Endobronchial Ultrasound-guided Biopsy Performed Under Optimal Conditions in Patients With Known or Suspected Lung Cancer May Render Mediastinoscopy Unnecessary
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Endobronchial Ultrasound-guided Biopsy Performed Under Optimal Conditions in Patients With Known or Suspected Lung Cancer May Render Mediastinoscopy Unnecessary. / Clementsen, Paul F; Skov, Birgit G; Vilmann, Peter; Krasnik, Mark.
I: Journal of Bronchology & Interventional Pulmonology, Bind 21, Nr. 1, 01.2014, s. 21-25.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Endobronchial Ultrasound-guided Biopsy Performed Under Optimal Conditions in Patients With Known or Suspected Lung Cancer May Render Mediastinoscopy Unnecessary
AU - Clementsen, Paul F
AU - Skov, Birgit G
AU - Vilmann, Peter
AU - Krasnik, Mark
PY - 2014/1
Y1 - 2014/1
N2 - BACKGROUND: Mediastinoscopy is the gold standard for preoperative mediastinal staging of patients with suspected or proven lung cancer. Since the development of endoscopic ultrasound-guided biopsy via the trachea (EBUS-TBNA), this status has been challenged. The purpose of the study was to examine whether mediastinoscopy is necessary, when EBUS-TBNA is performed in a center with (1) a high level of expertise, (2) "bed side" microscopy by a pathologist, (3) general anesthesia, and (4) achievement of representative tissue from station 4R, 7 and 4L, that is, the same mediastinal stations that mediastinoscopy gives access to.METHODS: A total of 95 consecutive patients with known or suspected lung cancer were referred for staging by EBUS-TBNA, which was performed as described.RESULTS: Benign and malignant disease was found in the mediastinum of 6 and 13 patients, respectively. The remaining 76 patients were operated, resulting in 9 benign and 67 malignant diagnoses; spread was found to station 4R, 5, and 5 and 6 in 4 patients. The negative predictive value (NPV) was 63/67=0.94. However, if you exclude station 5 and 6, as they cannot be reached by neither EBUS nor mediastinoscopy, NPV was 66/67=0.99. The sensitivity was 0.76, and the specificity was 1.0.CONCLUSIONS: When EBUS-TBNA is performed under optimal conditions including general anesthesia and "bed side" microscopy performed by a pathologist resulting in representative biopsies from station 4R, 7, and 4L, the NPV is so high that mediastinoscopy seems unnecessary.
AB - BACKGROUND: Mediastinoscopy is the gold standard for preoperative mediastinal staging of patients with suspected or proven lung cancer. Since the development of endoscopic ultrasound-guided biopsy via the trachea (EBUS-TBNA), this status has been challenged. The purpose of the study was to examine whether mediastinoscopy is necessary, when EBUS-TBNA is performed in a center with (1) a high level of expertise, (2) "bed side" microscopy by a pathologist, (3) general anesthesia, and (4) achievement of representative tissue from station 4R, 7 and 4L, that is, the same mediastinal stations that mediastinoscopy gives access to.METHODS: A total of 95 consecutive patients with known or suspected lung cancer were referred for staging by EBUS-TBNA, which was performed as described.RESULTS: Benign and malignant disease was found in the mediastinum of 6 and 13 patients, respectively. The remaining 76 patients were operated, resulting in 9 benign and 67 malignant diagnoses; spread was found to station 4R, 5, and 5 and 6 in 4 patients. The negative predictive value (NPV) was 63/67=0.94. However, if you exclude station 5 and 6, as they cannot be reached by neither EBUS nor mediastinoscopy, NPV was 66/67=0.99. The sensitivity was 0.76, and the specificity was 1.0.CONCLUSIONS: When EBUS-TBNA is performed under optimal conditions including general anesthesia and "bed side" microscopy performed by a pathologist resulting in representative biopsies from station 4R, 7, and 4L, the NPV is so high that mediastinoscopy seems unnecessary.
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Bronchoscopy
KW - Carcinoma, Non-Small-Cell Lung
KW - Cohort Studies
KW - Endoscopic Ultrasound-Guided Fine Needle Aspiration
KW - Female
KW - Humans
KW - Lung Neoplasms
KW - Lymph Nodes
KW - Male
KW - Mediastinoscopy
KW - Mediastinum
KW - Middle Aged
KW - Neoplasm Staging
KW - Retrospective Studies
KW - Sarcoma
KW - Small Cell Lung Carcinoma
KW - Thoracic Surgery, Video-Assisted
U2 - 10.1097/LBR.0000000000000028
DO - 10.1097/LBR.0000000000000028
M3 - Journal article
C2 - 24419182
VL - 21
SP - 21
EP - 25
JO - Journal of Bronchology & Interventional Pulmonology
JF - Journal of Bronchology & Interventional Pulmonology
SN - 1944-6586
IS - 1
ER -
ID: 138179739