Endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of intrathoracic lymph node metastases from extrathoracic malignancies
Jose Sanz-Santos
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Beatriz Cirauqui
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Estefania Sanchez
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Felipe Andreo
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Pere Serra
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Eduard Monso
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Eva Castella`
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Mariona Llatjos
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Miguel Mesa
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Juan Ruiz-Manzano
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Rafael Rosell
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B. Cirauqui R. Rosell Catalan Institute of Oncology
, Badalona,
Spain
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J. Sanz-Santos (&) Bronchoscopy Unit, Pulmonology Department, Hospital Germans Trias i Pujol
, Carretera de Canyet, s/n, 08916 Badalona,
Spain
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J. Sanz-Santos E. Sanchez F. Andreo P. Serra J. Ruiz-Manzano Pulmonology Department, Hospital Germans Trias i Pujol
, Badalona,
Spain
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R. Rosell Dexeus University Institute
,
Barcelona, Spain
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M. Mesa Thoracic Surgery Department, Hospital Germans Trias i Pujol
, Badalona,
Spain
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E. Castella` M. Llatjos Pathology Department, Hospital Germans Trias i Pujol
, Badalona,
Spain
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E. Monso Pulmonology Department, Hospital Parc Taul
, Sabadell,
Spain
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F. Andreo E. Monso Ciber de enfermedades respiratorias CiBeRes, Bunyola,
Spain
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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.
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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)