Endobronchial Ultrasound―guided Transbronchial Needle Aspiration for Non―Small Cell Lung Cancer Staging

• Published in: American journal of respiratory and critical care medicine 2014-03, Vol.189 (6), p.640-649
• Main Authors: KINSEY, C. Matthew, ARENBERG, Douglas A
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Biopsy, Fine-Needle - methods; Bronchi - diagnostic imaging; Bronchi - pathology; Carcinoma, Non-Small-Cell Lung - diagnostic imaging; Carcinoma, Non-Small-Cell Lung - pathology; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Humans; Image-Guided Biopsy - methods; Intensive care medicine; Lung cancer; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - pathology; Lymphatic Metastasis; Mediastinoscopy; Mediastinum - diagnostic imaging; Mediastinum - pathology; Medical sciences; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Neoplasm Staging; Pneumology; Tumors; Tumors of the respiratory system and mediastinum; Ultrasonography, Interventional
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.201311-2007ci

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.