- Department of Endoscopy and French-Brazilian Centre of Endoscopic Ultrasound (CFBEUS), Santa Casa de São Paulo Hospital, São Paulo, Brazil
| | - Ricardo Leite Ganc
- Department of Endoscopy and French-Brazilian Centre of Endoscopic Ultrasound (CFBEUS), Santa Casa de São Paulo Hospital, São Paulo, Brazil
| | - Augusto Pincke Cruz Carbonari
- Department of Endoscopy and French-Brazilian Centre of Endoscopic Ultrasound (CFBEUS), Santa Casa de São Paulo Hospital, São Paulo, Brazil
| | - Flávio Amaro Oliveira Bitar Silva
- Department of Endoscopy and French-Brazilian Centre of Endoscopic Ultrasound (CFBEUS), Santa Casa de São Paulo Hospital, São Paulo, Brazil
| | - Fang Chia Bin
- Department of Endoscopy and French-Brazilian Centre of Endoscopic Ultrasound (CFBEUS), Santa Casa de São Paulo Hospital, São Paulo, Brazil
| | - Lúcio Giovanni Baptista Rossini
- Department of Endoscopy and French-Brazilian Centre of Endoscopic Ultrasound (CFBEUS), Santa Casa de São Paulo Hospital, São Paulo, Brazil
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Karadsheh Z, Al-Haddad M. Endoscopic ultrasound-guided fine-needle aspiration needles: which one and in what situation? Gastrointest Endosc Clin N Am 2014; 24:57-69. [PMID: 24215760 DOI: 10.1016/j.giec.2013.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is increasingly used as a diagnostic and therapeutic tool for pancreatic and other gastrointestinal disorders. Several factors affect the outcome of EUS-FNA, one of which is needle size. The decision to use a specific needle depends on factors including location, consistency, and type of the lesion; presence of onsite cytopathologist; and need for additional tissue procurement for histology. This review provides a balanced perspective on the use of different needle sizes available, highlighting the differences among them and potential niche applications of each to maximize diagnostic yield of EUS-FNA.
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Affiliation(s)
- Zeid Karadsheh
- Department of Internal Medicine, Brockton Hospital, 680 Centre Street, Brockton, MA 02302, USA
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11
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12
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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: 916] [Impact Index Per Article: 83.3] [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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Diagnostic yield and safety of endoscopic ultrasound guided fine needle aspiration of central mediastinal lung masses. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2013; 2013:150492. [PMID: 23818747 PMCID: PMC3683425 DOI: 10.1155/2013/150492] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 05/11/2013] [Indexed: 11/18/2022]
Abstract
UNLABELLED Background and Aims. EUS-FNA is an accurate and safe technique to biopsy mediastinal lymph nodes. However, there are few data pertaining to the role of EUS-FNA to biopsy central lung masses. The aim of the study was to assess the diagnostic yield and safety of EUS-FNA of indeterminate central mediastinal lung masses. Methods. DESIGN Retrospective review of a prospectively maintained database; noncomparative. SETTING Tertiary referral center. From 10/2004 to 12/2010, all patients with a lung mass located within proximity to the esophagus were referred for EUS-FNA. MAIN OUTCOME MEASUREMENT EUS-FNA diagnostic accuracy and safety. Results. 73 consecutive patients were included. EUS allowed detection in 62 (85%) patients with lack of visualization prohibiting FNA in 11 patients. Among sampled lesions, one patient (1/62 = 1.6%) had a benign lung mass (hamartoma), while the remaining 61 patients (61/62 = 98.4%) had a malignant mass (primary lung cancer: 55/61 = 90%; lung metastasis: 6/61 = 10%). The sensitivity, specificity, and accuracy of EUS-FNA were 96.7%, 100%, and 96.7%, respectively. The sensitivity was 80.8% when considering nonvisualized masses. One patient developed a pneumothorax (1/62 = 1.6%). Conclusions. EUS-FNA appears to be an accurate and safe technique for tissue diagnosis of central mediastinal lung masses.
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Buxbaum JL, Eloubeidi MA, Lane CJ, Varadarajulu S, Linder A, Crowe AE, Jhala D, Jhala NC, Crowe DR, Eltoum IA. Dynamic telecytology compares favorably to rapid onsite evaluation of endoscopic ultrasound fine needle aspirates. Dig Dis Sci 2012; 57:3092-7. [PMID: 22729624 PMCID: PMC3640867 DOI: 10.1007/s10620-012-2275-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Accepted: 06/04/2012] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS Rapid onsite evaluation (ROSE) has been demonstrated to correlate with final cytologic interpretations and improves the diagnostic yield of endoscopic ultrasound (EUS)-fine needle aspiration (FNA); however, its availability is variable across centers. The aim of this prospective study was to evaluate whether remote telecytology can substitute for ROSE. METHODS Consecutive patients who underwent EUS-FNA for diverse indications at a high volume referral center were enrolled and all samples were prospectively evaluated by three methods. ROSE was performed by a cytopathologist in the procedure room; simultaneously dynamic telecytology was done by a different cytopathologist in a remote location at our institution. The third method, final cytologic interpretation in the laboratory, was the gold standard. Telecytology was performed using an Olympus microscope system (BX) which broadcasts live images over the Internet. Accuracy of telecytology and agreement with other methods were the principle outcome measurements. RESULTS Twenty-five consecutive samples were obtained from participants 40-87 years old (median age 63, 48 % male). There was 88 % agreement between telecytology and final cytology (p < 0.001) and 92 % agreement between ROSE and final cytology (p < 0.001). There was consistency between telecytology and ROSE (p value for McNemar's χ(2) = 1.0). Cohen's kappa for agreement for telecytology and ROSE was 0.80 (SE = 0.11), confirming favorable correlation. CONCLUSION Dynamic telecytology compares favorably to ROSE in the assessment of EUS acquired fine needle aspirates. If confirmed by larger trials, this system might obviate the need for onsite interpretation of EUS-FNA specimens.
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Affiliation(s)
- James L. Buxbaum
- Division of Gastroenterology, University of Southern California, Los Angeles, California
| | - Mohamad A. Eloubeidi
- Division of Gastroenterology, University of Alabama in Birmingham, Birmingham, Alabama
| | - Christianne J. Lane
- Division of Gastroenterology, University of Southern California, Los Angeles, California
| | - Shyam Varadarajulu
- Division of Gastroenterology, University of Alabama in Birmingham, Birmingham, Alabama
| | - Ami Linder
- Department of Pathology, University of Alabama in Birmingham, Birmingham, Alabama
| | - Amanda E. Crowe
- Department of Pathology, University of Alabama in Birmingham, Birmingham, Alabama
| | - Darshana Jhala
- Department of Pathology, University of Alabama in Birmingham, Birmingham, Alabama
| | - Nirag C. Jhala
- Department of Pathology, University of Alabama in Birmingham, Birmingham, Alabama
| | - David R. Crowe
- Department of Pathology, University of Alabama in Birmingham, Birmingham, Alabama
| | - Isam A. Eltoum
- Department of Pathology, University of Alabama in Birmingham, Birmingham, Alabama
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Kanno A, Ishida K, Hamada S, Fujishima F, Unno J, Kume K, Kikuta K, Hirota M, Masamune A, Satoh K, Notohara K, Shimosegawa T. Diagnosis of autoimmune pancreatitis by EUS-FNA by using a 22-gauge needle based on the International Consensus Diagnostic Criteria. Gastrointest Endosc 2012; 76:594-602. [PMID: 22898417 DOI: 10.1016/j.gie.2012.05.014] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 05/09/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND It is controversial whether EUS-guided FNA by using 22-gauge (G) needles is useful for the diagnosis or evaluation of autoimmune pancreatitis (AIP). OBJECTIVE To evaluate the usefulness of EUS-FNA by 22-G needles for the histopathological diagnosis of AIP. DESIGN A retrospective study. SETTING Single academic center. PATIENTS A total of 273 patients, including 25 with AIP, underwent EUS-FNA and histological examinations. RESULTS EUS-FNA by using 22-G needles provided adequate tissue samples for histopathological evaluation because more than 10 high-power fields were available for evaluation in 20 of 25 patients (80%). The mean immunoglobulin G4-positive plasma cell count was 13.7/high-power field. Obliterative phlebitis was observed in 10 of 25 patients (40%). In the context of the International Consensus Diagnostic Criteria for AIP, 14 and 6 of 25 patients were judged to have level 1 (positive for 3 or 4 items) and level 2 (positive for 2 items) histological findings, respectively, meaning that 20 of 25 patients were suggested to have lymphoplasmacytic sclerosing pancreatitis based on the International Consensus Diagnostic Criteria. The diagnosis in 1 patient was type 2 AIP because a granulocytic epithelial lesion was identified in this patient. LIMITATIONS A retrospective study with a small number of patients. CONCLUSIONS The results of this study suggest that EUS-FNA by using 22-G needles provides tissue samples adequate for histopathological evaluation and greatly contributes to the histological diagnosis of AIP.
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Affiliation(s)
- Atsushi Kanno
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Lankarani A, Wallace MB. Endoscopic ultrasonography/fine-needle aspiration and endobronchial ultrasonography/fine-needle aspiration for lung cancer staging. Gastrointest Endosc Clin N Am 2012; 22:207-19, viii. [PMID: 22632944 DOI: 10.1016/j.giec.2012.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This article reviews different techniques available for diagnosis and staging of patients with non-small cell lung cancer (NSCLC). The advantages and disadvantages of each staging method are highlighted. The role of the gastroenterologist in NSCLC staging is explored. A new algorithm is proposed for the staging of NSCLC that incorporates endoscopic and endobronchial ultrasonography for mediastinal staging in patients with intrathoracic disease.
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Affiliation(s)
- Ali Lankarani
- Department of Gastroenterology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL 32224, USA
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Puri R, Khaliq A, Kumar M, Sud R, Vasdev N. Esophageal tuberculosis: role of endoscopic ultrasound in diagnosis. Dis Esophagus 2012; 25:102-6. [PMID: 21777339 DOI: 10.1111/j.1442-2050.2011.01223.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Esophageal involvement by tuberculosis is rare and is commonly secondary to mediastinal lymph nodal involvement. Endoscopic ultrasound (EUS) is a good modality for evaluation of both esophageal wall and mediastinal lymph nodes. The objectives were to study the role of EUS in diagnosing esophageal tuberculosis, to differentiate primary from secondary form, and to assess the response. Retrospective analysis of data over 7 years (i.e. from 2003 to 2009) was used. The study was set in a tertiary care referral institute and focused on patients diagnosed with esophageal tuberculosis. Interventions used included endoscopy, EUS, EUS-FNA (fine needle aspiration) followed by antituberculosis treatment. The main outcome measurements were symptoms, endoscopic features, EUS features, pathological yield, and response to treatment. There were 32 cases of esophageal tuberculosis. The primary symptom was dysphagia, and endoscopy showed ulcers in 18/32 (56.25%) and extrinsic bulge in 20/32 (62.5%) in middle one third of esophagus. EUS showed lymph nodes adjacent to esophageal pathology in all cases. Subcarinal region was the most common site of lymphadenopathy and they were matted, heterogeneous with predominantly hypoechoic center. Histopathology of endoscopic biopsy of ulcers and EUS-FNA of lymph nodes provided the diagnosis of tuberculosis in 27/32 (84.35%). All patients were treated with antitubercular treatment and showed good clinical, endoscopic and endosonographic response. This is a retrospective study, and PCR and culture for Mycobacterium tuberculosis were not done. Esophageal tuberculosis does not appear to be a primary disease and is most likely secondary to mediastinal nodal tuberculosis. A conglomerated mass of heterogeneous with predominantly hypoechoic lymph nodes with intervening hyperechoic strands and foci on EUS appears to be characteristic of mediastinal tuberculosis.
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Affiliation(s)
- R Puri
- Institute of Digestive and Hepatobiliary Sciences, Medanta, The Medicity, Gurgaon, India.
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A review of noninvasive staging of the mediastinum for non-small cell lung carcinoma. Surg Oncol Clin N Am 2012; 20:681-90. [PMID: 21986265 DOI: 10.1016/j.soc.2011.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Lung cancer and bronchogenic carcinoma are malignancies originating from the airways and pulmonary parenchyma. Most (approximately 90%) lung cancers are classified as non-small cell lung cancer. This distinction carries important differences for staging, treatment, and prognosis. This article presents a review of mediastinal staging for patients with non-small cell lung cancer.
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Buxbaum JL, Eloubeidi MA. Transgastric endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) in patients with esophageal narrowing using the ultrasonic bronchovideoscope. Dis Esophagus 2011; 24:458-61. [PMID: 21385282 DOI: 10.1111/j.1442-2050.2011.01179.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Endobronchial ultrasound-guided fine needle aspiration (EBUS-FNA) is emerging as a critical technology in the evaluation of mediastinal lesions and is increasingly regarded as complementary to endoscopic ultrasound (EUS) in this arena. This complementary role may extend into the abdomen in cases where esophageal strictures prevent the passage of the echoendoscope. The objective of the study was to characterize the uses of EBUS-FNA in the evaluation of gastrointestinal lesions in patients with esophageal narrowing. The study design was a single-center case series. The setting was in a tertiary referral center. Four patients underwent EBUS-FNA to evaluate gastrointestinal lesions; esophageal strictures prevented EUS passage in three, the fourth patient did not tolerate transbronchial EBUS but had abdominal lesions within reach of the EBUS scope. EBUS was used to evaluate the liver, adrenal gland, a retroperitoneal mass, and a celiac axis lymph node. EBUS-FNA has greater potential to evaluate abdominal lesions than has been previously recognized. The EBUS scope represents a safe and readily available technology to evaluate patients with esophageal strictures. Interventional endoscopists should be exposed to this modality.
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Affiliation(s)
- J L Buxbaum
- Division of Gastroenterology, Department of Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California, USA
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Role of EUS for the evaluation of mediastinal adenopathy. Gastrointest Endosc 2011; 74:239-45. [PMID: 21802583 DOI: 10.1016/j.gie.2011.03.1255] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 03/30/2011] [Indexed: 12/11/2022]
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Wani S, Gupta N, Gaddam S, Singh V, Ulusarac O, Romanas M, Bansal A, Sharma P, Olyaee MS, Rastogi A. A comparative study of endoscopic ultrasound guided fine needle aspiration with and without a stylet. Dig Dis Sci 2011; 56:2409-14. [PMID: 21327919 DOI: 10.1007/s10620-011-1608-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Accepted: 01/29/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND Despite lack of evidence, use of a stylet during endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is assumed to improve the quality and diagnostic yield of specimens. AIM The purpose of this study was to compare EUS-FNA specimens obtained with stylet (S+) and without stylet (S-) for: (i) cellularity, contamination, adequacy, and amount of blood and (ii) diagnostic yield of malignancy. METHODS Patients who underwent EUS-FNA of solid lesions by two experienced endosonographers at a tertiary referral center using a 22-gauge FNA needle with suction were included. Stylet was used for all EUS-FNA procedures performed between January 2006 and September 2007 and no stylet was used between October 2007 and April 2009 allowing comparison between the two techniques. Cytology slides were retrieved, de-identified and evaluated by two experienced cytopathologists blinded to FNA technique. Slides were evaluated for cellularity, degree of contamination, adequacy, amount of blood and cytologic diagnosis. Fisher's exact and unpaired t-test were used for comparative analysis. RESULTS A total of 162 patients with 228 lesions were included. FNA of 106 and 122 lesions each was performed in the S+ and S- groups, respectively. FNA sites included pancreas [41 (18%)], lymph node [125 (55%)], liver [20 (9%)], adrenal [21 (9%)] and others [21 (9%)]. No significant differences in the cellularity (P=0.37), contamination (P=0.18), significant blood (P=0.42) and adequacy of specimen (P=0.45) were found between S+ and S- specimens. There was no statistically significant difference in the diagnostic yield of malignant lesions (P=0.48). CONCLUSIONS The use of stylet during FNA does not appear to confer any advantage with regards to the adequacy of specimen or diagnostic yield of malignancy.
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Affiliation(s)
- Sachin Wani
- Division of Gastroenterology and Hepatology, Department of Pathology, Veterans Affairs Medical Center, University of Kansas School of Medicine, 4801 E. Linwood Blvd, Kansas City, MO 64128-2295, USA
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Manucha V, Kaur G, Verma K. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of mediastinal lymph nodes: experience from region with high prevalence of tuberculosis. Diagn Cytopathol 2011; 41:1019-22. [PMID: 21538959 DOI: 10.1002/dc.21698] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Accepted: 02/25/2011] [Indexed: 11/11/2022]
Abstract
Utility of EUS-FNA in diagnosing granulomatous lesions of mediastinum in regions with high prevalence of tuberculosis has not yet been evaluated. In the present study, utility and limitations of EUS-FNA of mediastinal lesions from a tertiary care center with high prevalence of tuberculosis were studied. All cases where EUS-FNA had been performed to diagnose mediastinal lymphadenopathy from January 2006 to December 2008 were retrieved from the files of cytopathology laboratory. These were reviewed by the cytopathologist. Two hundred and eighty one EUS-FNA aspirates from 269 patients were evaluated. Satisfactory aspirates were available in 259 cases. A cytological diagnosis of granulomatous lymphadenitis was rendered in 206 cases. Of these, tuberculosis could be established as an etiology in 76 cases and sarcoidosis in 7 cases only. In remaining 123 cases the etiology of granulomatous lymphadenitis could not be established and clinical correlation was suggested. Malignancies were diagnosed or suspected in 24 and 5 cases, respectively. The study highlights that the dilemma of tuberculosis versus sarcoidosis persists in regions with high prevalence of tuberculosis. However, EUS-FNA is useful in diagnosing unsuspected malignancies and confirming the presence of granulomatous lymphadenitis.
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Affiliation(s)
- Varsha Manucha
- Department of Pathology, Cytopathology Division, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi 110060, India
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Wang KX, Ben QW, Jin ZD, Du YQ, Zou DW, Liao Z, Li ZS. Assessment of morbidity and mortality associated with EUS-guided FNA: a systematic review. Gastrointest Endosc 2011; 73:283-90. [PMID: 21295642 DOI: 10.1016/j.gie.2010.10.045] [Citation(s) in RCA: 263] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Accepted: 10/21/2010] [Indexed: 12/12/2022]
Abstract
BACKGROUND EUS-guided FNA (EUS-FNA) permits both morphologic and cytologic analysis of lesions within or adjacent to the GI tract. Although previous studies have evaluated the accuracy of EUS-FNA, little is known about the complications of EUS-FNA. Moreover, the frequency and severity of complications may vary from center to center and may be related to differences in individual experience. OBJECTIVE To systematically review the morbidity and mortality associated with EUS-FNA. DESIGN MEDLINE and EMBASE were searched to identify relevant English-language articles. MAIN OUTCOME MEASUREMENTS EUS-FNA-specific morbidity and mortality rates. RESULTS We identified 51 articles with a total of 10,941 patients who met our inclusion and exclusion criteria; the overall rate of EUS-FNA-specific morbidity was 0.98% (107/10,941). In the small proportion of patients with complications of any kind, the rates of pancreatitis (36/8246; 0.44%) and postprocedure pain (37/10,941; 0.34%) were 33.64% (36/107) and 34.58% (37/107), respectively. The mortality rate attributable to EUS-FNA-specific morbidity was 0.02% (2/10,941). Subgroup analysis showed that the morbidity rate was 2.44% in prospective studies compared with 0.35% in retrospective studies for pancreatic mass lesions (P=.000), whereas it was 2.33% versus 5.07% for pancreatic cysts (P=.036). LIMITATIONS Few articles reported well-designed, prospective studies and few focused on overall complications after EUS-FNA. CONCLUSIONS EUS-FNA-related morbidity and mortality rates are relatively low, and most associated events are mild to moderate in severity.
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Affiliation(s)
- Kai-Xuan Wang
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
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Lin LF, Huang PT, Tsai MH, Chen TM, Ho KS. Role of endoscopic ultrasound-guided fine-needle aspiration in lung and mediastinal lesions. J Chin Med Assoc 2010; 73:523-9. [PMID: 21051029 DOI: 10.1016/s1726-4901(10)70114-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Accepted: 07/01/2010] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) was initially introduced for diagnosing gastrointestinal and pancreatic lesions, and later on for lung and mediastinal lesions. It can provide tissue diagnosis of lung cancer where bronchoscopy is non-diagnostic. It is a minimally invasive method for lymph node (N) and metastasis (M) staging of non-small cell lung cancer, and is helpful for tissue proof of mediastinal mass with unknown origin. Few data on this topic have been reported from Eastern countries. We report our experience of using EUS-FNA for tissue proof of lung and mediastinal lesions. METHODS This was a retrospective analysis of prospectively collected data of 20 cases, with 21 EUS-FNAs of lung and mediastinal lesions (1 EUS-FNA performed on left adrenal gland) for tissue diagnosis and staging. With patients' informed written consent and fasting for 8 hours, EUS-FNA was performed with a linear echoendoscope using a 22- or 5-gauge needle and a syringe with 10-20 mL negative pressure. The cytology smear was fixed with 98% alcohol, while cell-block and tissue were sent for histology. There was no onsite cytopathologist. EUS-guided Tru-Cut biopsy was performed in 1 case. Malignancy was proven by FNA biopsy results, mediastinoscopy when performed, or by clinical course and follow-up. RESULTS Of the 20 cases, 19 were male and 1 was female; mean age was 63.9 ± 12.6 years. Median tumor size was 2.6 cm (range, 1.8-5.0 cm), and median number of punctures was 3 (range, 2-7). Eighteen EUS-FNA punctures were performed at the mediastinum, and 2 directly on lung mass. The size of the left adrenal metastasis for extramediastinal EUS-FNA was 1.2 cm. Of the 16 EUS-FNA-positive cases, 12 were for tissue diagnosis, 3 were for both tissue diagnosis and staging (N2 and M1 staging), and 1 was for N2 staging. EUS-FNA provided a tissue diagnosis in 14 cases where bronchoscopy was negative. In 16 positive EUS-FNAs, all except 1 had adequate tissue for FNA biopsy. The sensitivity, specificity, and diagnostic accuracy of EUS-FNA were 84.2%, 100%, and 85%, respectively. CONCLUSION EUS-FNA can diagnose lung cancer by confirmation of mediastinal lymph node metastasis, by direct puncture of lung tumor close to the esophagus. It is useful for lymph node (N) stations 5, 7, 8 and metastasis (M) staging in non-small cell lung cancer, and for the diagnosis of mediastinal mass of unknown etiology.
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Affiliation(s)
- Lien-Fu Lin
- Division of Gastroenterology, Department of Internal Medicine, Tung's Taichung Metroharbor Hospital, Mei Tsun Road Section 2, Taichung, Taiwan, R.O.C
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Endoscopic ultrasound-guided fine needle aspiration of pancreatic masses in a veteran population: comparison of results with 22- and 25-gauge needles. Pancreas 2010; 39:685-6. [PMID: 20562582 DOI: 10.1097/mpa.0b013e3181c5c597] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Hasan MK, Gill KRS, Wallace MB, Raimondo M. Lung cancer staging by combined endobronchial ultrasound (EBUS) and endoscopic ultrasound (EUS): The gastroenterologist's perspective. Dig Liver Dis 2010; 42:157-62. [PMID: 19692298 DOI: 10.1016/j.dld.2009.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2009] [Accepted: 07/17/2009] [Indexed: 12/11/2022]
Abstract
This review deals with the combined approach of endoscopic ultrasound and endobronchial ultrasound for lung cancer staging. The review provides an overview for the gastroenterologist who performs endosonography with regard to the current evidence supporting the use of endoscopic ultrasound and endobronchial ultrasound in clinical practice.
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Abstract
As limited as are the studies regarding peritoneal Natural Orifice Trans-Luminal Endoscopic Surgery, mediastinal transluminal experiments are certainly in their infancy. The authors evaluate the parallel development of minimally invasive thoracic surgery with regard to its counterpart in peritoneal laparoscopy to NOTES. Transesophageal interventions by both endosonographic and direct visualization are examined in the context of minimally invasive surgery and mediastinal NOTES. Techniques of viscerotomy creation, visualization, and closure are examined with particular emphasis on mediastinal structures. The state of current interventions is examined. Finally, current morbidity (including infectious complications) and survival outcomes are examined in those animals that have undergone transesophageal exploration.
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Khoo KL, Ho KY, Khor CJL, Nilsson B, Lim TK. First endoscopic procedure for diagnosis and staging of mediastinal lymphadenopathy. World J Gastroenterol 2009; 15:6096-101. [PMID: 20027684 PMCID: PMC2797668 DOI: 10.3748/wjg.15.6096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare a first diagnostic procedure of transbronchial needle aspiration (TBNA) with selection of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) or TBNA for mediastinal lymphadenopathy.
METHODS: Sixty-eight consecutive patients with mediastinal lymphadenopathy on computed tomography (CT), who required cytopathological diagnosis, were recruited. The first 34 underwent a sequential approach in which TBNA was performed first, followed by EUS-FNA if TBNA was unrevealing. The next 34 underwent a selective approach where either TBNA or EUS-FNA was selected as the first procedure based on the CT findings.
RESULTS: The diagnostic yield of TBNA as the first diagnostic procedure in the sequential approach was 62%. In the selective approach, the diagnostic yield of the first procedure was 71%. There was no significant difference in the overall diagnostic yield, but there were significantly fewer combined procedures with the selective approach.
CONCLUSION: Selecting either EUS-FNA or TBNA as the first diagnostic procedure achieved a comparable diagnostic yield with significantly fewer procedures than performing TBNA first in all patients.
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Hasegawa M, Sakai F, Kimura F, Inoue K, Nagai A. Size of noncancerous hilomediastinal lymph nodes measured on coronal and sagittal reconstruction CT images. Jpn J Radiol 2009; 27:416-22. [PMID: 20035413 DOI: 10.1007/s11604-009-0362-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Accepted: 08/10/2009] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine the sizes of hilomediastinal lymph nodes on coronal and sagittal reconstruction computed tomographic images of subjects without known malignancies. MATERIALS AND METHODS We evaluated 560 lymph nodes of 246 consecutive patients who underwent multidetector-row computed tomography (MDCT) of the chest, then reconstructed coronal and sagittal images on a viewer and measured short-axis diameters of lymph nodes in each station according to the American Thoracic Society (ATS) map for axial, coronal, and sagittal images. RESULTS On coronal images, short-axis diameters were significantly larger than on axial images in station #4R (P < 0.01). On sagittal images, short-axis diameters were significantly smaller than on axial images in stations #4L (P < 0.01), #10R (P < 0.001), and #10L (P < 0.05). On coronal and sagittal images, short-axis diameters were significantly smaller than on axial images in stations #11R (P < 0.001). In #7, diameters were significantly larger on coronal images than on axial and sagittal images (P < 0.001), and diameters were significantly smaller on sagittal images than on axial images (P < 0.01). CONCLUSION In stations #4R, #4L, #7, #10R, #10L, and #11R, measurements of short-axis diameters of hilomediastinal lymph nodes differed on coronal and sagittal images. On coronal and sagittal images, evaluation of hilomediastinal lymph nodes requires unique size criteria for every station.
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Affiliation(s)
- Mizue Hasegawa
- Department of Diagnostic Radiology, Saitama International Medical Center, Saitama Medical University, Hidaka, Japan.
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Estadificación del cáncer de pulmón mediante punción aspirativa con aguja fina guiada por ultrasonografía endoscópica y endobronquial. Arch Bronconeumol 2009; 45:603-10. [DOI: 10.1016/j.arbres.2008.09.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2008] [Revised: 08/27/2008] [Accepted: 09/02/2008] [Indexed: 11/15/2022]
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Kim E, Telford JJ. Endoscopic ultrasound advances, part 1: diagnosis. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2009; 23:594-601. [PMID: 19816621 PMCID: PMC2776547 DOI: 10.1155/2009/876057] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Accepted: 07/27/2009] [Indexed: 12/17/2022]
Affiliation(s)
- Edward Kim
- Division of Internal Medicine, University of British Columbia
| | - Jennifer J Telford
- Division of Gastroenterology, St Paul’s Hospital, Vancouver, British Columbia
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Harewood GC, Pascual J, Raimondo M, Woodward T, Johnson M, McComb B, Odell J, Jamil LH, Gill KRS, Wallace MB. Economic analysis of combined endoscopic and endobronchial ultrasound in the evaluation of patients with suspected non-small cell lung cancer. Lung Cancer 2009; 67:366-71. [PMID: 19473723 DOI: 10.1016/j.lungcan.2009.04.019] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Revised: 04/23/2009] [Accepted: 04/26/2009] [Indexed: 10/20/2022]
Abstract
Lung cancer remains the most common cause of cancer-related death in the United States. This study evaluated the costs of alternative diagnostic evaluations for patients with suspected non-small cell lung cancer (NSCLC). Researchers used a cost-minimization model to compare various diagnostic approaches in the evaluation of patients with NSCLC. It was less expensive to use an initial endoscopic ultrasound (EUS) with fine needle aspiration (FNA) to detect a mediastinal lymph node metastasis ($18,603 per patient), compared with combined EUS FNA and endobronchial ultrasound (EBUS) with FNA ($18,753). The results were sensitive to the prevalence of malignant mediastinal lymph nodes; EUS FNA remained least costly, if the probability of nodal metastases was <32.9%, as would occur in a patient without abnormal lymph nodes on computed tomography (CT). While EUS FNA combined with EBUS FNA was the most economical approach, if the rate of nodal metastases was higher, as would be the case in patients with abnormal lymph nodes on CT. Both of these strategies were less costly than bronchoscopy or mediastinoscopy. The pre-test probability of nodal metastases can determine the most cost-effective testing strategy for evaluation of a patient with NSCLC. Pre-procedure CT may be helpful in assessing probability of mediastinal nodal metastases.
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Schipper P, Schoolfield M. Minimally invasive staging of N2 disease: endobronchial ultrasound/transesophageal endoscopic ultrasound, mediastinoscopy, and thoracoscopy. Thorac Surg Clin 2009; 18:363-79. [PMID: 19086606 DOI: 10.1016/j.thorsurg.2008.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In 2005 the American College of Surgeons conducted a survey examining lung cancer practice patterns at 729 hospitals in the United States. In 11,668 surgically treated patients, 92% received a preoperative chest CT. Only 27% of these patients underwent mediastinoscopy, and lymph node material was sampled in less than half of these patients. At the time of surgical resection, additional mediastinal lymph nodes were sampled in only 58% of patients. In the remaining 42% only the lymph node material attached to the surgical specimen (N1 nodes) was sampled. Although this article discusses the finer points of the minimally invasive evaluation of the N2 lymph nodes, any procedure to evaluate these nodes is better than simply ignoring them.
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Affiliation(s)
- Paul Schipper
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Mail Code L353, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97229, USA.
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Imai K, Minamiya Y, Saito H, Nakagawa T, Hosono Y, Nanjo H, Tozawa K, Hashimoto M, Kimura Y, Ogawa JI. Accuracy of helical computed tomography for the identification of lymph node metastasis in resectable non-small cell lung cancer. Surg Today 2008; 38:1083-90. [PMID: 19039633 DOI: 10.1007/s00595-008-3801-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2008] [Accepted: 05/28/2008] [Indexed: 12/18/2022]
Abstract
PURPOSE The criteria for the diagnosis of lymph node metastasis (LNM) in non-small cell lung cancer were investigated using helical computed tomography (hCT). The conventional criterion (1-cm short axis threshold) is generally accepted; however, this criterion is based on conventional CT. New criteria for LNM were investigated because the resolution of hCT is better than that of conventional CT. METHODS Ninety-seven NSCLC patients examined with hCT were enrolled. Both the long axis (LA) and short axis (SA) of the nodes were measured using hCT. RESULTS Based on the receiver operating characteristic curves, the thresholds that gave optimal sensitivity and specificity for LNM were 13 mm for LA and 9 mm for SA. The LNM diagnosis was re-evaluated using the combination of cutoff values. When the LA was > or =13 mm and the SA was > or =9 mm, the sensitivity, specificity, and accuracy were 56.3%, 92.1%, and 88.1%, respectively. When the LA was > or =13 mm or SA was > or =9 mm, sensitivity, specificity, and accuracy were 75.0%, 74.7%, and 74.7%, respectively. These values were not so different from the conventional criterion recalculated from these data. CONCLUSION The new criteria are considered to be useful for making a LNM diagnosis. The conventional criteria for the LNM diagnosis might therefore be applicable even for hCT.
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Affiliation(s)
- Kazuhiro Imai
- Division of Thoracic Surgery, Department of Surgery, Akita University School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
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Radiographic Staging of Mediastinal Lymph Nodes in Non–Small Cell Lung Cancer Patients. Thorac Surg Clin 2008; 18:349-61. [DOI: 10.1016/j.thorsurg.2008.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Puli SR, Reddy JBK, Bechtold ML, Ibdah JA, Antillon D, Singh S, Olyaee M, Antillon MR. Endoscopic ultrasound: it's accuracy in evaluating mediastinal lymphadenopathy? A meta-analysis and systematic review. World J Gastroenterol 2008; 14:3028-37. [PMID: 18494054 PMCID: PMC2712170 DOI: 10.3748/wjg.14.3028] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2007] [Revised: 01/03/2008] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the accuracy of endoscopic ultrasound (EUS), EUS-fine needle aspiration (FNA) in evaluating mediastinal lymphadenopathy. METHODS Only EUS and EUS-FNA studies confirmed by surgery or with appropriate follow-up were selected. Articles were searched in Medline, Pubmed, and Cochrane control trial registry. Only studies from which a 2 multiply 2 table could be constructed for true positive, false negative, false positive and true negative values were included. Two reviewers independently searched and extracted data. The differences were resolved by mutual agreement. Meta-analysis for the accuracy of EUS was analyzed by calculating pooled estimates of sensitivity, specificity, likelihood ratios, and diagnostic odds ratios. Pooling was conducted by both Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (random effects model). The heterogeneity of studies was tested using Cochran's Q test based upon inverse variance weights. RESULTS Data was extracted from 76 studies (n = 9310) which met the inclusion criteria. Of these, 44 studies used EUS alone and 32 studies used EUS-FNA. FNA improved the sensitivity of EUS from 84.7% (95% CI: 82.9-86.4) to 88.0% (95% CI: 85.8-90.0). With FNA, the specificity of EUS improved from 84.6% (95% CI: 83.2-85.9) to 96.4% (95% CI: 95.3-97.4). The P for chi-squared heterogeneity for all the pooled accuracy estimates was > 0.10. CONCLUSION EUS is highly sensitive and specific for the evaluation of mediastinal lymphadenopathy and FNA substantially improves this. EUS with FNA should be the diagnostic test of choice for evaluating mediastinal lymphadenopathy.
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Shami VM, Jones DR, Hernandez A, Stelow EB. Endoscopic ultrasound-guided fine needle aspiration of a malignant pleural effusion to diagnose and stage lung cancer: when should this approach be considered? Dig Dis Sci 2008; 53:757-9. [PMID: 17717747 DOI: 10.1007/s10620-007-9920-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2006] [Accepted: 07/04/2007] [Indexed: 12/09/2022]
Affiliation(s)
- Vanessa M Shami
- Department of Medicine, Division of Gastroenterology, University of Virginia Health Sciences, Charlottesville, VA 22908, USA.
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Oki M, Saka H, Kitagawa C, Tanaka S, Shimokata T, Kawata Y, Mori K, Kajikawa S, Ichihara S, Moritani S. Real-time endobronchial ultrasound-guided transbronchial needle aspiration is useful for diagnosing sarcoidosis. Respirology 2008; 12:863-8. [PMID: 17986115 DOI: 10.1111/j.1440-1843.2007.01145.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Several studies of real-time endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) have reported a sensitivity of approximately 90% in the diagnosis of mediastinal and hilar malignancies. However, few studies have addressed its role in the diagnosis of sarcoidosis. The aim of the present study was to assess the utility of EBUS-TBNA in confirming a pathological diagnosis of sarcoidosis. METHODS Fifteen consecutive patients with suspected sarcoidosis and mediastinal and/or hilar lymphadenopathy were investigated prospectively. EBUS-TBNA with an echo-bronchoscope and a dedicated echogenic 22-gauge needle was carried out in patients under conscious sedation, followed by conventional TBNA of the same lesion using a 19-gauge needle. RESULTS EBUS-TBNA and/or TBNA demonstrated non-caseating epithelioid cell granulomas in 14 of 15 patients (93%). All 14 patients with a pathological diagnosis of sarcoidosis were considered to have sarcoidosis based on subsequent clinical assessments. The single patient with a negative EBUS-TBNA and TBNA had a malignant melanoma diagnosed following surgical biopsy. EBUS-TBNA confirmed a diagnosis of sarcoidosis in 13 of the 14 patients (93%) by identifying non-caseating epithelioid cell granulomas in 18 of 23 lymph nodes (78%) sampled. When two needle aspirates of one or two lymph nodes were carried out, the percentage positive pathological diagnosis for sarcoidosis for (i) EBUS-TBNA; (ii) TBNA; and (iii) the combination of EBUS-TBNA and TBNA were 93% (13 of 14 patients), 93% (13 of 14 patients) and 100% (14 of 14 patients), respectively. There were no complications associated with the procedures. CONCLUSION EBUS-TBNA is less invasive and acceptably sensitive as a method for obtaining pathological confirmation of sarcoidosis.
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Affiliation(s)
- Masahide Oki
- Department of Respiratory Medicine, Nagoya Medical Center, Nagoya, Japan.
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Peng HQ, Greenwald BD, Tavora FR, Kling E, Darwin P, Rodgers WH, Berry A. Evaluation of performance of EUS-FNA in preoperative lymph node staging of cancers of esophagus, lung, and pancreas. Diagn Cytopathol 2008; 36:290-6. [DOI: 10.1002/dc.20796] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Diagnosis of intra-abdominal and mediastinal sarcoidosis with EUS-guided FNA. Gastrointest Endosc 2008; 67:28-34. [PMID: 18155422 DOI: 10.1016/j.gie.2007.07.049] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Accepted: 07/31/2007] [Indexed: 02/08/2023]
Abstract
BACKGROUND In the presence of a compatible clinical picture, the diagnosis of sarcoidosis requires pathologic confirmation of noncaseating epithelioid granuloma in affected tissues. The standard procedure of choice for most patients is a bronchoscopy with transbronchial biopsy (TBB), which has a diagnostic yield of 40% to 90%. The lowest yield with TBB is in cases that present with predominant mediastinal or intra-abdominal lymphadenopathy (LN) and minimal parenchymal lung involvement. OBJECTIVE To study the diagnostic yield of EUS-guided FNA in diagnosing sarcoidosis with predominant LN or masses. DESIGN Retrospective chart review. SETTING Teaching university hospital. PATIENTS Analysis of 21 consecutive patients with sarcoidosis and predominant mediastinal and/or intra-abdominal LN or masses who underwent EUS-guided FNA. RESULTS EUS-guided FNA diagnosed sarcoidosis in 18 of 21 patients (86%). In 3 patients, EUS-guided FNA was either not diagnostic or inconclusive, and patients underwent mediastinoscopy with lymphadenectomy, which established the diagnosis of sarcoidosis. Seven of the 21 patients (33%) had intra-abdominal LN and/or masses, and EUS-guided FNA of the intra-abdominal pathology was diagnostic of sarcoidosis in 4 of the 7 patients (57%). Four of the 21 patients (19%) had a history of malignancy, and use of EUS-guided FNA helped in ruling out the recurrence of malignancy in 3 of the 4 patients (75%). LIMITATIONS Mycobacterial and fungal culture was not obtained in all patients. CONCLUSIONS EUS-guided FNA offers a practical, minimally invasive technique for the diagnosis of sarcoidosis in patients who present with predominant mediastinal and/or intra-abdominal LN or masses.
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Detterbeck FC, Jantz MA, Wallace M, Vansteenkiste J, Silvestri GA. Invasive mediastinal staging of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007; 132:202S-220S. [PMID: 17873169 DOI: 10.1378/chest.07-1362] [Citation(s) in RCA: 442] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The treatment of non-small cell lung cancer (NSCLC) is determined by accurate definition of the stage. If there are no distant metastases, the status of the mediastinal lymph nodes is critical. Although imaging studies can provide some guidance, in many situations invasive staging is necessary. Many different complementary techniques are available. METHODS The current guidelines and medical literature that are applicable to this issue were identified by computerized search and were evaluated using standardized methods. Recommendations were framed using the approach described by the Health and Science Policy Committee of the American College of Chest Physicians. RESULTS Performance characteristics of invasive staging interventions are defined. However, a direct comparison of these results is not warranted because the patients selected for these procedures have been different. It is crucial to define patient groups, and to define the need for an invasive test and selection of the best test based on this. CONCLUSIONS In patients with extensive mediastinal infiltration, invasive staging is not needed. In patients with discrete node enlargement, staging by CT or positron emission tomography (PET) scanning is not sufficiently accurate. The sensitivity of various techniques is similar in this setting, although the false-negative (FN) rate of needle techniques is higher than that for mediastinoscopy. In patients with a stage II or a central tumor, invasive staging of the mediastinal nodes is necessary. Mediastinoscopy is generally preferable because of the higher FN rates of needle techniques in the setting of normal-sized lymph nodes. Patients with a peripheral clinical stage I NSCLC do not usually need invasive confirmation of mediastinal nodes unless a PET scan finding is positive in the nodes. The staging of patients with left upper lobe tumors should include an assessment of the aortopulmonary window lymph nodes.
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Affiliation(s)
- Frank C Detterbeck
- Division of Thoracic Surgery, Department of Surgery, Yale University, 330 Cedar St, FMB 128, New Haven, CT 06520-8062, USA.
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Sawhney MS, Bakman Y, Holmstrom AM, Nelson DB, Lederle FA, Kelly RF. Impact of Preoperative Endoscopic Ultrasound on Non-small Cell Lung Cancer Staging. Chest 2007; 132:916-21. [PMID: 17573497 DOI: 10.1378/chest.06-2571] [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: 11/01/2022] Open
Abstract
AIM To determine if the addition of preoperative endoscopic ultrasound (EUS) to non-small cell lung cancer staging can reduce the proportion of patients in whom malignant mediastinal lymph nodes (inoperable disease) are discovered at surgery. METHODS All patients with lung cancer who underwent mediastinoscopy or thoracotomy for cancer diagnosis, staging, or treatment from 1999 to 2005 were identified. Patients who had undergone preoperative EUS were designated as the EUS group. The control group was composed of similar patients who had not undergone preoperative EUS, and were frequency matched to those in the EUS group in a 3:1 ratio by preoperative cancer stage. The proportion of patients in whom malignant mediastinal lymph nodes were diagnosed at surgery was the primary outcome. RESULTS Forty-four patients (average age, 67.8 years) met criteria for the EUS group, and 132 patients (average age, 67.4 years) were selected as control subjects. Overall, in the EUS group, 3 of 44 patients (6.8%) were found to have malignant mediastinal lymph nodes at surgery, compared with 41 of 132 patients (31.1%) in the control group (p = 0.003). In patients undergoing thoracotomy for cancer resection, 3% in the EUS group, compared with 20% in the control group, were found to have malignant mediastinal lymph nodes at surgery (p = 0.01). There was also a trend toward lower yield of mediastinoscopy done for cancer diagnosis or staging in the EUS group (p = 0.08). CONCLUSIONS Preoperative EUS in lung cancer patients may reduce unnecessary surgery at which advanced inoperable disease is discovered.
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Affiliation(s)
- Mandeep S Sawhney
- Section of Gastroenterology, Minneapolis VA Medical Center, Minneapolis, MN, USA.
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Hernandez A, Kahaleh M, Olazagasti J, Jones DR, Daniel T, Stelow E, White GE, Shami VM. EUS-FNA as the initial diagnostic modality in centrally located primary lung cancers. J Clin Gastroenterol 2007; 41:657-60. [PMID: 17667048 DOI: 10.1097/mcg.0b013e31802fc1cf] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND AIMS The need to safely and accurately diagnose lung neoplasms is crucial as the only prospect for a cure is surgical resection. A small amount of data exists on the use of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) as the initial diagnostic modality of primary lung cancer. METHODS We performed a retrospective review of an established prospective database of all patients undergoing EUS-FNA of a primary lung neoplasm adjacent to the esophagus during January 2001 to August 2005 in one tertiary care center. The indications for the procedure, diagnostic accuracy, and complications were reviewed. RESULTS A total of 17 cases (9 females, 8 males) were identified. The mean age was 66 (SD 10.6). There were 9 lesions within the hilum and 8 lesions within the upper lobes. The median size of the lung lesions was 5 (range 2 to 12)x4 (range 2 to 9) cm. The median and mean number of FNA passes was 3. All the procedures provided an accurate diagnosis of the primary lung lesion without need for further intervention. One patient with active hemoptysis was transiently hospitalized for aspiration pneumonia postprocedure. CONCLUSIONS EUS-FNA is a safe, relatively cost-effective, and accurate initial diagnostic modality for the diagnosis of lung lesions adjacent to the esophagus or invading the mediastinum. Although further randomized prospective trials are warranted, this modality should be considered as a first step in the diagnostic armamentarium in centrally located lung lesions.
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Affiliation(s)
- Alfredo Hernandez
- Digestive Health Center of Excellence, Department of Radiology, University of Virginia, Charlottesville, VA 22908, USA
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Prasad P, Wittmann J, Pereira SP. Endoscopic ultrasound of the upper gastrointestinal tract and mediastinum: diagnosis and therapy. Cardiovasc Intervent Radiol 2007; 29:947-57. [PMID: 16933163 DOI: 10.1007/s00270-005-0184-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Endoscopic ultrasound (EUS) has developed significantly over the last two decades and has had a considerable impact on the imaging and staging of mass lesions within or in close proximity to the gastrointestinal (GI) tract. In conjunction with conventional imaging such as helical computed tomography and magnetic resonance imaging, the indications for EUS include (1) differentiating between benign and malignant lesions of the mediastinum and upper GI tract, (2) staging malignant tumors of the lung, esophagus, stomach, and pancreas prior to surgery or oncological treatment, (3) excluding common bile duct stones before laparoscopic cholecystectomy, thereby avoiding the need for endoscopic retrograde cholangiopancreatography (ERCP) in some patients, and (4) assessing suspected lesions that are either equivocal or not seen on conventional imaging. In recent years, EUS has charted a course similar to that taken by ERCP, evolving from a purely diagnostic modality to one that is interventional and therapeutic. These indications include (5) obtaining a tissue diagnosis by EUS-guided fine-needle aspiration or trucut-type needle biopsy and (6) providing therapy such as coeliac plexus neurolysis and pancreatic pseudocyst drainage--in many cases, more accurately and safely than conventional techniques. Emerging investigational techniques include EUS-guided enteric anastomosis formation and fine-needle injection therapy for malignant disease.
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Affiliation(s)
- Priyajit Prasad
- Digestive Disease Center, Medical University of South Carolina, Charleston, SC, USA
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Perez NE, Maryala S, Seren S, Feng J, Pansare V, Dhar R. Metastatic prostate cancer presenting as mediastinal lymphadenopathy identified by EUS with FNA. Gastrointest Endosc 2007; 65:948-9. [PMID: 17466216 DOI: 10.1016/j.gie.2006.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2006] [Accepted: 10/01/2006] [Indexed: 02/08/2023]
Affiliation(s)
- Nolan E Perez
- Division of Gastroenterology, Wayne State University School of Medicine, Detroit, Michigan, USA
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Fernández-Esparrach G, Pellisé M, Solé M, Belda J, Sendino O, Llach J, Mata A, Bordas JM, Ginés A. [Usefulness of endoscopic ultrasound-guided fine needle aspiration in the diagnosis of mediastinal lesions]. Arch Bronconeumol 2007; 43:219-224. [PMID: 17397586 DOI: 10.1157/13100541] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
OBJECTIVE Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a safe and effective technique for the diagnosis of focal pancreatic lesions and enlarged abdominal lymph nodes. The aim of this study was to assess the usefulness of EUS-FNA in the diagnosis of mediastinal lesions. PATIENTS AND METHODS A retrospective review was performed of all consecutive cases in which EUS-FNA was used for the diagnosis of a mediastinal lesion between January 2001 and September 2003. We used a radial echoendoscope to assess the characteristics of the lesion and a linear-array echoendoscope to perform transesophageal needle aspiration with a 22-gauge needle. Histopathology of the resected specimen was considered as the gold standard in surgically treated patients whereas cytology obtained by EUS-FNA was the gold standard when surgery was not indicated. RESULTS EUS-FNA was performed in 59 patients with a total of 89 lesions with mean (SD) dimensions of 2.4 (2.0) cm x 1.6 (1.4) cm. Malignant lesions were larger than benign ones (short axis, 2.7 [1.4] as compared with 1.0 [0.9] cm; P< .001). The diagnosis was obtained for 53 patients (90%) and 81 lesions (91%) with a mean of 2 (1) passes per lesion. The sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of EUS-FNA were 81%, 100%, 100%, 75%, and 88%, respectively, when analyzed by lesion, and 88%, 100%, 100%, 80%, and 92% when analyzed by patient. CONCLUSIONS EUS-FNA is an effective technique for the diagnosis of mediastinal lesions. The likelihood of malignancy increases with size.
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Affiliation(s)
- Glòria Fernández-Esparrach
- Unidad de Endoscopia, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Barcelona, Spain
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Fernández-Esparrach G, Pellisé M, Solé M, Belda J, Sendino O, Llach J, Mata A, Bordas JM, Ginés A. Usefulness of Endoscopic Ultrasound-Guided Fine Needle Aspiration in the Diagnosis of Mediastinal Lesions. ACTA ACUST UNITED AC 2007; 43:219-24. [PMID: 17397586 DOI: 10.1016/s1579-2129(07)60054-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a safe and effective technique for the diagnosis of focal pancreatic lesions and enlarged abdominal lymph nodes. The aim of this study was to assess the usefulness of EUS-FNA in the diagnosis of mediastinal lesions. PATIENTS AND METHODS A retrospective review was performed of all consecutive cases in which EUS-FNA was used for the diagnosis of a mediastinal lesion between January 2001 and September 2003. We used a radial echoendoscope to assess the characteristics of the lesion and a linear-array echoendoscope to perform transesophageal needle aspiration with a 22-gauge needle. Histopathology of the resected specimen was considered as the gold standard in surgically treated patients whereas cytology obtained by EUS-FNA was the gold standard when surgery was not indicated. RESULTS EUS-FNA was performed in 59 patients with a total of 89 lesions with mean (SD) dimensions of 2.4 (2.0) cm x 1.6 (1.4) cm. Malignant lesions were larger than benign ones (short axis, 2.7 [1.4] as compared with 1.0 [0.9] cm; P< .001). The diagnosis was obtained for 53 patients (90%) and 81 lesions (91%) with a mean of 2 (1) passes per lesion. The sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of EUS-FNA were 81%, 100%, 100%, 75%, and 88%, respectively, when analyzed by lesion, and 88%, 100%, 100%, 80%, and 92% when analyzed by patient. CONCLUSIONS EUS-FNA is an effective technique for the diagnosis of mediastinal lesions. The likelihood of malignancy increases with size.
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Affiliation(s)
- Glòria Fernández-Esparrach
- Unidad de Endoscopia, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Barcelona, Spain
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Abstract
The available tools for diagnosing and staging lung cancer patients can be broadly categorized into non-invasive, minimally invasive and invasive (surgical) modalities. Non-invasive modalities include CT and PET. Minimally invasive modalities are endoscopic approaches, including endoscopic ultrasound, endobronchial ultrasound and transbronchial fine needle aspiration without ultrasound guidance. This review focuses on the non-invasive and minimally invasive techniques involving imaging. Application of Bayesian principles indicates that tests with a high sensitivity and specificity for detection of both systemic metastases and mediastinal nodal involvement are required for treatment selection and planning in patients with non-small cell lung cancer who would be considered for treatment with curative intent. Combined PET/CT using the glucose analogue fluorine-18 fluorodeoxyglucose currently provides the best diagnostic performance for this purpose and should now be considered the standard of care for staging non-small cell lung cancer. Endoscopic ultrasound and endobronchial ultrasound have important complementary roles to allow further evaluation of equivocal nodal abnormalities on PET or CT and to allow pathological samples to be obtained. Diagnostic CT has an important role in defining tumour relations for patients deemed suitable for surgical resection and as the initial investigation for patients with potential symptoms of lung cancer or proven lung cancer that would not be considered for curative treatment on medical grounds.
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Affiliation(s)
- Rodney J Hicks
- Centre for Molecular Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
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