title: [Usefulness of transbronchial punction and mediastinoscopy in mediastinal nodal staging of non-microcytic bronchogenic carcinoma. Preliminary study].
abstract: Preliminary study to compare the sensitivity and specificity of transbronchial needle aspiration (TBNA) and mediastinoscopy/anterior mediastinotomy (MED/AMED) and/or thoracotomy for staging of mediastinal nodes in non-small cell carcinoma. To determine the sensitivity and specificity of computerized tomography (CT) as a screening technique. Thirty-three patients with non-small cell carcinoma but no remote metastasis and good lung function were evaluated. A chest CT scan was performed before bronchoscopy in 27 patients and before surgery in the others. Nodular areas considered diseased based on CT images were staged by TBNA. When CT images were not available before bronchoscopy. TBNA for staging was performed in the subcarinal region. Results by TBNA were compared with those obtained by MED/AMED and/or thoracotomy. The prevalence of metastatic nodular disease was 47%. CT detected enlarged mediastinal nodes in 24 patients; the images were considered normal in 9 patients. Sensitivity and specificity of CT was 93% and 54%, respectively, with a positive predictive value (PPV) of 68% and negative predictive value (NPV) of 87.5%. The sensitivity and specificity of MED/AMED were 73% and 100%, respectively; PPV was 100% and NPV was 75%. The sensitivity and specificity of TBNA were 36% and 92%, respectively; PPV was 83% and NPV was 57%. The pneumothorax with pleural empyema suffered by one patient after MED could have been avoided, given that the earlier TBNA was positive. TBNA is a safe, useful technique for staging nodes in non-small cell carcinoma. Although the sensitivity of TBNA is lower than that of MED, regions that are difficult to reach with the latter technique can be sampled by TBNA. Furthermore, MED can be rendered unnecessary by positive TBNA results. CT imaging of the chest is sensitive but its specificity is low for detecting ganglial metastasis.
authors.affiliation: Unidad de Neumología, Hospital San Pedro de Alcántara, Cáceres.
authors.forename: C
authors.initials: C
authors.lastname: Disdier
authors.forename: G
authors.initials: G
authors.lastname: Varela
authors.forename: J
authors.initials: J
authors.lastname: Sánchez de Cos
authors.forename: O
authors.initials: O
authors.lastname: Bengoechea
authors.forename: M
authors.initials: M
authors.lastname: Jiménez
authors.forename: J
authors.initials: J
authors.lastname: Garín
authors.forename: J J
authors.initials: JJ
authors.lastname: Cruz
authors.forename: J F
authors.initials: JF
authors.lastname: Masa
mesh_terms: D000368:Aged; D001980:Bronchi; D002283:Carcinoma, Bronchogenic / Q000473:pathology* / Q000556:secondary; D003663:Decision Trees; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008481:Mediastinoscopy; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011677:Punctures / Q000379:methods; D012680:Sensitivity and Specificity; D013908:Thoracotomy
vernacular_title: Utilidad de la punción transbronquial y la mediastinoscopia en la estadificación ganglionar mediastínica del carcinoma broncogénico no microcítico. Estudio preliminar.