Mediastinal staging procedures in lung cancer: EBUS, TBNA and mediastinoscopy

ARL Medford, CM Free, S Agrawal, JA Bennett

Research output: Contribution to journalArticle (Academic Journal)peer-review

77 Citations (Scopus)

Abstract

PURPOSE OF REVIEW: There is increasing awareness of minimally invasive endoscopic techniques for mediastinal staging in lung cancer. Traditionally, cervical mediastinoscopy has been utilized. Endobronchial ultrasound-guided fine needle aspiration (EBUS) has recently emerged as a potential alternative. RECENT FINDINGS: EBUS has sensitivity for lung cancer which is at least equivalent (if not superior) to cervical mediastinoscopy. However, cervical mediastinoscopy remains superior to EBUS and other techniques in its high negative predictive value. More recent data suggest EBUS may have a role in presurgical staging of radiologically normal subcentimetre nodes and its negative predictive value may be equivalent to surgical staging. Ongoing comparative studies between EBUS and cervical mediastinoscopy may well clarify relative performance and cost analyses. SUMMARY: Currently, insufficient data are present to recommend replacing cervical mediastinoscopy with EBUS for lung cancer staging; the negative predictive value of EBUS requires validation. However, EBUS can be recommended for initial staging as a minimally invasive option provided negative results are followed by cervical mediastinoscopy. This would also allow cervical mediastinoscopy to be reserved for re-staging. Conventional transbronchial needle aspiration has a limited role only as a first-line staging procedure but may aid diagnosis. In the future, EBUS may have a role in presurgical staging of the radiologically normal mediastinum and re-staging if prior staging is done by cervical mediastinoscopy.
Translated title of the contributionMediastinal staging procedures in lung cancer: EBUS, TBNA and mediastinoscopy
Original languageEnglish
Pages (from-to)334 - 342
JournalCurrent Opinion in Pulmonary Medicine
Volume15(4)
Publication statusPublished - 2009

Fingerprint Dive into the research topics of 'Mediastinal staging procedures in lung cancer: EBUS, TBNA and mediastinoscopy'. Together they form a unique fingerprint.

Cite this