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Bronchoscopic needle aspiration in the diagnosis of mediastinal lymphadenopathy and staging of lung cancer  [cached]
Punamiya Vikas,Mehta Ankur,Chhajed Prashant
Journal of Cancer Research and Therapeutics , 2010,
Abstract: Transbronchial needle aspiration (TBNA) has the potential to allow adequate mediastinal staging of non-small cell lung cancer with enlarged lymph nodes in most patients without the need for mediastinoscopy. Metastasis to the mediastinal lymph nodes is one of the most important factors in determining resectability and prognosis in non-small cell lung cancer. The importance of TBNA as a tool for diagnosing intrathoracic lymphadenopathy as well as in the staging of lung cancer has been reported in various studies. We performed a literature search in PubMed and Journal of Bronchology using the keyword transbronchial needle aspiration. TBNA is a safe and effective procedure to diagnose mediastinal lymphadenopathy. Real-time bronchoscopic ultrasound-guided TBNA is the new kid on the block, which can further enhance the sensitivity of bronchoscopy in the diagnosis of mediastinal lesions.
The role of Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) for qualitative diagnosis of mediastinal and hilar lymphadenopathy: a prospective analysis
Ting Ye, Hong Hu, Xiaoyang Luo, Haiquan Chen
BMC Cancer , 2011, DOI: 10.1186/1471-2407-11-100
Abstract: 101 patients with mediastinal and hilar lymphadenopathy or suspected lung cancer in our institution were included in this prospective study. EBUS-TBNA was performed in all cases. The final diagnosis was confirmed by cytology, surgical results, and/or clinical follow-up for at least 6 months. Sensitivity, specificity, accuracy, and positive and negative predictive values were calculated using standard formulas.In 101 patients, EBUS-TBNA was successfully performed to obtain samples from 225 lymph nodes, 7 lung masses, 1 mediastinal mass and 2 esophageal masses. 63 malignant tumors and 38 benign diseases were confirmed. Epidermal growth factor receptor mutation was detected in 10 biopsy samples, and epidermal growth factor receptor mutation was detected in 4 cases. With respect to the correct diagnosis of mediastinal and hilar lymphadenopathy, EBUS-TBNA had a sensitivity of 95.08%, specificity of 100%, positive predictive value of 100%, negative predictive value of 93.02%, and overall accuracy of 97.02%. The relationship of diagnostic accuracy and number of lymph node passes or size of lymph nodes was both insignificant (p = 0.27; p = 0.23). The procedure was uneventful without complications.EBUS-TBNA is an accurate and safe tool in diagnosis of mediastinal and hilar lymphadenopathy. It cannot completely replace mediastinoscopy, it may indeed reduce the number of mediastinoscopy procedures. In some cases, it can necessarily be the first-line procedure before mediastinoscopy.Patients with mediastinal lymphadenopathy or suspected lung cancer required accurate diagnosis to determine optimal treatment. For these patients, mediastinal nodal sampling is often necessary and has traditionally been performed by mediastinoscopy or anterior mediastinotomy. However, mediastinoscopy, with a sensitivity of 80% to 85% and a specificity of nearly 100%, which is considered the gold standard for diagnosis with tissue confirmation of mediastinal lymphadenophy and lung cancer with mediast
Kimura's disease accompanied by mediastinal lymphadenopathy misdiagnosed as lung cancer: Case report and review of literatures
Xi SUN,Li BAI,Jie GAO
Medical Journal of Chinese People's Liberation Army , 2012,
Abstract: Objective  To further investigate the diagnostic pitfalls of Kimura's disease(KD). Methods  We report one case of Kimura's disease accompanied with mediastinal lymphadenopathy admitted to General Hospital of Chinese PLA in the year 2010. After searching on PubMed and Chinese Medical Journal Searching Engines(Wanfang data base,Cqvip data base),we have found literatures reporting another 3 cases of Kimura's disease with mediastinal lymphadenopathy. Plus the one we presented, all four patients' clinical data were collected and analyzed thereafter. Up-to-date advancement on KD's diagnosis and therapy would also be reviewed. Results  Our case, a 61-year-old male, was initially misdiagnosed as lung cancer with mediastinal metastasis in 2008, but histopathology had confirmed only eosinophil infiltration in enlarged mediasinal lymph nodes, no malignant cells were identified. In the year 2010, he complained bilateral orbital masses, one of which was surgically removed, and was later confirmed as Kimura's disease by histopathology. Clinical features of 4 patients, including our case and the other 3 retrieved in literatures, were available, 2 of whom were misdiagnosed as lung cancer while the other 2 as lymphoma in the beginning. All the 4 patients were responsive to steroid therapy. Conclusions  Kimura's disease could be associated with mediastinal lymphadenopathy which may confuse the physicians in diagnosing. Newly developed minimal invasive approaches such as endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) are helpful for the differential diagnosis.
Pulmonary artery injury during mediastinoscopy controlled without gauze packing
Muneo Minowa, Masayuki Chida, Syunsuke Eba, Yuji Matsumura
Journal of Cardiothoracic Surgery , 2011, DOI: 10.1186/1749-8090-6-15
Abstract: Although many studies have found that mediastinoscopy is extremely safe, the most serious complication that can occur is hemorrhage from the large vessels in the mediastinum. There are few articles relating to injury to major vessels during mediastinoscopy [1-5] and there are few articles relating to this condition in the provided Medline search. This is an underreported condition, since in any group of general thoracic surgeons, discussion do no more than gravitate to anecdotes relating to mediastinoscopy.Some reports have recommended gauze packing for massive bleeding from large vessels [4,5]. In fact, there are times when compression with material like surgicel? will be requires, and there might also be times when surgical exploration will be required. However, we speculated that bleeding from a low-pressure circulation system component, such as the superior vena cava or pulmonary artery, would cease without the use of such packing without resulting in a large hematoma or a pseudoaneurysm, because the mediastinum is a closed compartmental space separate from the pleural cavity or open air space. Herein, we report a case of injury to the right pulmonary artery during a mediastinoscopy procedure that was successfully controlled without gauze packing.A 77-year-old male with mediastinal lymphadenopathy was referred to our hospital. Chest computed tomography (CT) scanning demonstrated #4R and #7 lymphadenopathy without tumors in the lung field (Figure 1). A gastrointestinal fiberscope examination found no malignancy in the upper gastrointestinal tract, while 18F-fluorodeoxy-glucose positron emission tomography showed a positive accumulation in the mediastinal lymph nodes without other suspicious lesions.The patient underwent a video-assisted mediastinoscopy procedure in a supine position with a 5-cm cervical incision. The pretracheal lymph nodes adjoining the right pulmonary artery were found to be enlarged and carefully punch-biopsied several times. While a biopsy pr
Predictors of malignancy in EUS-guided FNA for mediastinal lymphadenopathy in patients without history of lung cancer
Luz Leticia,Moreira Daniel,Khan Mahboob,Eloubeidi Mohamad
Annals of Thoracic Medicine , 2011,
Abstract: Background: Mediastinal lymphadenopathy (ML) poses a great diagnostic challenge. Objective: To investigate the predictors of malignancy in endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) of ML in patients without known lung cancer. Design: Retrospective study. Setting: Tertiary referral center. Methods: One hundred eight patients without known lung cancer who underwent EUS guided-FNA for ML between 2000 and 2007. All subjects underwent EUS-guided FNA. Data was collected on patients′ demographics, and lymph node (LN) characteristics. Diagnosis of LN malignancy was based on FNA findings and clinical follow-up. Results: One hundred eight patients were analyzed; 58 (54%) were men and 87 (79%) were Caucasian. Mean age was 55 years. Prior malignancy was present in 48 (43%) patients. A total of 126 FNA samples from 126 distinct LNs were performed. Twenty-five (20%) LNs were positive for malignancy. Mean short and long-axis for LNs were 13 and 29 mms respectively. Round shape and sharp borders were found in 29 (15%) and 25 (22%) LNs, correspondingly. Independent predictors of a malignant FNA were: Prior cancer (OR 13.10; 95% CI 2.7-63.32; P = 0.001), short axis (OR 1.10; 95% CI 1.00-1.22; P = 0.041) and sharp LN borders (OR 5.47; 95% CI 1.01-29.51; P = 0.048). Age, race, gender, long axis, round shape were not associated with cancer in our cohort. Limitations: Retrospective design and lack of surgical gold standard. Conclusions: Increased risk of malignancy was associated with prior history of cancer, larger LN short axis and presence of LN sharp borders. These predictors may help guide endoscopists perform FNA in malignant LNs, increasing the overall efficiency of EUS-FNA for ML.
The Significance of Video-Mediastinoscopy in Diagnostic Accuracy  [cached]
Murat Oncel,Guven Sadi Sunam
Cukurova Medical Journal , 2013,
Abstract: Purpose: Video-mediastinoscopy, which has been recently employed, is a method for the diagnosis of mediastinal diseases and staging lung cancer. Material and Method: In our study, we retrospectively evaluated patients admitted to our clinic between 2008-2011 to determine the diagnostic success of video-mediastinoscopy. Results: A total of 58 (88%) cases out of 66 were diagnosed. Lymphadenopathy was not observed in 2 cases. Sarcoidosis was the most common type of mediastinal pathology seen in 28 (67%) cases. Tuberculous lymphadenitis was the second most common seen in 11 (27%) cases. Eight (5.3%) cases had anthrocosis, and 12 cases had reactive lymphadenitis. N3 counterpart staging was performed. Two of them were found to be positive. N2 found to be positive in 4 cases. These findings were correlated with PET scan. Mortality was not observed in any of the patients. Repeated mediastinoscopy for investigating N3 in one patient leads to disappearance of temporary hoarseness after about 2 months, which occurred due to paralysis recurrens. One patient had cervical subcutaneous emphysema, and one had major bleeding. Conclusion: Video-mediastinoscopy is a highly effective tool and important in finalizing the diagnosis. Moreover, it is reliable for the complete secure exploration of the mass, which we believe that it could be used in all patients required especially those with thoracic and mediastinal pathologies. [Cukurova Med J 2013; 38(4.000): 719-722]
The value of mediastinoscopy in the staging of lung cancer with clinical N2 disease  [cached]
Hui ZHAO,Jun WANG,Jun LIU,Jianfeng LI
Chinese Journal of Lung Cancer , 2008,
Abstract: Background and objective To determine the value of mediastinoscopy in the mediastinal staging of lung cancer with clinical N2 disease. Methods We retrospectively reviewed 87 patients received mediastinoscopy for known or suspected lung cancer, including 83 cervical mediastinoscopies and 4 parasternal mediastinoscopies. All patients were staged clinical N2 for enlarged ipsilateral mediastinal and/or subcarinal lymph nodes (short axis > 1.0 cm)on computed tomography scan. Results Of the 87 patients, 61 cases proved N2 disease on mediastinoscopy. The other 26 mediastinoscopy-negative patients underwent thoracotomy for lung resection and mediastinal lymph node dissection in the same operative session. Final pathologic N staging were consistent for mediastinoscopic sampling and surgical dissection in 24 patients. N2 disease was found in 2 patients (false-negative of mediastinoscopy). The sensitivity, specificity, and accuracy of mediastinoscopy were 96.8%, 100%, and 97.7%, respectively. There was no mortality and only 1 complication(1.1%) for all 87 mediastinoscopic procedures. Conclusion Mediastinoscopy is a highly effective and safe procedure for the mediastinal staging of lung cancer with clinical N2 disease.
Experiences on the application of video-assisted mediastinoscopy for 40 patients with mediastinal lesions  [cached]
Zhen LIANG,Weidong HU,Zhendong GU,Keneng CHEN
Chinese Journal of Lung Cancer , 2008,
Abstract: Background and objective To evaluate the clinical experiences on the application of video-assisted mediastinoscopy for 40 patients with mediastinal lesions. Methods Forty patients underwent video-assisted mediastinoscopy through neck-way surgery, including 17 cases with sole mediastinal nodule or mass, of which the pathologic diagnosis was warranted; 18 cases diagnosed as lung cancer with enlarged mediastinal lymph nodes, of which the clinical stage needed to be clarified; and 5 cases of mediastinal mass with miscellaneous clinical conditions. The results of mediastinoscopy biopsy and pathological diagnosis were analyzed. Results Satisfied tissue for detailed examination was obtained for all of the 40 cases who underwent mediastinoscopy. The successful rate for biopsy was 100%. The final pathologic diagnosis were 11 cases of lymph node metastasis from lung cancer, 4 cases of lymph node metastasis from unknown site, 9 cases of sarcoidosis, 6 cases of lymph node reactive hyperplasia, 4 cases of tuberculosis, 2 cases of lymphoma, 2 cases of mediastinal cyst, 1 case of retrosternal thyroid, 1 case of inflammatory granuloma. Two cases of postoperative hemorrhage related to surgery were successfully treated. Conclusion Video-assisted mediastinoscopy is safe and useful. It's essential for the diagnosis of sole mediastinal mass, a good method to clarify the pathologic stage of patients with lung cancer, and the only way to get the pathologic diagnosis for some special mediastinal disease.
The Clinical Value of Routine Preoperative Surgical Staging to Mediastinal Lymph Nodes on Lung Cancer  [PDF]
Ye XU,Yang SHENTU,Min ZHENG,Ming GUO
Chinese Journal of Lung Cancer , 2010,
Abstract: Background and objective The aim of this study is the clinical value of preoperative routine surgical staging to mediastinal lymph nodes on lung cancer. Methods Seventy-six cases underwent lymph nodes biopsy with mediastinoscopy. The diagnostic efficacy of thoracic CT scan and mediastinoscopy on mediastinal lymph nodes metastasis were compared. Results The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of thoracic CT scan and mediastinoscopy on diagnosing mediastinal lymph nodes metastasis were 68.5%, 66.7%, 68.4%, 84.6%, 16.7% and 87.5%, 100%, 84.2%, 100%, 60%, respectively. Conclusion Routine preoperative mediastinoscopy had obvious advantage compared with thoracic CT scan on mediastinal lymph nodes staging. The routine preoperative surgical staging of mediastinal lymph nodes on lung cancer had high clinical value.
Application of Videomediastinoscopy in Positive PET Finding for Mediastinal Lymph Node of Lung Cancer  [PDF]
Baodong LIU,Xiuyi ZHI,Qingsheng XU,Yi ZHANG
Chinese Journal of Lung Cancer , 2010,
Abstract: Background and objective Positron emission tomography (PET) is used increasingly in staging of non-small cell lung cancer (NSCLC) as a non-invasive tool. However, the role of PET in mediastinal lymphatic staging of NSCLC is not clear. The aim of this study was to demonstrate the efficacy of mediastinoscopy in determining mediastinal lymphatic metastasis in cases of positive PET finding. Methods We performed PET preoperatively in 68 patients with clinically operable NSCLC between 2003 and 2008. Mediastinal lymphatic defined as metastasis by PET (SUVmax>2.5) was recorded. Mediastinoscopy being performed initially in all patients. Involvement of mediastinal lymph nodes was verified to compare the sensitivity and specificity of mediastinoscopy and the related PET results. Results From 2003 to 2008, 61 mediastinoscopy were performed. There were 38 men and 23 women, aged from 41 to 81 years (mean 60 years). Localization of the tumor was right lung in 41 patients and left lung in 20 patients. After the operation, 45 patients were demonstrated to have N2 or N3 disease. Ten patients with N3 mediastinal metastasis for chemotherapy, 38 patients with N2 mediastinal metastasis for neuadiuvant chemotherapy while lung resection and systemic mediastinal lymphatic dissection through thoracotomy was performed in the remaining 16 patients with no mediastinal metastasis. The positive prediction value of PET scan was 73.8% (45/61). The sensitivity, specificity, accuracy, positive prediction value and negative prediction value in diagnosis of metastasis of mediastinal lymph nodes were 93.8% (45/48), 100% (13/13), 95.1% (58/61), 100% (45/45), 81.3% (13/16) for mediastinoscopy, respectively. Conclusion PET results do not provide acceptable accuracy rates. Mediastinoscopy still remains the gold standard for mediastinal staging of NSCLC.
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