Endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of intrathoracic lymph node metastases from extrathoracic malignancies

Clinical & Experimental Metastasis, Apr 2013

Intrathoracic lymph node enlargement is a common finding in patients with extrathoracic malignancies. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a technique that is commonly used for lung cancer diagnosis and staging but that has not been widely investigated for the diagnosis of enlarged mediastinal and lobar lymph nodes in patients with extrathoracic malignancies. We conducted a retrospective study of 117 patients with extrathoracic malignancies who underwent EBUS-TBNA for diagnosis of intrathoracic lymph node enlargement from October 2005 to December 2009 and compared the EBUS-TBNA findings with the final diagnoses. EBUS-TBNA diagnosed mediastinal metastases in 51 of the 117 (43.6 %) cases and gave an alternate diagnosis or ruled out the presence of malignancy in 35 (56.4 %). Fourteen of these 35 patients underwent further surgical investigation, while the remaining 21 had clinical and radiological follow-up for 18 months. No false negatives were found in the surgery group. In the follow-up group, 13 patients had stable or regressive lymphadenopathy, and eight developed clinicoradiological progression and were assumed to have been false negatives by EBUS-TBNA. The sensitivity and negative predictive value of EBUS-TBNA were 86.4 and 75 %, respectively. Immunohistochemical staining (IHC) was performed in 80.4 % of the samples obtained by EBUS-TBNA. In samples obtained from ten patients with metastatic breast cancer, estrogen receptor expression was successfully assessed in eight patients and progesterone receptor and human epidermal growth factor receptor 2 in four. EBUS-TBNA is an accurate procedure for the diagnosis of thoracic lymph node metastases in patients with extrathoracic malignancies and should be an initial diagnostic tool in these patients. Furthermore, EBUS-TBNA can obtain high-quality specimens from metastatic lymph nodes for use in molecular analyses.

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Endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of intrathoracic lymph node metastases from extrathoracic malignancies

Jose Sanz-Santos 0 1 2 3 4 5 6 7 8 Beatriz Cirauqui 0 1 2 3 4 5 6 7 8 Estefania Sanchez 0 1 2 3 4 5 6 7 8 Felipe Andreo 0 1 2 3 4 5 6 7 8 Pere Serra 0 1 2 3 4 5 6 7 8 Eduard Monso 0 1 2 3 4 5 6 7 8 Eva Castella` 0 1 2 3 4 5 6 7 8 Mariona Llatjos 0 1 2 3 4 5 6 7 8 Miguel Mesa 0 1 2 3 4 5 6 7 8 Juan Ruiz-Manzano 0 1 2 3 4 5 6 7 8 Rafael Rosell 0 1 2 3 4 5 6 7 8 0 B. Cirauqui R. Rosell Catalan Institute of Oncology , Badalona, Spain 1 J. Sanz-Santos (&) Bronchoscopy Unit, Pulmonology Department, Hospital Germans Trias i Pujol , Carretera de Canyet, s/n, 08916 Badalona, Spain 2 J. Sanz-Santos E. Sanchez F. Andreo P. Serra J. Ruiz-Manzano Pulmonology Department, Hospital Germans Trias i Pujol , Badalona, Spain 3 R. Rosell Dexeus University Institute , Barcelona, Spain 4 M. Mesa Thoracic Surgery Department, Hospital Germans Trias i Pujol , Badalona, Spain 5 E. Castella` M. Llatjos Pathology Department, Hospital Germans Trias i Pujol , Badalona, Spain 6 E. Monso Pulmonology Department, Hospital Parc Taul , Sabadell, Spain 7 F. Andreo E. Monso Ciber de enfermedades respiratorias CiBeRes, Bunyola, Spain 8 B. Cirauqui Departament de Medicina, Universitat Auto`noma de Barcelona , Bellaterra, Spain Intrathoracic lymph node enlargement is a common finding in patients with extrathoracic malignancies. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a technique that is commonly used for lung cancer diagnosis and staging but that has not been widely investigated for the diagnosis of enlarged mediastinal and lobar lymph nodes in patients with extrathoracic malignancies. We conducted a retrospective study of 117 patients with extrathoracic malignancies who underwent EBUS-TBNA for diagnosis of intrathoracic lymph node enlargement from October 2005 to December 2009 and compared the EBUS-TBNA findings with the final diagnoses. EBUS-TBNA diagnosed mediastinal metastases in 51 of the 117 (43.6 %) cases and gave an alternate diagnosis or ruled out the presence of malignancy in 35 (56.4 %). Fourteen of these 35 patients underwent further surgical investigation, while the remaining 21 had clinical and radiological follow-up for 18 months. - No false negatives were found in the surgery group. In the follow-up group, 13 patients had stable or regressive lymphadenopathy, and eight developed clinicoradiological progression and were assumed to have been false negatives by EBUS-TBNA. The sensitivity and negative predictive value of EBUS-TBNA were 86.4 and 75 %, respectively. Immunohistochemical staining (IHC) was performed in 80.4 % of the samples obtained by EBUS-TBNA. In samples obtained from ten patients with metastatic breast cancer, estrogen receptor expression was successfully assessed in eight patients and progesterone receptor and human epidermal growth factor receptor 2 in four. EBUS-TBNA is an accurate procedure for the diagnosis of thoracic lymph node metastases in patients with extrathoracic malignancies and should be an initial diagnostic tool in these patients. Furthermore, EBUS-TBNA can obtain high-quality specimens from metastatic lymph nodes for use in molecular analyses. Intrathoracic hilar and/or mediastinal nodal enlargement in patients with concurrent or previously diagnosed extrathoracic malignancies is a common finding both by computed tomography (CT) or positron emission tomography-computed tomography (PET-CT). Nodal enlargement can be found at the time of the initial diagnosis, which may affect staging and therefore be crucial for the choice of treatment, or it may be identified during or after the course of a radical treatment, which may imply a disease relapse. In addition, nodal enlargement may be from a primary intrathoracic malignancy, such as lung cancer, which will require a change in treatment. In all these situations, intrathoracic nodal enlargement requires pathologic confirmation and generally represents a challenge for the clinician. For many years, mediastinoscopy was the only diagnostic procedure for mediastinal lymphadenopathy. However, this surgical technique requires general anesthesia and is not the most suitable for patients undergoing chemotherapy. Over the last years, endoscopy ultrasoundguided fine needle aspiration (EUS-FNA) has proven to be an alternative to surgery for sampling mediastinal nodes in these patients [1, 2], but it cannot reach all the nodal stations. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a relatively novel technique whose usefulness in the diagnosis and staging of lung cancer [3] is widely recognized. However, few studies have focused on the use of EBUS-TBNA in the diagnosis of intrathoracic lymph node metastases in patients with extrathoracic malignancies [47]. Furthermore, although EBUS-TBNA has been used successfully to collect samples for molecular analyses in lung cancer patients [8], only one single study has reported the feasibility of EBUSTBNA to obtain samples from metastatic extrathoraci (...truncated)


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Jose Sanz-Santos, Beatriz Cirauqui, Estefania Sanchez, Felipe Andreo, Pere Serra, Eduard Monso, Eva Castellà, Mariona Llatjós, Miguel Mesa, Juan Ruiz-Manzano, Rafael Rosell. Endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of intrathoracic lymph node metastases from extrathoracic malignancies, Clinical & Experimental Metastasis, 2013, pp. 521-528, Volume 30, Issue 4, DOI: 10.1007/s10585-012-9556-3