ABSTRACT
A tissue diagnosis is frequently needed for accurate lung cancer staging of mediastinal nodes as well as the assessment of mediastinal masses. Noninvasive imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI), positron-emission tomography (PET), and PET-CT provide some answers but no tissue diagnosis. Transbronchial needle aspiration (TBNA), a safe procedure that is performed during routine bronchoscopy, has a high impact on patient management. Unfortunately, TBNA remains underused in current daily practice, mainly due to the lack of real-time needle visualization. The introduction of echo-endoscopes has overcome this problem. Endobronchial ultrasound–guided TBNA (EBUS-TBNA) allows real-time controlled tissue sampling of paratracheal, subcarinal, and hilar lymph nodes. Mediastinal lymph nodes located adjacent to the esophagus can be assessed by esophageal ultrasound-guided fine needle aspiration (EUS-FNA). Owing to the complementary reach of EBUS-TBNA and EUS-FNA in assessing different regions of the mediastinum, recent studies suggest that complete and accurate mediastinal staging can be achieved by the combination of both procedures. It is expected that implementation of minimally invasive endoscopic methods of EBUS-TBNA and EUS-FNA will reduce the need for surgical staging of lung cancer significantly.
KEYWORDS
Lung cancer - mediastinal staging - lymph node - endobronchial ultrasound - endoesophageal ultrasound - EBUS - EUS
REFERENCES
-
1 American Cancer Society .Cancer facts and figures. 2009 Available at: http://www.cancer.org/research/cancerfactsfigures Accessed August 31, 2010
-
2
Silvestri G A, Gould M K, Margolis M L American College of Chest Physicians et al.
Noninvasive staging of non-small cell lung cancer: ACCP evidenced-based clinical practice guidelines (2nd edition).
Chest.
2007;
132
(3, Suppl)
178S-201S
-
3
Detterbeck F C, Jantz M A, Wallace M, Vansteenkiste J, Silvestri G A. American College of Chest Physicians .
Invasive mediastinal staging of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition).
Chest.
2007;
132
(3, Suppl)
202S-220S
-
4
Detterbeck F C, Boffa D J, Tanoue L T.
The new lung cancer staging system.
Chest.
2009;
136
(1)
260-271
-
5
Baum R P, Swietaszczyk C, Prasad V.
FDG-PET/CT in lung cancer: an update.
Front Radiat Ther Oncol.
2010;
42
15-45
-
6
Erasmus J J, Sabloff BSCT.
CT, positron emission tomography, and MRI in staging lung cancer.
Clin Chest Med.
2008;
29
(1)
39-57, v
-
7
Medford A R, Bennett J A, Free C M, Agrawal S.
Mediastinal staging procedures in lung cancer: EBUS, TBNA and mediastinoscopy.
Curr Opin Pulm Med.
2009;
15
(4)
334-342
-
8
Schieppati E.
Not available [article in undetermined language]
Clin Torax.
1949;
1
(7)
303-306
-
9
Wang K P, Terry P, Marsh B.
Bronchoscopic needle aspiration biopsy of paratracheal tumors.
Am Rev Respir Dis.
1978;
118
(1)
17-21
-
10
Holty J E, Kuschner W G, Gould M K.
Accuracy of transbronchial needle aspiration for mediastinal staging of non-small cell lung cancer: a meta-analysis.
Thorax.
2005;
60
(11)
949-955
-
11
Haponik E F, Russell G B, Beamis Jr J F et al..
Bronchoscopy training: current fellows' experiences and some concerns for the future.
Chest.
2000;
118
(3)
625-630
-
12
Herth F J.
Mediastinal staging—the role of endobronchial and endo-oesophageal sonographic guided needle aspiration.
Lung Cancer.
2004;
45
(Suppl 2)
S63-S67
-
13
Yasufuku K, Chiyo M, Sekine Y et al..
Real-time endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal and hilar lymph nodes.
Chest.
2004;
126
(1)
122-128
-
14
Herth F J.
Endobronchial ultrasound-guided biopsy of coin lesions.
Future Oncol.
2007;
3
(3)
273-275
-
15
Ernst A, Feller-Kopman D, Herth F J.
Endobronchial ultrasound in the diagnosis and staging of lung cancer and other thoracic tumors.
Semin Thorac Cardiovasc Surg.
2007;
19
(3)
201-205
-
16
Groth S S, Whitson B A, D'Cunha J, Maddaus M A, Alsharif M, Andrade R S.
Endobronchial ultrasound-guided fine-needle aspiration of mediastinal lymph nodes: a single institution's early learning curve.
Ann Thorac Surg.
2008;
86
(4)
1104-1109
discussion 1109-1110
-
17
Gu P, Zhao Y Z, Jiang L Y, Zhang W, Xin Y, Han B H.
Endobronchial ultrasound-guided transbronchial needle aspiration for staging of lung cancer: a systematic review and meta-analysis.
Eur J Cancer.
2009;
45
(8)
1389-1396
-
18
Adams K, Shah P L, Edmonds L, Lim E.
Test performance of endobronchial ultrasound and transbronchial needle aspiration biopsy for mediastinal staging in patients with lung cancer: systematic review and meta-analysis.
Thorax.
2009;
64
(9)
757-762
-
19
Cameron S E, Andrade R S, Pambuccian S E.
Endobronchial ultrasound-guided transbronchial needle aspiration cytology: a state of the art review.
Cytopathology.
2010;
21
(1)
6-26
-
20
Herth F J, Eberhardt R, Krasnik M, Ernst A.
Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically and positron emission tomography-normal mediastinum in patients with lung cancer.
Chest.
2008;
133
(4)
887-891
-
21
Herth F J, Ernst A, Eberhardt R, Vilmann P, Dienemann H, Krasnik M.
Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically normal mediastinum.
Eur Respir J.
2006;
28
(5)
910-914
-
22
Haas A R.
Infectious complications from full extension endobronchial ultrasound transbronchial needle aspiration.
Eur Respir J.
2009;
33
(4)
935-938
-
23
Vilmann P, Herth F, Krasnik M.
State of the art lecture: mediastinal EUS.
Endoscopy.
2006;
38
(Suppl 1)
S84-S87
-
24
Annema J T, Rabe K F.
State of the art lecture: EUS and EBUS in pulmonary medicine.
Endoscopy.
2006;
38
(Suppl 1)
S118-S122
-
25
von Bartheld M B, Rabe K F, Annema J T.
Transaortic EUS-guided FNA in the diagnosis of lung tumors and lymph nodes.
Gastrointest Endosc.
2009;
69
(2)
345-349
-
26
Eloubeidi M A.
Endoscopic ultrasound-guided fine-needle aspiration in the staging and diagnosis of patients with lung cancer.
Semin Thorac Cardiovasc Surg.
2007;
19
(3)
206-211
-
27
Micames C G, McCrory D C, Pavey D A, Jowell P S, Gress F G.
Endoscopic ultrasound-guided fine-needle aspiration for non-small cell lung cancer staging: a systematic review and metaanalysis.
Chest.
2007;
131
(2)
539-548
-
28
Herth F J, Lunn W, Eberhardt R, Becker H D, Ernst A.
Transbronchial versus transesophageal ultrasound-guided aspiration of enlarged mediastinal lymph nodes.
Am J Respir Crit Care Med.
2005;
171
(10)
1164-1167
-
29
Vilmann P, Krasnik M, Larsen S S, Jacobsen G K, Clementsen P.
Transesophageal endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) biopsy: a combined approach in the evaluation of mediastinal lesions.
Endoscopy.
2005;
37
(9)
833-839
-
30
Wallace M B, Pascual J M, Raimondo M et al..
Minimally invasive endoscopic staging of suspected lung cancer.
JAMA.
2008;
299
(5)
540-546
-
31
Rintoul R C, Skwarski K M, Murchison J T, Wallace W A, Walker W S, Penman I D.
Endobronchial and endoscopic ultrasound-guided real-time fine-needle aspiration for mediastinal staging.
Eur Respir J.
2005;
25
(3)
416-421
-
32
Hwangbo B, Lee G K, Lee H S et al..
Transbronchial and transesophageal fine-needle aspiration using an ultrasound bronchoscope in mediastinal staging of potentially operable lung cancer.
Chest.
2010;
138
(4)
795-802
-
33
Herth F JF, Krasnik M, Kahn N, Eberhardt R, Ernst A.
Combined endoscopic-endobronchial ultrasound-guided fine-needle aspiration of mediastinal lymph nodes through a single bronchoscope in 150 patients with suspected lung cancer.
Chest.
2010;
138
(4)
790-794
-
34
Szlubowski A, Zieliński M, Soja J et al..
A combined approach of endobronchial and endoscopic ultrasound-guided needle aspiration in the radiologically normal mediastinum in non-small-cell lung cancer staging—a prospective trial.
Eur J Cardiothorac Surg.
2010;
37
(5)
1175-1179
-
35
Betticher D C, Hsu Schmitz S F, Tötsch M et al..
Mediastinal lymph node clearance after docetaxel-cisplatin neoadjuvant chemotherapy is prognostic of survival in patients with stage IIIA pN2 non-small-cell lung cancer: a multicenter phase II trial.
J Clin Oncol.
2003;
21
(9)
1752-1759
-
36
Vansteenkiste J, Dooms C, De Leyn P.
The multidisciplinarity of stage III non-small cell lung cancer.
Eur J Cancer.
2009;
45
(Suppl 1)
92-105
-
37
De Leyn P, Stroobants S, De Wever W et al..
Prospective comparative study of integrated positron emission tomography-computed tomography scan compared with remediastinoscopy in the assessment of residual mediastinal lymph node disease after induction chemotherapy for mediastinoscopy-proven stage IIIA-N2 non-small-cell lung cancer: a Leuven Lung Cancer Group Study.
J Clin Oncol.
2006;
24
(21)
3333-3339
-
38
Herth F J, Annema J T, Eberhardt R et al..
Endobronchial ultrasound with transbronchial needle aspiration for restaging the mediastinum in lung cancer.
J Clin Oncol.
2008;
26
(20)
3346-3350
-
39
Szlubowski A, Herth F J, Soja J et al..
Endobronchial ultrasound-guided needle aspiration in non-small-cell lung cancer restaging verified by the transcervical bilateral extended mediastinal lymphadenectomy—a prospective study.
Eur J Cardiothorac Surg.
2010;
37
(5)
1180-1184
-
40
Annema J T, Veseliç M, Versteegh M I, Willems L N, Rabe K F.
Mediastinal restaging: EUS-FNA offers a new perspective.
Lung Cancer.
2003;
42
(3)
311-318
-
41
Stigt J A, Oostdijk A H, Timmer P R, Shahin G M, Boers J E, Groen H J.
Comparison of EUS-guided fine needle aspiration and integrated PET-CT in restaging after treatment for locally advanced non-small cell lung cancer.
Lung Cancer.
2009;
66
(2)
198-204
-
42
Varadarajulu S, Eloubeidi M.
Can endoscopic ultrasonography-guided fine-needle aspiration predict response to chemoradiation in non-small cell lung cancer? A pilot study.
Respiration.
2006;
73
(2)
213-220
Felix J. F HerthM.D. Ph.D.
Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg
Amalienstraße 5, D-69126 Heidelberg, Germany
eMail: Felix.Herth@thoraxklinik-heidelberg.de
