title: Endoscopic and endobronchial ultrasound-guided needle aspiration in the mediastinal staging of non-small cell lung cancer.
abstract: Invasive staging of mediastinal lymph nodes is recommended for the majority of patients with potentially resectable non-small cell lung cancer. In the past, 'blind' transbronchial needle aspiration during bronchoscopy and mediastinoscopy, a surgical procedure conducted under general anesthesia, were the only diagnostic methods. The latter is still considered the 'gold standard'; however, two novel, minimally-invasive techniques have emerged for the evaluation of the mediastinum: endoscopic (transesophageal) and endobronchial ultrasound--both performed using a dedicated echoendoscope, facilitating the ultrasound-guided, real-time aspiration of mediastinal lymph nodes. These methods are well-tolerated under local anesthesia and moderate sedation, with very low complication rates. Current guidelines on the invasive mediastinal staging of lung cancer still state that a negative needle aspiration result from these methods should be confirmed by mediastinoscopy. As more experience is gathered and echoendoscopes evolve, a thorough endosonographic evaluation of the mediastinum by both techniques, will obviate the need for surgical staging in the vast majority of patients and reduce the number of futile thoracotomies.
authors.affiliation: Ierapetra General Hospital, Crete, Greece. ksyrigos@med.uoa.gr
authors.forename: Thomas
authors.initials: T
authors.lastname: Raptakis
authors.forename: Paraskevi
authors.initials: P
authors.lastname: Boura
authors.forename: Sotirios
authors.initials: S
authors.lastname: Tsimpoukis
authors.forename: Ioannis
authors.initials: I
authors.lastname: Gkiozos
authors.forename: Konstantinos N
authors.initials: KN
authors.lastname: Syrigos
mesh_terms: D044963:Biopsy, Fine-Needle / Q000379:methods*; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000473:pathology*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D019160:Endosonography; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D008198:Lymph Nodes; D008207:Lymphatic Metastasis / Q000473:pathology*; D008479:Mediastinal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D008481:Mediastinoscopy; D008482:Mediastinum / Q000000981:diagnostic imaging* / Q000473:pathology; D009367:Neoplasm Staging / Q000379:methods*
keywords: Staging; echoendoscope; endosonographic evaluation; mediastinal lymph nodes; review; surgical procedure