GuidelineRole of EUS for the evaluation of mediastinal adenopathy
Section snippets
EUS
Radial EUS performed within the esophagus provides an image of the mediastinum similar to an axial view on a CT scan. FNA cannot be performed with the radial EUS endoscope. The linear EUS endoscope produces an approximately 180-degree image relative to the endoscope tip and allows FNA. EUS can identify lymph nodes in the posterior and inferior mediastinum. Stations 8 and 9 are accessible, as are posterior nodes at station 7 (Fig. 1). If enlarged, station 5 nodes may be accessible.4, 5, 6, 7
Obtaining tissue from mediastinal adenopathy
CT and PET scans can detect abnormal mediastinal lymphadenopathy, but are usually inadequate for diagnosis and locoregional staging of malignancy.10, 11, 12, 13, 14, 15, 16 Thus, tissue sampling is often required.13 Mediastinal tissue can be obtained by needle techniques or surgical biopsy. Needle techniques include transthoracic needle aspirate (TTNA), transbronchial needle aspirate (TBNA), EBUS-FNA , EUS-FNA, and EUS needle core biopsy. Surgical biopsy techniques include cervical
Lung cancer
Lung cancer is the most frequent cause of cancer death in the United States46 and in the world.47 Staging and treatment of lung cancer are determined by radiologic imaging and tissue diagnosis. The American Joint Committee on Cancer stages nodal metastases with lung cancer anatomically.48
A CT scan of the chest with imaging of the liver and adrenal glands should be performed in patients with suspected or known lung cancer who may undergo treatment.12 Mediastinal lymph nodes with a short-axis
Recommendations
- 1
In patients with known or suspected potentially resectable lung cancer whose imaging reveals mediastinal adenopathy, we suggest that EUS-FNA be performed in patients with paraesophageal, posterior, and inferior mediastinal adenopathy, if the expertise if available. ⊕⊕○○ Similarly, we suggest that EBUS-FNA be performed in patients with paratracheal mediastinal adenopathy if this information adds to the staging of the lung cancer. ⊕⊕○○ EUS-FNA and EBUS-FNA have been shown to be safe, and
Disclosure
The following authors disclosed financial relationships relevant to this publication: Dr Decker: consultant to Facet Biotechnology; Dr Fanelli: honoraria from Ethicon, consultant to RTI; owner/governor: New Wave Surgical Corp; Dr Jain: research support from Barrx; Dr Evans: consultant to Cook Medical. The other authors disclosed no financial relationships relevant to this publication.
References (104)
- et al.
The role of EUS for evaluation of mediastinal adenopathy
Gastrointest Endosc
(2003) - et al.
The role of endoscopy in the assessment and treatment of esophageal cancer
Gastrointest Endosc
(2003) - et al.
Accessing the aortopulmonary window (#5) and the paraaortic (#6) lymph nodes in patients with non-small cell lung cancer
Ann Thorac Surg
(2007) - et al.
Endoscopic ultrasound-guided fine needle aspiration of mediastinal lymph node in patients with suspected lung cancer after positron emission tomography and computed tomography scans
Ann Thorac Surg
(2005) - et al.
Endoscopic ultrasound in lung cancer patients with a normal mediastinum on computed tomography
Ann Thorac Surg
(2004) - et al.
Towards a minimally invasive staging strategy in NSCLC: analysis of PET positive mediastinal lesions by EUS-FNA
Lung Cancer
(2004) - et al.
Positron emission tomographic imaging with fluorodeoxyglucose isefficacious in evaluating malignant pulmonary disease
J Thorac Cardiovasc Surg
(1999) - et al.
Noninvasive staging of non-small cell lung cancer: ACCP evidenced-based clinical practice guidelines (2nd edition)
Chest
(2007) - et al.
Invasive mediastinal staging of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition)
Chest
(2007) - et al.
Comparative efficacy of positron emission tomography with fluorodeoxyglucose in evaluation of small (<1 cm), intermediate (1 to 3 cm), and large (>3 cm) lymph node lesions
Chest
(2000)
Accuracy of computed tomographic scan and surgical assessment for staging of bronchial carcinomaA prospective study
J Thorac Cardiovasc Surg
Transthoracic aspiration biopsy of pulmonary and mediastinal lesions
Eur J Radiol
Image-guided fine needle aspirate strategies for staging of lung cancer
Clin Lung Cancer
Role of fiberscopic transbronchial needle aspiration in the staging of N2 disease due to non-small cell lung cancer
Ann Thorac Surg
Utility of the Wang 18-gauge transbronchial histology needle in the staging of bronchogenic carcinoma
Chest
The diagnostic yield of transbronchial needle aspiration in superior vena cava syndrome
Lung Cancer
Transbronchial lung biopsy through the fibre optic bronchoscopeResults and complications in 452 examinations
Respir Med
A prospective cooperative study of complications following flexible fiberoptic bronchoscopy
Chest
Endoscopic ultrasonography-guided fine-needle aspiration biopsy of lymph nodes
Gastrointest Endosc
Mediastinoscopy as a routine outpatient procedure
Ann Thorac Surg
Ambulatory mediasttinoscopy and anterior mediastinotomy
Ann Thorac Surg
Outpatient mediastinoscopy
J Thorac Cardiovasc Surg
Retrospective analysis of the clinical performance of anterior mediastinotomy
Ann Thorac Surg
Invasive staging of non-small cell lung cancer: a review of the current evidence
Chest
Extended cervical mediastinoscopyA single staging procedure for bronchogenic carcinoma of the left upper lobe
J Thorac Cardiovasc Surg
Cerebrovascular accident complicating extended cervical mediastinoscopy
Ann Thorac Surg
Treatment of non-small cell lung cancer-stage IIIA: ACCP evidence-based clinical practice guidelines (2nd edition)
Chest
Endosonographic features predictive of malignancy in mediastinal lymph nodes in patients with lung cancer
Gastrointest Endosc
Endoscopic ultrasound guided biopsy versus mediastinoscopy for analysis of paratracheal and subcarinal lymph nodes in lung cancer staging
Lung Cancer
Role of transesophageal endosonography-guided fine-needle aspiration in the diagnosis of lung cancer
Chest
Endoscopic ultrasound-guided fine needle aspiration for staging patients with carcinoma of the lung
Ann Thorac Surg
Transaortic EUS-guided FNA in the diagnosis of lung tumors and lymph nodes
Gastrointest Endosc
Endoscopic ultrasound-guided fine needle aspiration cytology of solid liver lesions: a large single-center experience
Am J Gastroenterol
Detection of occult liver metastases during EUS for staging of malignancies
Gastrointest Endosc
A large single-center experience of EUS-guided FNA of the left and right adrenal glands: diagnostic utility and impact on patient management
Gastrointest Endosc
Transduodenal EUS-guided FNA of the right adrenal gland
Gastrointest Endosc
EUS-guided FNA of the left adrenal gland in patients with thoracic or GI malignancies
Gastrointest Endosc
Left adrenal gland hemorrhage as a complication of EUS-FNA
Gastrointest Endosc
Mediastinal restaging: EUS-FNA offers a new perspective
Lung Cancer
Comparison of EUS-guided fine needle aspiration and integrated PET-CT in restaging after treatment for locally advanced non-small cell lung cancer
Lung Cancer
The utility of sonographic features during endobronchial ultrasound-guided transbronchial needle aspiration for lymph node staging in patients with lung cancer: a standard endobronchial ultrasound image classification system
Chest
Combined endoesophageal-endobronchial ultrasound-guided fine-needle aspiration of mediastinal lymph nodes through a single bronchoscope in 150 patients with suspected lung cancer
Chest
Cost-minimization analysis of alternative diagnostic approaches in a modeled patient with non-small cell lung cancer and subcarinal lymphadenopathy
Mayo Clin Proc
EUS-guided fine-needle aspiration combined with flow cytometry and immunocytochemistry in the diagnosis of lymphoma
Gastrointest Endosc
EUS-guided biopsy for the diagnosis and classification of lymphoma
Gastrointest Endosc
EUS-guided FNA combined with flow cytometry in the diagnoses of suspected or recurrent intrathoracic or retroperitoneal lymphoma
Gastrointest Endosc
Endobronchial ultrasound-guided transbronchial needle aspiration for the evaluation of suspected lymphoma
J Thorac Oncol
EUS-guided 19-gauge trucut needle biopsy for diagnosis of lymphoma missed by EUS-guided FNA
Gastrointest Endosc
The additional value of EUS-guided Tru-cut biopsy to EUS-guided FNA in patients with mediastinal lesions
Gastrointest Endosc
Esophageal endoscopic ultrasound with fine-needle aspiration with an on-site cytopathologist: high accuracy for the diagnosis of mediastinal lymphadenopathy
Chest
Cited by (33)
Endoscopic Ultrasonography in the Evaluation of Posterior Mediastinal Lesions
2018, Endosonography, Fourth EditionEUS-guided tissue acquisition: An evidence-based approach (with videos)
2014, Gastrointestinal EndoscopyCitation Excerpt :Lymphoproliferative disorders often require histologic specimens to best delineate architecture and allow for performance of flow cytometry (immunophenotyping). Although FNA specimens can have a high yield for metastatic lesions, FNA generally is not ideal for hematologic malignancy.67,202 Multiple observational studies have shown a range of diagnostic accuracy of FNA for the diagnosis of abnormal lymphocytes (70%-90%), but more importantly, these studies have shown much lower rates of accurate classification of lymphoma (Supplemental Table 5, available online at www.giejournal.org).39,101,203-223
EUS in the Evaluation of Posterior Mediastinal Lesions
2014, Endosonography, Third editionAdvances in cytopathology for lung cancer. The impact and challenges of new technologies
2013, Thoracic Surgery ClinicsCitation Excerpt :In EUS, the endoscope is introduced in the esophagus and the biopsy done through the esophageal wall, whereas, in EBUS, the probe is adapted to a bronchoscope and the biopsy is done through the tracheal and/or bronchial wall. EUS/EBUS had a great impact on the staging of lung cancer because it can sample peritracheal and periesophageal mediastinal node stations, and help to determine the resectability of a tumor.9,10 This less invasive technique has shown high sensitivity and might replace mediastinoscopy to a great extent in the near future.
Endoscopic Ultrasonography/Fine-Needle Aspiration and Endobronchial Ultrasonography/Fine-Needle Aspiration for Lung Cancer Staging
2012, Gastrointestinal Endoscopy Clinics of North AmericaCitation Excerpt :Evaluation of this station has traditionally required a paramedian mediastinotomy (Chamberlain procedure). EUS-FNA is recommended as the first-line method for assessment of stage 5 nodes by the American Society for Gastrointestinal Endoscopy.37 Another advantage of EUS is that it can detect metastatic disease to subdiaphragmatic sites such as left adrenal, celiac lymph nodes, and liver.