Diagnosis Of Mediastinal Diseases Research Articles

Endobronchial Ultrasound-Guided Fine Needle Aspiration (EBUS-FNA) in the Diagnosis of Mediastinal Disease in Less Than or Equal To 50-Year-Old Patients

Endobronchial Ultrasound-Guided Fine Needle Aspiration (EBUS-FNA) in the Diagnosis of Mediastinal Disease in Less Than or Equal To 50-Year-Old Patients

Recent advances in convex probe endobronchial ultrasound: a narrative review.

Convex probe endobronchial ultrasound (CP-EBUS) has been widely used in the lymph node staging and restaging of lung tumors and the diagnosis of mediastinal diseases. Recent years have seen continuous progress in this technology. For diagnosis, elastography technology can preliminarily distinguish between benign and malignant lesions, so that reduce the number of punctures. CP-EBUS can also be used as an endoscopic ultrasound (EUS) to guide needle aspirations of liver lesions, retroperitoneal lymph nodes and left adrenal gland (LAG) lesions sometimes. Some advances help diagnosing more accurately and effectively, such as the intranodal forceps biopsy (IFB), the new type of 22G needle, the rapid on-site evaluation (ROSE) and the cancer gene methylation, etc. In addition, special advances are being made in diagnosis using artificial intelligence (AI). For treatment, CP-EBUS has yielded novel research results when applied to transbronchial needle injection (TBNI) and radioactive seed implantation in clinical cases, and blocking of the cardiac plexus in animal studies. The next-generation CP-EBUS is also ready for use in the clinic and the technology will be improving continuously. Through this review, we hope to educate clinicians on the latest uses of CP-EBUS and open up further research ideas for readers interested in this technology.

Anterior Mediastinal Lesion Segmentation Based on Two-Stage 3D ResUNet With Attention Gates and Lung Segmentation.

ObjectivesAnterior mediastinal disease is a common disease in the chest. Computed tomography (CT), as an important imaging technology, is widely used in the diagnosis of mediastinal diseases. Doctors find it difficult to distinguish lesions in CT images because of image artifact, intensity inhomogeneity, and their similarity with other tissues. Direct segmentation of lesions can provide doctors a method to better subtract the features of the lesions, thereby improving the accuracy of diagnosis.MethodAs the trend of image processing technology, deep learning is more accurate in image segmentation than traditional methods. We employ a two-stage 3D ResUNet network combined with lung segmentation to segment CT images. Given that the mediastinum is between the two lungs, the original image is clipped through the lung mask to remove some noises that may affect the segmentation of the lesion. To capture the feature of the lesions, we design a two-stage network structure. In the first stage, the features of the lesion are learned from the low-resolution downsampled image, and the segmentation results under a rough scale are obtained. The results are concatenated with the original image and encoded into the second stage to capture more accurate segmentation information from the image. In addition, attention gates are introduced in the upsampling of the network, and these gates can focus on the lesion and play a role in filtering the features. The proposed method has achieved good results in the segmentation of the anterior mediastinal.ResultsThe proposed method was verified on 230 patients, and the anterior mediastinal lesions were well segmented. The average Dice coefficient reached 87.73%. Compared with the model without lung segmentation, the model with lung segmentation greatly improved the accuracy of lesion segmentation by approximately 9%. The addition of attention gates slightly improved the segmentation accuracy.ConclusionThe proposed automatic segmentation method has achieved good results in clinical data. In clinical application, automatic segmentation of lesions can assist doctors in the diagnosis of diseases and may facilitate the automated diagnosis of illnesses in the future.

Role of Transbronchial Needle Core Biopsy in the Diagnosis of Mediastinal Diseases: Experience With an Innovative Endoscopic Technique Using a Rigid Tru-Cut Needle.

Enlarged lymph nodes or mediastinal masses diagnosed by computed tomographic scan before the advent of bronchoscopic procedures (TBNA or EBUS) were usually investigated using a thoracic surgical approach. In this paper, we report the experience with the use of a modified rigid tru-cut needle in the bioptical approach to mediastinal masses; to determine whether it could be considered a valid alternative to surgery, we investigated the diagnostic accuracy of this new endoscopic technique. A total of 156 selected patients with radiographic evidence of lymphadenopathy or mediastinal masses (subcarinal and paratracheal with a short-axis diameter >3 cm) were studied in our center by rigid bronchoscopy using a 18-G tru-cut needle to obtain a core biopsy of the lesion. In 140 of 156 cases (89.7%), a histologically correct diagnosis was reached without perioperative or postoperative complications. A total of 114 (81.4%) malignant and 26 (18.6%) benign lesions were diagnosed avoiding further invasive surgical approach. Our results confirm that, in selected cases, transbronchial rigid core biopsy could be considered a safe and valid alternative technique to more invasive surgical approach in the diagnosis of mediastinal diseases.

Uniportal video-assisted thoracic surgery in the diagnosis of mediastinal lymphadenopathy of unknown aetiology

Background: Recently endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) has been widely reported to be useful for patients with lung cancer for lymph node staging, and this tool may be the first line procedure for patients with mediastinal and hilar lymphadenopathy of unknown aetiology. However, more invasive techniques as mediastinoscopy and video-assisted thoracic surgery (VATS) are useful in well-selected patients, and surgery has a significant role in the evaluation of some areas in the mediastinum. The purpose of the current study was to investigate the clinical utility of VATS with the uni-portal approach in the diagnosis of mediastinal lymphadenopathies of unknown aetiology. Methods: Retrospective chart review of our VATS database between 2003 and 2013 (10-year experience) was performed. All mediastinal lymphadenopathies of unknown origin were included in the study and were classified and designated according to the International Staging System. Pathological diagnosis was determined in all patients and was classified into two categories: malignant lymphadenopathy and benign lymphadenopathy. Results: A total of 136 patients with mediastinal lymphadenopathy of unknown origin were identified, and the final diagnosis was available in all patients’ means of VATS surgery with uniportal technique. We no consider mediastinoscopy cases. The final diagnosis was available in all patients and was 114 malignant lymphadenopathies and 22 benign lymphadenopathies. VATS was safe (without complications) and had a sensitivity and a specificity of 100%, and it permits to study all areas of the mediastinum. Additionally, VATS surgery is accurate in the diagnosis of EBUS-TBNA negative lymphadenopathy (26 patients, 19%). Conclusions: VATS is a safe and reliable minimally invasive approach for a sampling of mediastinal and hilar lymphadenopathies, and it should be considered a second line procedure for a sampling of mediastinal tissue. However, in some areas of the mediastinum (anterior, posterior, left 5–6 lymph node stations) and in the cases where EBUS-TBNA fails, this is a winning tool for obtaining a pathological diagnosis of mediastinal disease. We also believe that for these patients are paramount a multidisciplinary approach.

Mediastinoscopy in Assessing Mediastinal Lymphadenopathy and Lung Disease

Background: Mediastinoscopy is the gold standard procedure for the pathological staging and diagnosis of mediastinal diseases. The aim of the study is to describe the significance of anterior cervical Mediastinoscopy in evaluating patients with mediastinal lymphadenopathy and lung parenchymal disease. Material and Methods: From January 2014 until June 2017 we conducted a retrospective study of 52 consecutive patients with mediastinal lymphadenopathy and lung parenchymal disease who underwent anterior cervical Mediastinoscopy. The main indications for cervical Mediastinoscopy were isolated mediastinal lymphadenopathy, undetermined lung mass with mediastinal lymphadenopathy, and the clinical staging of patients with lung cancer. Results: The study subjects consisted of 37 men and 15 women, aged 13 to 87 (mean age 50.8). Eight patients had mediastinoscopy for staging lung cancer, 27 patients had mediastinoscopy to diagnose isolated mediastinal lymphadenopathy, and 17 patients had mediastinoscopy for an undetermined lung parenchymal mass. Among the patients with isolated mediastinal lymphadenopathy, sarcoidosis was diagnosed in 6, tuberculosis in 9, reactive lymph nodes in 4, metastasis in 5 and lymphoma in 3. Lymph node metastasis (N2, N3) was found in 5 patients with lung cancer. There was no surgical-related mortality or morbidity. Conclusions: Mediastinoscopy is a safe and reliable procedure in diagnosing mediastinal diseases and is still the first choice among the investigative modalities in the clinical staging of bronchogenic carcinoma.

The risk of tumor cell dissemination in mediastinoscopy: a cytological study.

Mediastinoscopy is an invasive procedure that is used in the diagnosis of mediastinal diseases and in staging lung cancer. Tumor cell seeding during mediastinoscopy along the mediastinum and the incision line is a very rare complication. This study aimed to test the safety of mediastinoscopy in terms of tumor seeding by cytological evaluation of mediastinal lavage samples taken before and after biopsy. The patients who underwent mediastinoscopy in our hospital between 2011 and 2014 were studied prospectively. Seventy-three patients with a diagnosis of lung or mediastinal malignancy were included in the study. All patients underwent classical cervical mediastinoscopy and mediastinal lavages were taken before and after the biopsy. Both lavage samples were sent to the pathology department in syringes for malignant cell cytology screening. The results of the histopathological examinations of lymph node biopsies were reactive in 25 patients and positive for malignancy in 48 patients. In 2 of 48 patients whose lymph nodes were reported to be positive for malignancy, the mediastinal lavage sample was reported to be positive for malignancy after biopsy, although it was negative preoperatively. In two patients, both the pre- and postbiopsy lavage samples were reported to be positive for malignancy. While performing dissection and biopsy during mediastinoscopy, tumor seeding into the mediastinum may occur. Long follow-up periods and large patient series are needed to determine how cytopathological examination of both fluids would affect the prognosis.

Does video-assisted mediastinoscopy have a better lymph node yield and safety profile than conventional mediastinoscopy?

A best evidence topic was written according to a structured protocol. The question addressed was whether video-assisted mediastinoscopy (VAM) has a better lymph node yield and safety profile than the conventional mediastinoscopy (CM). A total of 194 papers were found, using the reported searches, of which five represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Two studies to date have directly compared CM and VAM with respect to lymph node yield, calculated diagnostics performance and complication rate. In both of these, lymph node yield is shown to be higher using VAM with better sensitivity, negative predictive value and accuracy rates. The favourable figures of lymph node sampling are found to be statistically significant in the single study providing such analysis. Complication rates using VAM are low, however, in the one instance where it is reported as higher than CM, the extensive lymph node dissection used in this technique may be a reasonable explanation for this finding. All studies described here exemplify VAM as a safe and useful tool in mediastinal staging, lymph node dissection and tissue diagnosis of mediastinal diseases given its superior visualization of surrounding structures and advantage of bimanual dissection. The future scope for diagnostic and therapeutic indications of cervical mediastinscopy is anticipated with recent advances and new techniques, such as video-assisted mediastinoscopic lymphadenectomy and virtual mediastinscopy.

The value of mediastinoscopy in the diagnosis of thoracic sarcoidosis

To evaluate the role of mediastinoscopy in the diagnosis of thoracic sarcoidosis. This study was retrospective. Mediastinoscopy was performed in a total of 30 patients who had enlarged mediastinal lymph nodes on chest CT and were clinically suspected of having sarcoidosis from November 1999 to June 2004. Biopsy tissues from peritracheal, retrosternal, subcarinal, or bilateral hilar regions were obtained for pathological study. All the patients had a definitive pathologic diagnosis, consisting of 24 cases of stage I and 6 stage II thoracic sarcoidosis. The diagnostic consistency between preoperation and postoperation was 40% (12/30), and the misdiagnosis rate preoperation was 60% (18/30). In this series, the initial diagnosis had been malignancy in 17 cases (57%), of whom 3 had received chemotherapy at local hospitals. The overall incidences of postoperative complication and mortality were 0. Our experience showed that mediastinoscopy is a valuable procedure which helps confirm the diagnosis of mediastinal disease. Given its safety and efficacy, it should be considered in the diagnosis and differential diagnosis of thoracic sarcoidosis of stage I or II.

Diagnostic role of videothoracoscopy in mediastinal diseases.

In order to assess the role of videothoracoscopy in the diagnosis of mediastinal diseases, we report a retrospective analysis of 52 cases of mediastinal biopsy performed with this technique. Between January 1992 and December 1996 52 patients (39 men and 13 women, mean age 53 +/- 29 years) with mediastinal lesions were referred to our department for videothoracoscopic biopsy. There were eight lesions in the anterior mediastinum, while the remaining 44 were in the middle (25 right and 19 left). The adenopathies were solitary or located in positions not within reach of the mediastinoscope, or combined with pulmonary nodules or diffuse pulmonary diseases. The procedure was performed from the right side in 30 cases and from the left side in 22. In nine cases the complete excision of the mass was achieved. In the eight patients with pulmonary disease a wedge resection was carried out at the same time. Diagnosis was achieved in all cases of mediastinal and lung disease (100%). No conversion to open thoracotomy and no intraoperative complications occurred. The mean hospital stay after surgery was 2.3 +/- 1.3 days in the 49 (94.2%) patients with no complications. The postoperative complications consisted of one case of fatal pulmonary embolism and two cases of prolonged air leak. conclusion: This analysis shows that videothoracoscopy is an effective and reliable method of obtaining a diagnosis of solitary unilateral mediastinal lesions or of adenopathies not within reach of the mediastinoscope. In some cases it also allows the complete excision of the mass. If a procedure on the lung such as a wedge resection is needed, it can be performed at the same time. Since this is a strictly unilateral procedure, it cannot be used in routine preoperative lung cancer staging.

SONOGRAPHIC EVALUATION OF THE CRANIAL MEDIASTINUM IN SMALL ANIMALS

Clinical records, radiographs, and sonograms of 17 animals presented for possible cranial mediastinal disease were reviewed. Radiographs were evaluated for accuracy in detection of mediastinal masses. Sonography of the mediastinum was performed using a parasternal approach with the animals in sternal or lateral recumbency. The mediastinum was evaluated for the presence of a mass or other disease. Masses were characterized by echogenicity, size, number, and margination. Mediastinal vessels were studied to determine if there was vascular invasion or compression. A comparison of radiographic and sonographic assessment in cranial mediastinal disease indicates sonography adds valuable information in the diagnosis of mediastinal disease. Results of ultrasound‐guided, fine‐needle aspirate were documented and found to be advantageous in establishing a diagnosis in mediastinal masses.