Lymph node assessment in early stage non-small cell lung cancer lymph node dissection or sampling?
AbstractLymph node assessment is an essential component of the treatment of lung cancer. Identification of the correct “N” stage is important for staging which in turn determines treatment. Assessment of lymph nodes may be accomplished using imaging with CT scan and PET–CT, invasive techniques such as mediastinoscopy, endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) or endoscopic ultrasoun d fine needle aspiration (EUS-FNA). Ultimately, regardless of any pre-resection assessment, lymph nodes must be assessed at the time of resection. The question to be addressed in this report is the role of mediastinal lymph node dissection versus lymph node sampling. However, the issues surrounding lymph node assessment in NSCLC are complex, depending on clinical stage, imaging and histology.
This study was performed in order to define the prevalence of mediastinal LN metastases discovered on combined endosonography by endobronchial ultrasound (EBUS) and endoscopic ultrasound (EUS) fine needle aspiration in patients with a radiologically normal mediastinum. This study consists of a retrospective, single-institution, tertiary care referral center review of a prospectively maintained database.
Conclusion: Systematic sampling of the mediastinum by EBUS-TBNA, regardless of PET/CT features, is to be recommended over targeted sampling.
Authors: Ozturk A, Gullu YT Abstract OBJECTIVE: To determine the correlation and/or discrepancies between positron emission tomography (PET-CT) findings, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and surgery in the staging of non-small cell lung carcinoma. MATERIAL AND METHODS: Data were evaluated retrospectively from a prospective interventional endoscopy database. Positive results with EBUS-TBNA was the first end point and all cytology negatives were confirmed with mediastinoscopy/surgery. RESULTS: Four hundred and eighty three patients were included and 1017 lymph nodes...
ConclusionsIn clinical practice, systematic sampling of the mediastinum by EBUS-TBNA, regardless of PET/CT features, is to be recommended over targeted sampling.
Surgery is the gold standard treatment for operable patients with stage Ⅰ or Ⅱ non-small lung cancer (NSCLC) . Stereotactic Body Radiation Therapy (SBRT) is an alternative treatment option for non-surgical T1-2N0 NSCLC patients [2–4]. Recent studies shows that non-surgical patients with stage Ⅰ NSCLC can be treated by SBRT with reasonable local control [5–7 ]. NSCLC with confirmed nodal metastasis (N1 or N2 disease) is usually an exclusion for SBRT. Nodal statuses are first assessed by radiological examination such as computed tomography (CT) and/or F-fluoro-2-deoxy-d-glucose (FDG)-positron emission tomography (PET).
Conclusions: The combined EBUS-TBNA and EUS-FNA technique is a successful procedure for nodal staging in potentially operable NSCLC patients. PMID: 30246650 [PubMed - in process]
Conclusions In clinical practice, systematic sampling of the mediastinum by EBUS-TBNA, regardless of PET/CT features, is to be recommended over targeted sampling.
CONCLUSIONS: In clinical practice, systematic sampling of the mediastinum by EBUS-TBNA, regardless of PET/CT features, is to be recommended over targeted sampling. PMID: 29630875 [PubMed - as supplied by publisher]
AbstractLung cancer is among the most common cancers and by far the commonest cause of cancer-related mortality worldwide as well as in India. Practice patterns vary widely, and there is scarce published literature on patterns of care in early-stage lung cancer in India. Diagnostic work-up includes a contrast-enhanced computed tomography (CECT) scan of the thorax and upper abdomen, and if there are no metastases, a formal metastatic work-up includes a positron emission tomography (PET) –CT scan and a magnetic resonance imaging (MRI) of the brain. Mediastinal staging has wide variations with endoscopic (endosonographi...
Conclusions: The majority of biopsy-proven mediastinal lymph nodes metastases are not associated with positive results on preoperative CT or PET. CT and PET have low positive predictive value for mediastinal lymph node. This study supports the routine utilization of invasive mediastinal lymph nodes staging in NSCLC, especially for patients with tumors of>4 cm diameter, regardless of CT or PET-CT results.