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Khaitan PG, Holliday T, Carroll A, Hofstetter WL, Bayley EM, Zhou N, Desale S, Watson TJ. Can Clinical Response Predict Pathologic Response Following Neoadjuvant Chemoradiation for Esophageal Cancer? J Gastrointest Surg 2022; 26:1345-1351. [PMID: 35414141 DOI: 10.1007/s11605-022-05315-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 03/11/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Approximately 20-40% of patients with locally advanced esophageal cancer will achieve a pathologic complete response (ypCR) following neoadjuvant chemoradiotherapy (nCRT). Predicting ypCR based on a clinical complete response (ycCR) has been a challenge. This study assessed the correlation between ycCR and ypCR, as determined from esophagectomy specimens. METHODS Patients undergoing esophagectomy following nCRT at three major institutions between 2005 and 2018 were reviewed. Restaging, including PET/CT, endoscopy with biopsy, and esophageal ultrasound (EUS), was performed to determine ycCR. RESULTS Six hundred sixty patients were included, with 93.3% with esophageal adenocarcinoma histology. Six hundred fifty-eight of these patients underwent PET, 304 EUS, and 584 underwent a biopsy. Following nCRT, 148 (22.4%) were found to have a ypCR. Only 12/32 (37.5%) determined to have a ycCR were found to have a ypCR, while 136/628 (21.6%) with a non-ycCR were found to have a ypCR (p 0.075). Individual modality PPV was 28% for PET, 54% for EUS, and 26% for biopsy. When PET was combined with EUS, 168 reports were concordant and the PPV of ypCR was 50%, though the number of patients was low (1/2). With all 3 re-staging modalities combined, the PPV and NPV both rose to 100%. CONCLUSIONS Current restaging tools cannot reliably predict ypCR after nCRT. While multimodal restaging appears to be a more accurate predictor of ypCR than any testing modality alone, patients cannot reliably be advised to avoid an esophagectomy on the assumption that ycCR predicts ypCR at this time.
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Affiliation(s)
- Puja G Khaitan
- Department of Surgery, Division of Thoracic and Esophageal Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, 110 Irving Street, NW (G253), Washington DC, 20010, USA.
- Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA.
| | - Tyler Holliday
- Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA
| | - Austin Carroll
- Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA
| | - Wayne L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Erin M Bayley
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nicolas Zhou
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sameer Desale
- Department of Biostatistics and Biomedical Informatics, Medstar Health Research Institute, Hyattsville, MD, USA
| | - Thomas J Watson
- Department of Surgery, Division of Thoracic and Esophageal Surgery, Beaumont Health, Detroit, MI, USA
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Verhoeven RLJ, Leoncini F, Slotman J, de Korte C, Trisolini R, van der Heijden EHFM. Accuracy and Reproducibility of Endoscopic Ultrasound B-Mode Features for Observer-Based Lymph Nodal Malignancy Prediction. Respiration 2021; 100:1088-1096. [PMID: 34167125 DOI: 10.1159/000516505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/06/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Endoscopic ultrasound routinely guides lymph node evaluation for the staging of a known or suspected lung cancer. Characteristics seen on B-mode imaging might help the observer decide on the lymph nodes of risk. The influence of nodal size on the predictivity of these characteristics and the agreement with which operators can combine these for malignancy risk prediction is to be determined. OBJECTIVES We evaluated (1) if prospectively scored individual B-mode ultrasound features predict malignancy when further divided by size and (2) assessed if observers were able to reproducibly agree on still lymph node image malignancy risk. METHODS Lymph nodes as visualized by EBUS were prospectively scored for B-mode characteristics. Still B-mode images were furthermore collected. After collection, a repeated scoring of a subset of lymph nodes was retrospectively performed (n = 11 observers). RESULTS Analysis of 490 lymph nodes revealed the short axis size is an objective measure for stratifying risk of malignancy (ROC area under the curve 0.78). With ≥8-mm size, 210/237 malignant lymph nodes were correctly identified (89% sensitivity, 46% specificity, 61% PPV, and 81% NPV). Secondary addition of B-mode features in <8-mm nodes had limited value. Retrospective analysis of intra- and interobserver scoring furthermore revealed significant disagreement. CONCLUSIONS Lymph nodes of ≥8-mm size and preferably even smaller should be aspirated regardless of other B-mode features. Observer disagreement in scoring both small and large lymph nodes suggests it is infeasible to include subjective features for stratification. Future research should focus on (integrating) other (semi)quantitative values for improving prediction.
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Affiliation(s)
- Roel L J Verhoeven
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Radiology, Medical Ultrasound Imaging Center (MUSIC), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Fausto Leoncini
- Interventional Pulmonology, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Jorik Slotman
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Radiology, Medical Ultrasound Imaging Center (MUSIC), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Chris de Korte
- Department of Radiology, Medical Ultrasound Imaging Center (MUSIC), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rocco Trisolini
- Interventional Pulmonology, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
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Dayan G, Soder S, Godin A, Maietta A, Stephenson P, Lemieux B, Liberman M. Endosonography-Guided Biopsy as a First Test in the Diagnosis of Lymphoma. Semin Thorac Cardiovasc Surg 2021; 34:1102-1109. [PMID: 34157382 DOI: 10.1053/j.semtcvs.2021.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 12/18/2022]
Abstract
To evaluate the diagnostic accuracy of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) and Endoscopic Ultrasound-guided Fine Needle Aspiration (EUS-FNA) in the diagnosis of lymphoma. A retrospective analysis of patients with suspected mediastinal lymphoproliferative disorders who underwent EBUS-TBNA, EUS-FNA or combined procedures from 2009 to 2019 was conducted using a prospectively maintained interventional thoracic endoscopy database. Demographic data, imaging, needle size, surgical biopsy, complications rate and pathology reports were reviewed. Over a 10-year period, a total of 444 patients were investigated with endosonography as the first diagnostic procedure for mediastinal adenopathy suspicious for lymphoma. Lymphoma was diagnosed in 77 patients (17.3%). In total, 68 patients (88.3%) were diagnosed using endosonographic mediastinal tissue sampling. Four patients had both lymphoproliferative disorders and lung cancer. Nine patients (11.7%) required a surgical biopsy to confirm the lymphoma diagnosis (6 non-diagnostic; 3 inadequate samples from endosonographic biopsies). In patients with adequate biopsies via endosonography, the sensitivity for the diagnosis of lymphoma, was 91.9% (n = 68/74). The histopathologic subtype of lymphoma was determined by endosonographic biopsies in 61 patients (89.7%) with an increased sensitivity (92.6%) for low grade Non-Hodgkin lymphoma (NHL). No acute complication related to endosonography was observed. Endosonographic biopsy (EBUS and/or EUS) of mediastinal adenopathy in patients with suspected lymphoma is a highly sensitive and safe diagnostic test. Endosonography should be the first test in the diagnosis of suspicious mediastinal lymphoma and should be followed by surgical biopsy in cases of insufficient sampling or indefinite diagnosis.
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Affiliation(s)
- Gabriel Dayan
- Department of Surgery, Division of Thoracic Surgery, CHUM Endoscopic Tracheobronchial and Oesophageal Center (CETOC), University of Montreal, Montreal, Quebec, Canada
| | - Stephan Soder
- Department of Surgery, Division of Thoracic Surgery, CHUM Endoscopic Tracheobronchial and Oesophageal Center (CETOC), University of Montreal, Montreal, Quebec, Canada
| | - Anny Godin
- Department of Surgery, Division of Thoracic Surgery, CHUM Endoscopic Tracheobronchial and Oesophageal Center (CETOC), University of Montreal, Montreal, Quebec, Canada
| | - Antonio Maietta
- Department of Pathology, University of Montreal, Montreal, Quebec, Canada
| | | | - Bernard Lemieux
- Division of Hematology, Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Moishe Liberman
- Department of Surgery, Division of Thoracic Surgery, CHUM Endoscopic Tracheobronchial and Oesophageal Center (CETOC), University of Montreal, Montreal, Quebec, Canada.
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Mathew R, Meena N, Roy WE, Chen C, Macchiraella M, Bartter T. Rapid On-Site Cytologic Evaluation: A Feasibility Study Using Ancillary Interventional Pulmonary Personnel. Respiration 2021; 100:1-6. [PMID: 33540414 DOI: 10.1159/000513432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 11/25/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Ancillary health professionals helping in a procedural service is a common practice everywhere. OBJECTIVES This was a proof-of-concept study to assess feasibility of using ancillary personnel for rapid on-site cytologic evaluation (ROSE) at interventional pulmonary procedures. METHODS After a training interval, a respiratory therapist (RT) performed ROSE on consecutive interventional pulmonary specimens. Sample sites included lymph nodes, lung, liver, and the left adrenal gland. RT findings were subsequently correlated with blinded cytopathology-performed ROSE and with final histopathology results, with primary foci of adequacy and the presence or absence of malignancy. RESULTS Seventy consecutive cases involved 163 separate sites for ROSE analysis. Adequacy: There was a high level of concordance between RT-performed ROSE (RT-ROSE) and cytopathology ROSE (CYTO-ROSE). They agreed upon the adequacy of 159 specimens. The Cohen's κ coefficient ± asymptotic standard error (ASE) was 0.74 ± 0.175, with p < 0.0001. Malignancy: RT-ROSE concurred highly with CYTO-ROSE, with agreement on 150 (92%) of the 163 specimens. Cohen's κ coefficient ± ASE was 0.83 ± 0.045, with p < 0.0001. When the comparison was for malignancy by case rather than individual site, Cohen's κ coefficient ± ASE was 0.68 ± 0.08, with p < 0.0001. CONCLUSION This study demonstrates that ancillary personnel supporting an interventional pulmonary service can be trained to perform initial ROSE. Cytopathology can be called after sampling and staining have produced adequate samples. This setup streamlines ROSE evaluation with regard to time and cost.
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Affiliation(s)
- Roshen Mathew
- Division of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA,
| | - Nikhil Meena
- Division of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Winnie Elma Roy
- University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Chien Chen
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Maggie Macchiraella
- Respiratory Department, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Thaddeus Bartter
- Division of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Achufusi TG, Sharma A, Sapkota B. Multiple myeloma presenting as plasmacytoma causing obstructive jaundice. Proc (Bayl Univ Med Cent) 2020; 33:266-267. [PMID: 32313483 DOI: 10.1080/08998280.2020.1722051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 01/21/2020] [Accepted: 01/23/2020] [Indexed: 10/24/2022] Open
Abstract
Jaundice, weight loss, and anorexia are common symptoms that raise concern for pancreatic malignancy. Although the most common form of pancreatic malignancy is pancreatic adenocarcinoma, not all pancreatic malignancies are exocrine in origin. Pancreatic plasmacytomas are plasma cell tumors that can lead to similar presentations. Plasmacytomas are classified as either intra- or extramedullary, depending on their location; intramedullary plasmacytomas are more common than extramedullary plasmacytomas. Here, we present a case of pancreatic plasmacytoma in association with advanced multiple myeloma diagnosed using endoscopic ultrasonography-guided fine-needle aspiration.
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Affiliation(s)
- Ted George Achufusi
- Department of Internal Medicine, SUNY Upstate Medical UniversitySyracuseNew York
| | - Anuj Sharma
- Department of Internal Medicine, SUNY Upstate Medical UniversitySyracuseNew York
| | - Bishnu Sapkota
- Department of Gastroenterology, SUNY Upstate Medical UniversitySyracuseNew York
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Skovgaard Christiansen I, Kuijvenhoven JC, Bodtger U, Naur TMH, Ahmad K, Singh Sidhu J, Nessar R, Salih GN, Høegholm A, Annema JT, Clementsen PF. Endoscopic Ultrasound with Bronchoscope-Guided Fine Needle Aspiration for the Diagnosis of Paraesophageally Located Lung Lesions. Respiration 2018; 97:277-283. [PMID: 30253411 DOI: 10.1159/000492578] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 07/25/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Diagnosing centrally located lung tumors without endobronchial abnormalities and not located near the major airways is a diagnostic challenge. Tumors near or adjacent to the esophagus can be aspirated and detected with esophageal ultrasound (EUS) using gastrointestinal endoscopes. OBJECTIVE To assess the feasibility and diagnostic yield of endoscopic ultrasound with bronchoscope-guided fine needle aspiration (EUS-B-FNA) in paraesophageally located lung tumors and its added value to bronchoscopy and endobronchial ultrasound (EBUS). METHODS Retrospective, multicenter international study (from January 1, 2015 until January 1, 2018) of patients with suspected lung cancer, undergoing bronchoscopy, EBUS, and endoscopic ultrasound bronchoscopy (EUS-B) in one session by a single operator (pulmonologist), in whom the primary lung tumor was detected and aspirated by EUS-B. In the absence of malignancy following endoscopy, transthoracic ultrasound needle aspiration, clinical and radiological follow-up of at least 6 months was performed. The yield and sensitivity of EUS-B-FNA and its added value to bronchoscopy and EBUS was assessed. RESULTS 58 patients were identified with the following diagnosis: non-small-cell lung cancer (n = 43), small-cell lung cancer (n = 6), mesothelioma (n = 2), metastasis (n = 1), nonmalignant (n = 6). The yield and sensitivity of EUS-B-FNA for detecting lung cancer was 90%. In 26 patients (45%), the intrapulmonary tumor was exclusively detected by EUS-B. Adding EUS-B to conventional bronchoscopy and EBUS increased the diagnostic yield for diagnosing lung cancer in para-esophageally located lung tumors from 51 to 91%. No EUS-B-related complications were observed. CONCLUSION EUS-B-FNA is a feasible and safe technique for diagnosing centrally located intrapulmonary tumors that are located near or adjacent to the esophagus. EUS-B should be considered in the same endoscopy session following nondiagnostic bronchoscopy and EBUS.
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Affiliation(s)
- Ida Skovgaard Christiansen
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark.,Department of Respiratory Medicine, Næstved Hospital, Næstved, Denmark
| | - Jolanda Corina Kuijvenhoven
- Academic Medical Center, Department of Respiratory Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Uffe Bodtger
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark.,Department of Respiratory Medicine, Næstved Hospital, Næstved, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Therese Maria Henriette Naur
- Department of Respiratory Medicine, Næstved Hospital, Næstved, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Khaliq Ahmad
- Department of Respiratory Medicine, Næstved Hospital, Næstved, Denmark
| | | | - Rafi Nessar
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Goran Nadir Salih
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Asbjørn Høegholm
- Department of Respiratory Medicine, Næstved Hospital, Næstved, Denmark
| | - Jouke Tabe Annema
- Academic Medical Center, Department of Respiratory Medicine, University of Amsterdam, Amsterdam, The Netherlands,
| | - Paul Frost Clementsen
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Counts SJ, Kim AW. Diagnostic Imaging and Newer Modalities for Thoracic Diseases: PET/Computed Tomographic Imaging and Endobronchial Ultrasound for Staging and Its Implication for Lung Cancer. PET Clin 2018; 13:113-26. [PMID: 29157382 DOI: 10.1016/j.cpet.2017.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Modalities to detect and characterize lung cancer are generally divided into those that are invasive [endobronchial ultrasound (EBUS), esophageal ultrasound (EUS), and electromagnetic navigational bronchoscopy (ENMB)] versus noninvasive [chest radiography (CXR), computed tomography (CT), positron emission tomography (PET), and magnetic resonance imaging (MRI)]. This chapter describes these modalities, the literature supporting their use, and delineates what tests to use to best evaluate the patient with lung cancer.
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Counts SJ, Kim AW. Diagnostic Imaging and Newer Modalities for Thoracic Diseases: PET/Computed Tomographic Imaging and Endobronchial Ultrasound for Staging and Its Implication for Lung Cancer. Surg Clin North Am 2017; 97:733-50. [PMID: 28728712 DOI: 10.1016/j.suc.2017.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Modalities to detect and characterize lung cancer are generally divided into those that are invasive [endobronchial ultrasound (EBUS), esophageal ultrasound (EUS), and electromagnetic navigational bronchoscopy (ENMB)] versus noninvasive [chest radiography (CXR), computed tomography (CT), positron emission tomography (PET), and magnetic resonance imaging (MRI)]. This chapter describes these modalities, the literature supporting their use, and delineates what tests to use to best evaluate the patient with lung cancer.
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Crombag LMMJ, Szlubowski A, Stigt JA, Schuurbiers O, Korevaar DA, Bonta PI, Annema JT. EUS-B-FNA vs conventional EUS-FNA for left adrenal gland analysis in lung cancer patients. Lung Cancer 2017; 108:38-44. [PMID: 28625645 DOI: 10.1016/j.lungcan.2017.02.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION In patients with lung cancer, left adrenal glands (LAG) suspected for distant metastases (M1b) based on imaging require further evaluation for a definitive diagnosis. Tissue acquisition is regularly performed using conventional EUS-FNA. The aim of this study was to investigate the success rate of endoscopic ultrasound guided fine-needle aspiration using the EBUS scope (EUS-B-FNA) for LAG analysis. METHODS This is a prospective multicenter study in consecutive patients with (suspected) lung cancer and suspected mediastinal and LAG metastases. Following complete mediastinal staging using the EBUS scope (EBUS+EUS-B), the LAG was evaluated and sampled by both EUS-B (experimental procedure) and conventional EUS (current standard of care). RESULTS The success rate for LAG analysis (visualized, sampled and adequate tissue obtained) was 89% (39/44; 95% CI 76-95%) for EUS-B-FNA, and 93% (41/44; 95%CI 82-98%) for EUS-FNA. In the absence of metastases at EUS-B and/or EUS, surgical verification of the LAG or 6 months clinical and radiological follow-up was obtained, but missing for 5 patients. The prevalence of LAG metastases was 54% (21/39). In patients in whom LAG was seen and sampled, sensitivity for LAG metastases was at least 87% (95%CI 65-97%) for EUS-B, and at least 83% (95%CI 62-95%) for conventional EUS. CONCLUSION LAG analysis by EUS-B shows a similar high success rate in comparison to conventional EUS. IMPLICATION Both a mediastinal nodal and LAG evaluation can be adequately performed with just an EBUS scope and single endoscopist. This staging strategy is likely to reduce patient-burden and costs.
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Abstract
Radiographic imaging using computed tomographic (CT) scan and positron emission tomography/CT are primarily helpful in identifying distant metastases. In general, if patients have evidence of lymph node involvement that is proved pathologically by endoscopic ultrasound/fine needle aspiration, this information is considered definitive, and the patient can be referred for the appropriate stage-specific therapy. Laparoscopy combined with laparoscopic ultrasound and peritoneal lavage has been shown to have sensitivity of 67% and specificity of 92% for lymph node disease. Thoracoscopy may help identify involved lymph node in the mediastinum before resection and help determine the field of radiation.
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Affiliation(s)
- Mark J Krasna
- Meridian Cancer Care, 1945 Route 33-Ackerman South, Room 553, Neptune, NJ 07753, USA; Rutgers-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ 08903, USA.
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