Combined Endobronchial and Transesophageal Approach of an Ultrasound Bronchoscope for Mediastinal Staging of Lung Cancer

Kyung Jong Lee,Man Pyo Chung,Joungho Han,Gee Young Suh,Hojoong Kim,O Jung Kwon,Sang-Won Um,Min Wu

doi:10.1371/journal.pone.0091893

Kyung Jong Lee, Man Pyo Chung + Show 6 more

Open Access

https://doi.org/10.1371/journal.pone.0091893

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Journal: PloS one	Publication Date: Mar 14, 2014
Citations: 45	License type: CC BY 4.0

Affiliation: Samsung Medical Center, Sungkyunkwan University

Abstract

BackgroundWe evaluated the utility of a combined approach using endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and transesophageal bronchoscopic ultrasound-guided fine-needle aspiration (EUS-FNA-B/E) for mediastinal staging of lung cancer.MethodsAn EBUS-TBNA database was analyzed retrospectively. EUS-FNA-B/E was performed after EBUS-TBNA when mediastinal lymph nodes were not accessible using EBUS-TBNA or when tissue sampling using EBUS-TBNA alone was inadequate.ResultsDuring the study period, 44 patients were enrolled. EBUS-TBNA and EUS-FNA-B/E were performed on 79 and 52 lymph nodes, respectively. The sensitivity, specificity, and accuracy of mediastinal N-staging using EBUS-TBNA alone were 79%, 100%, and 84%, respectively. The sensitivity, specificity, and accuracy of mediastinal N-staging using a combination of EBUS-TBNA and EUS-FNA-B/E were 100%, 100%, and 100%, respectively. Significant differences in sensitivity (P = 0.008) and accuracy (P = 0.004) of mediastinal N-staging were evident when EBUS-TBNA alone and the combined procedure were compared. The nodal stage shifted higher after use of the EUS-FNA-B/E procedure in six cases (13%). No serious complication associated with the procedures was noted.ConclusionsUse of a combination of EBUS-TBNA and EUS-FNA-B/E can afford better sensitivity and accuracy of mediastinal N-staging compared with use of EBUS-TBNA alone. Such combined procedures should be considered for examination of lesions that are inaccessible or difficult to access by EBUS-TBNA.

Highlights

Lung cancer is the leading cause of mortality associated with malignancy despite recent advances in lung cancer management strategies [1]
Mediastinoscopy plays a key role in staging of mediastinal lymph nodes suspicious for metastasis on positron-emission-tomography imaging, systemic lymph node dissection requires the use of general anesthesia [4]
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been developed to diagnose and stage non-small cell lung cancer; the technique is an alternative to mediastinoscopy [5]

Summary

Introduction

Lung cancer is the leading cause of mortality associated with malignancy despite recent advances in lung cancer management strategies [1]. A combination of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and EBUS-TBNA can afford a more accurate and systematic assessment of the mediastinum [6]. Use of this combination is associated with several limitations when mediastinal node staging is performed in clinical practice. The procedure requires expert endoscopists and expensive equipment, increasing medical costs and the time required for lung cancer evaluation [7] It would be better if EBUS-TBNA and EUS-FNA could be performed sequentially, in the same setting, by the same operator. We evaluated the utility of a combined approach using endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and transesophageal bronchoscopic ultrasound-guided fine-needle aspiration (EUS-FNA-B/E) for mediastinal staging of lung cancer

Methods

Results

Conclusion