For the sampling of mediastinal lymph nodes in patients with lung cancer, use of real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) appears to be a safe and effective approach. These results were published in the journal Thorax.

Lung cancer remains the leading cause of cancer death in the U.S. Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, accounting for 75%–80% of all lung cancers.

Accurate staging of NSCLC is essential before definitive therapy can begin. Staging involves determining the extent to which cancer has spread.

The mediastinum is the area behind the breast bone and consists of blood vessels, lymph nodes, and other structures. Because lung cancer frequently spreads to lymph nodes in the mediastinum, biopsies to this area are often necessary.

An endoscopic ultrasound-guided fine needle aspiration biopsy is often used to evaluate the mediastinum. This technique is performed in order to avoid the more invasive procedures of mediastinoscopy or thoracotomy. An ultrasound machine is used to take pictures of the mediastinum from the esophagus, allowing a small biopsy needle to be directly inserted into the suspicious area, without making an incision in the chest.

Researchers in Germany recently described their experience with an alternative approach to the sampling of mediastinal lymph nodes: real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).[1] In transbronchial needle aspiration, a needle is passed through the wall of the trachea or bronchus and into the underlying lymph node.[2] Real-time ultrasound indicates that the ultrasound device was still in place and sending images while the biopsy was performed. The study included 502 patients, a majority of whom had lung cancer.

  • 535 of 572 lymph nodes (94%) were successfully sampled.
  • The procedure correctly classified lymph nodes with and without cancer in a high proportion of study subjects.

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The researchers conclude that EBUS-TBNA appears to be a safe and effective approach to sampling mediastinal lymph nodes.

References:

[1] Herth FJF, Eberhardt R, Vilmann P, Krasnik M, Ernst A. Real-time Endobronchial Ultrasound Guided Transbronchial Needle Aspiration for Sampling Mediastinal Lymph Nodes. Thorax. 2006;61:795-798.

[2] Lloyd C, Silvestri GA. Mediastinal Staging of Non-small Cell Lung Cancer. Cancer Control. 2001;8:311-317.

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