EBUS Equals Mediastinoscopy for NSCLC Staging
PHILADELPHIA Endobronchial ultrasoundguided biopsy of mediastinal lymph nodes in patients with operable nonsmall cell lung cancer worked as effectively for staging as did the standard approach mediastinoscopy in the first head-to-head comparison of the two methods.
"Our results showed that EBUS-TBNA [endobronchial ultrasoundguided transbronchial needle aspiration], when performed as in this study, can replace mediastinoscopy for accurate staging of the mediastinum in potentially resectable lung cancer," Dr. Kazuhiro Yasufuku said at the annual meeting of the American Association for Thoracic Surgery.
Based on these results, which were obtained in 153 patients treated by any one of seven surgeons working at Toronto General Hospital, Dr. Yasufuku and his colleagues now routinely use EBUS-TBNA as their initial approach for staging patients with inoperable nonsmall cell lung cancer (NSCLC), who account for about 70% of all NSCLC patients they treat. As long as they can collect adequate cell specimens for cytologic analysis from the lymph node stations they routinely assess, they rely exclusively on EBUS-TBNA for staging, which allows them to avoid mediastinoscopy for most of their patients, Dr. Yasufuku said in an interview.
"We knew that EBUS-TBNA was good, but [until now] we never knew how it compared with the gold standard, mediastinoscopy," he said. The major limiting factor is lymph node size, he noted. Surgeons find it challenging to routinely obtain an adequate cell specimen from nodes smaller than 5 mm in diameter, Dr. Yasufuku said. "The smaller the node, the harder it is to put a needle into it."
The Toronto group uses rapid, onsite cytologic evaluation, which means that a cytologist attends the procedure in the combined surgical and endoscopy suite. In the study, and also in routine practice, "we can make repeated needle passes until we obtain good specimens. The surgeon can learn how to place the needle by getting immediate feedback" on the specimens, he said.
The specimens obtained allow for a tissue diagnosis, and typically provide enough material to assess cells for the presence of epidermal growth factor receptor mutations, he added.
EBUS-TBNA uses local rather than general anesthesia, is less invasive, and has fewer complications compared with mediastinoscopy, said Dr. Yasufuku, a thoracic surgeon and director of the interventional thoracic surgery program at Toronto General and the University of Toronto.
Mediastinal Lymph Nodes - News
PHILADELPHIA – Endobronchial ultrasound–guided biopsy of mediastinal lymph nodes in patients with operable non–small cell lung cancer worked as effectively for staging as did the standard approach – mediastinoscopy – in the first head-to-head
A total-body computed tomographic scan revealed a tumor of the right lung lower lobe with ipsilateral, mediastinal lymph node swelling. Moreover, bone scintigraphy revealed no bone metastases. No other metastases were found, so we planned a multi-modal
The abdominal MR (May 2011) performed sequentially with the raise in the tumor marker showed no metastasis, but the PET-CT (also performed May 2011) showed suspected lesions on the peritoneum as lymph nodes. But the liver and local operation area was
Endoscopic Ultrasound-Guided Mediastinal Lymph Node Aspiration for Lung Cancer Diagnosis and Staging. Qualitative Analysis of Peripheral Pulmonary Lesions Using Endobronchial Ultrasonography. Diagnosis of Peripheral Pulmonary Lesions Using
it is the current paradigm that T cells cannot divide in the airway, and that their accumulation in the lumen of the respiratory tract is the exclusive result of recruitment from other sites, such as mediastinal lymph nodes.
EBUS Equals Mediastinoscopy for NSCLC Staging - OncologySTAT
PHILADELPHIA (EGMN) - Endobronchial ultrasound-guided biopsy of mediastinal lymph nodes in patients with operable non-small cell lung cancer worked as effectively for staging as did the standard approach - mediastinoscopy - in the first head-to-head comparison of the two methods."Our results showed that EBUS-TBNA [endobronchial ultrasound-guided transbronchial needle aspiration], when performed as in this study, can replace mediastinoscopy for accurate staging of the mediastinum in potentially resectable...
Mediastinal Lymph Nodes - Bookshelf
General Thoracic Surgery
From here, drainage is proximal to the hilar or mediastinal lymph node groups or both. Lymphatic drainage from the middle and right lower lobes and the left ...Difficult Decisions in Thoracic Surgery, An Evidence-Based Approach
In particular, an anatomic resection (with individual ligation of the vessels and lobar bronchus) and complete mediastinal lymph node dissection should be ...Anatomic Basis of Tumor Surgery
Small blood vessels and lymphatic vessels are cauterized to prevent postoperative bleeding and exudation of lymph. Mediastinal Lymph-Node Dissection Right ...Normal lymph node topography, CT atlas
Mediastinum Following Nomina Anatomica [32] the mediastinal lymph nodes are ... Anterior Mediastinal Lymph Nodes On the right side, these lymph nodes ...Fundamentals of body CT
DIFFERENTIAL DIAGNOSIS OF MEDIASTINAL LYMPH NODE ENLARGEMENT Lung Cancer Approximately 35% of patients diagnosed with lung cancer have mediastinal node ...Day-by-day Guide Directory
Mediastinal Lymph Node: What are enlarged mediastinal lymph nodes?
Mediastinal lymph nodes are lymph nodes located in the mediastinum. The mediastinum is an area in the central part of the chest in between the two lungs. ...
Lymph Node Map
In 2009 a new Lung cancer lymph node map was proposed by the International Association ... Hilar nodes are proximal lobar nodes, distal to the mediastinal pleural ...
Medcyclopaedia - Lymphadenopathy, mediastinal
Lymphadenopathy, mediastinal. enlargement of the lymph nodes located within the ... Enlarged nodes may be calcified (see calcification mediastinal lymph node), or low in ...
Endobronchial Ultrasound (EBUS) Biopsy of Mediastinal Lymph Nodes
RICE Endobronchial Ultrasound (EBUS) Biopsy of Mediastinal Lymph Nodes
Mediastinal Lymph Node Staging by FDG-PET in Patients with ...
<i>Background:</i> Accurate staging of mediastinal and hilar lymph nodes is a critical factor determining operability in patients with non-small cell lung cancer ...