The Indian Journal of Chest Diseases and Allied Sciences

Register      Login

VOLUME 62 , ISSUE 4 ( October-December, 2020 ) > List of Articles

Original Article

Mediastinal Sampling with Endobronchial Ultrasound in Cancer Patients: Is It Always Metastatic?

Tiyas Sen Dutt, Bivas Biswas, Deepak Dabkara, Sandip Ganguli, Moses, Divya Midha, Geetasheree, Debdeep Dey, Argha Chatterjee, Sumit Mukhopadhay, Priya Ghosh, Sagar Basak, Soumen Chatterjee

Keywords : Mediastinal staging, EBUS-TBNA, Non-metastatic, Cancer, Lung, Breast

Citation Information : Dutt TS, Biswas B, Dabkara D, Ganguli S, Moses, Midha D, Geetasheree, Dey D, Chatterjee A, Mukhopadhay S, Ghosh P, Basak S, Chatterjee S. Mediastinal Sampling with Endobronchial Ultrasound in Cancer Patients: Is It Always Metastatic?. Indian J Chest Dis Allied Sci 2020; 62 (4):193-196.

DOI: 10.5005/ijcdas-62-4-193

License: CC BY-NC 4.0

Published Online: 07-11-2022

Copyright Statement:  Copyright © 2020; The Author(s).


Abstract

Objective: The overall management and prognosis of a cancer patient depends on the histopathology, molecular genetics and staging of the disease. Staging refers to the size and the spread of the cancer. Knowing the stage of the cancer helps us to determine the natural history of the disease and median survival. It also helps us plan the best treatment for the patient. Mediastinal staging with invasive modalities, like endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become important for appropriate tissue sampling in patients with mediastinal involvement in various benign and malignant diseases. Methods: A retrospective, cross-sectional study was done in a single tertiary care cancer centre from January, 2018 to December, 2018.The patients were referred for mediastinal staging and/or for diagnostic evaluation. The procedure EBUS-TBNA with rapid on-site evaluation (ROSE) was done for 123 patients as a day-care procedure in the bronchoscopy suite of the institution. Results: Out of the total of 123 cases that underwent EBUS, 119 patients had an EBUS-TBNA for lymph node assessment. Staging in lung cancer, breast cancer, colon cancer, renal cell carcinoma was done in 63 (52.9%) cases and diagnostic evaluation of either a mediastinal mass lesion or a lung mass with mediastinal extension of lymph nodal involvement was done in 56 (47.1%) cases. Out of the 63 cases those underwent EBUS-TBNA for staging, 39 (61.9%) cases were non metastatic; 15 (38.4%) were diagnosed with granulomatous inflammation and 24 (61.5%) cases had reactive lymphadenitis. The remaining 24 of 63 cases had metastatic disease. Out of the 56 cases for diagnostic evaluation, 17 (30.3%) had granulomatous inflammation, 7 (12.5%) had reactive lymphadenitis and 32 (57.1%) had malignant disease. Conclusions: Tissue pathology is always the crux to label a patient with the appropriate diagnosis. Moreover, accurate tissue sampling is important for mediastinal nodes in a diagnosed malignant disease, like lung cancer and breast cancer. This will help in appropriate staging and choose the proper treatment strategy.


PDF Share
  1. Yasufuku K, Nakajima T, Fujiwara, Yoshino I, Keshavjee S. Utility of endobronchial ultrasound-guidedtransbronchial needle aspiration in the diagnosis of mediastinal masses of unknown etiology. Ann Thorac Surg 2011;91:831–6.
  2. Devereaux BM, Leblanc JK, Yousif E, Kesler K, Brooks J, Mathur P, et al. Clinical utility of EUS-guided fine-needle aspiration of mediastinal masses inthe absence of known pulmonary malignancy. Gastrointest Endosc 2002;56:397–401.
  3. Larsen SS, Krasnik M, Vilmann P. Endoscopic ultrasoundguided biopsy of mediastinal lesions has a major impact on patient management. Thorax 2002;57:98–103.
  4. Kelemen JJ, 3rd, Naunheim KS. Minimally invasive approachesto mediastinal neoplasm. Semin Thorac Cardiovasc Surg 2000;12:301–6.
  5. Gelberg J, GrondinS, Tremblay A. Mediastinal staging for lung cancer. Can Respir J 2014;21:159–161.
  6. Silvestri GA, Gonzalez AV, Jantz MA, Margolis ML, Gould MK, Tanoue LT, et al. Methods of staging non-small cell lung cancer. Diagnosis and Management of lung Cancer, 3rd edition. American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2013;143:e211S-e250S.
  7. Navani N, Lawrence DR, Kolvekar S, Hayward M, McAsey D, Kocjan G, et al. REMEDY Trial Investigators. Endobronchial ultrasound-guided transbronchial needle aspiration prevents mediastinoscopies in the diagnosis of isolated mediastinal lymphadenopathy:a prospective trial. Am J Respir Crit Care Med 2012;186:255–60.
  8. Yasufuku K, Chiyo M, Sekine Y, Chhajed PN, Shibuya K, Iizasa T, et al. Real-time endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal and hilar lymph nodes. Chest 2004;126:122–8.
  9. Yasufuku K, Chiyo M, Koh E, Moriya Y, Iyoda A, Sekine Y, et al. Endobronchial ultrasound guided transbronchial needle aspiration for staging of lung cancer. Lung Cancer 2005;50:347–54.
  10. Grosu HB, Ost DE, Morice RC, Eapen GA, Li L, Song J, et al. Mediastinal granulomatous inflammation and overall survival in patients with a history of malignancy. Ann Am Thorac Soc 2015;12:1534–41.
  11. Dhamija A, Basu A, Sharma V, Bakshi P, Verma K. Mediastinal adenopathy in India: through the eyes of endobranchial ultrasound. J Assoc Physicians India 2015;63:15–8.
  12. Gahlot T, Parakh U, Verma K, Bhalotra B, Jain N. Endobronchial ultrasound-guided transbronchial needle aspiration in diagnosing mediastinal lymphadenopathy. Lung India 2017;34:241–6.
  13. Annema JT, Hoekstra OS, Smit EF, Veseliç M, VersteeghMI, Rabe KF. Towards a minimally invasive staging strategy in NSCLC: analysis of PET positive mediastinal lesions by EUS-FNA. Lung Cancer 2004;44:53–60.
  14. Vilmann P, Krasnik M, Larsen SS, Jacobsen GK, Clementsen P. Transesophageal Endoscopic ultrasoundguided fineneedle aspiration (EUS-FNA) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUSTBNA) biopsy: a combined approach in the evaluation of Smediastinal lesions. Endoscopy 2005;37:833–9.
  15. Nakajima T, Yasufuku K, Takahashi R, Shingyoji M, Hirata T, Itami M, et al. Comparison of 21-gauge and 22-gauge aspiration needle during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Respirology 2011;16:90–4.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.