Endobronchial ultrasound-guided transbronchial needle aspiration for non-small cell lung cancer staging.
Real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an established technique for invasive mediastinal staging of non-small cell lung cancer (NSCLC). Needle-based techniques are now recommended as a first-line diagnostic modality for mediastinal staging. Accurate performance of systematic staging with EBUS-TBNA requires a detailed knowledge of mediastinal anatomy. This examination begins at the N3 lymph nodes, progressing through the N2 and N1 lymph node stations, unless a higher station lymph node is positive for malignant cells by rapid on-site cytologic examination. Objective methods of identifying EBUS-TBNA targets include sampling any lymph node station with a visible lymph node or with a lymph node greater than 5 mm in short axis. Three passes per station or the use of rapid on-site cytologic examination with identification of diagnostic material (tumor or lymphocytes) up to five passes are well-established techniques. Obtaining sufficient tissue for molecular profiling may require performing more than three passes. The operating characteristics of EBUS-TBNA are similar to mediastinoscopy. However, mediastinoscopy should be considered in the setting of a negative EBUS-TBNA and a high posterior probability of N2 or N3 involvement.
1 Department of Pulmonary and Critical Care, University of Vermont College of Medicine, Burlington, Vermont; and.
C Matthew
CM
Kinsey
Douglas A
DA
Arenberg
D044963:Biopsy, Fine-Needle / Q000379:methods; D001980:Bronchi / Q000000981:diagnostic imaging / Q000473:pathology*; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000473:pathology*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis; D008481:Mediastinoscopy; D008482:Mediastinum / Q000000981:diagnostic imaging / Q000473:pathology*; D009367:Neoplasm Staging; D018084:Ultrasonography, Interventional