Ayten Kayı CANGIR, Cabir YÜKSEL, Serkan ENÖN, Koray CEYHAN, Durdu KARASOY

Should transbronchial needle aspiration and rapid on-site cytologic evaluation be performed before mediastinoscopy? "Analysis of 239 cases"

Bu çalışmada mediastinoskopi yapılması planlanan hastalarda ameliyathanede yapılan transbronşiyal iğne aspirasyonu ile birlikte hızlı yerinde sitolojik değerlendirmenin rolü ve etkinliği değerlendirildi.Çalışma planı: Ocak 2004 - Aralık 2012 tarihleri arasında akciğer kanseri veya mediastinal lenfadenopati tanısı konulmuş veya bu tanıdan şüphelenilen toplam 239 hastaya (153 erkek, 86 kadın; ort yaş 53.3±13.7 yıl; dağılım 14-85 yıl) transbronşiyal iğne aspirasyonu hızlı yerinde sitolojik değerlendirme uygulandı. Tanı başarısı, lenf nodlarının yerleşim yeri ve büyüklüğü ve örnekleme sayısı analiz edildi.Bul gu lar: Toplam 227 (%93.03) hastadan tanı için örnek alındı ve 297 lenf nodu örneklendi. Lenf nodu istasyonları ve boyutları arasında istatistiksel açıdan anlamlı ilişki tespit edildi (p=0.018). Subkarinal lenf nodlarında tanı oranı en yüksek idi (%91.5) ve bunların %49.5'i benign idi. Ortalama lenf nodu çapları malign grupta (n=123) 23.9±10.4 mm, benign grupta (n=135) 19.4±7.4 mm, tanı konulamayan grupta (n=39) 19.1±8.8 mm idi ve lenf nodlarının çapları biribirinden istatistiksel olarak anlamlı düzeyde farklı idi (p=0.001). Beş hastaya tekrar transbronşiyal iğne aspirasyonu uygulandı ve bunların üçünde metastaz saptanmadı. Tüm negatif sonuçlar (n=12) rezeksiyon sonrası histopatolojik inceleme ile doğrulandı.So nuç: Yerinde değerlendirme, yetersiz örnek riskini azaltmakta ve transbronşiyal iğne aspirasyonunun tanısal doğruluk oranını artırmaktadır. Akciğer kanserini evreler iken veya mediastinal lenfadenopati tanısı koyar iken transbronşiyal iğne aspirasyonu seçilecek ilk işlem olabilir. İşlem mediastinoskopi planlanan hastalarda göğüs cerrahları tarafından ameliyathanede uygulanabilir

Mediastinoskopi öncesi transbronşiyal iğne aspirasyonu ve hızlı yerinde sitolojik değerlendirme yapılmalı mıdır? "239 olgunun analizi"

This study aims to assess the role and efficiency of transbronchial needle aspiration accompanied by rapid on-site cytologic evaluation performed in the operating room in patients who are planned to undergo mediastinoscopy.Methods: A total of 239 patients (153 males, 86 females; mean age 53.3±13.7 years; range 14 to 85 years) who were diagnosed with or suspected to have lung cancer or mediastinal lymphadenopathy between January 2004 and December 2012 were performed transbronchial needle aspiration rapid on-site cytologic evaluation. Diagnosis success, localization and size of lymph nodes, and number of sampling were analyzed.Results: Diagnostic specimens were obtained from a total of 227 patients (93.03%) and 297 lymph nodes were sampled. A statistically significant difference was detected between lymph node stations and dimensions (p=0.018). Subcarinal lymph nodes had the highest diagnosis rate (91.5%) and 49.5% of these were benign. Mean lymph node diameters were 23.9±10.4 mm in malignant group (n=123), 19.4±7.4 mm in benign group (n=135), and 19.1±8.8 mm in undiagnosed group (n=39) and the diameters were statistically significantly different from each other (p=0.001). A repeat transbronchial needle aspiration was performed in five patients and no metastasis was detected in three of them. All negative results (n=12) were confirmed with histopathological examination after resection.Conclusion: On-site evaluation decreases the risk of inadequate specimens and increases diagnostic accuracy rate of transbronchial needle aspiration. Transbronchial needle aspiration may be the initial procedure of choice while staging lung cancer or diagnosing mediastinal lymph node. Procedure may be performed by thoracic surgeons in the operating room in patients planned for mediastinoscopy

PDF

___

Baram D, Garcia RB, Richman PS. Impact of rapid on-site cytologic evaluation during transbronchial needle aspiration. Chest 2005;128:869-75.
Diette GB, White P Jr, Terry P, Jenckes M, Rosenthal D, Rubin HR. Utility of on-site cytopathology assessment for bronchoscopic evaluation of lung masses and adenopathy. Chest 2000;117:1186-90.
Baram D. Comparison of the diagnostic accuracy of transbronchial needle aspiration for bronchogenic carcinoma and other malignancies. J Bronchol 2004;11:87-91.
Nakajima T, Yasufuku K, Saegusa F, Fujiwara T, Sakairi Y, Hiroshima K, et al. Rapid on-site cytologic evaluation during endobronchial ultrasound-guided transbronchial needle aspiration for nodal staging in patients with lung cancer. Ann Thorac Surg 2013;95:1695-9.
Iyoda A, Baba M, Shibuya K, Moriya Y, Yasufuku K, Sekine Y, et al. Transbronchial fine needle aspiration cytological examination: a useful tool for diagnosing primary lung cancer. Thorac Cardiovasc Surg 2006;54:117-9.
Yasufuku K, Fujisawa T. Staging and diagnosis of non-small cell lung cancer: invasive modalities. Respirology 2007;12:173-83.
Kunst PW, Lee P, Paul MA, Senan S, Smit EF. Restaging of mediastinal nodes with transbronchial needle aspiration after induction chemoradiation for locally advanced non-small cell lung cancer. J Thorac Oncol 2007;2:912-5.
Holty JE, Kuschner WG, Gould MK. Accuracy of transbronchial needle aspiration for mediastinal staging of non-small cell lung cancer: a meta-analysis. Thorax 2005;60:949-55.
Krasnik M, Vilmann P, Larsen SS, Jacobsen GK. Preliminary experience with a new method of endoscopic transbronchial real time ultrasound guided biopsy for diagnosis of mediastinal and hilar lesions. Thorax 2003;58:1083-6.
Herth FJ. Mediastinal staging--the role of endobronchial and endo-oesophageaL sonographic guided needle aspiration. Lung Cancer 2004;45:63-7.
Yasufuku K, Nakajima T, Motoori K, Sekine Y, Shibuya K, Hiroshima K, et al. Comparison of endobronchial ultrasound, positron emission tomography, and CT for lymph node staging of lung cancer. Chest 2006;130:710-8.
Trisolini R, Cancellieri A, Tinelli C, Paioli D, Scudeller L, Casadei GP, et al. Rapid on-site evaluation of transbronchial aspirates in the diagnosis of hilar and mediastinal adenopathy: a randomized trial. Chest 2011;139:395-401.
Sarkiss M, Kennedy M, Riedel B, Norman P, Morice R, Jimenez C, et al. Anesthesia technique for endobronchial ultrasound-guided fine needle aspiration of mediastinal lymph node. J Cardiothorac Vasc Anesth 2007;21:892-6.
Groth SS, Andrade RS. Endobronchial and endoscopic ultrasound-guided fine-needle aspiration: a must for thoracic surgeons. Ann Thorac Surg 2010;89:2079-83.
Vansteenkiste J, Dooms C. Positron emission tomography in nonsmall cell lung cancer. Curr Opin Oncol 2007;19:78-83.
Gonzalez-Stawinski GV, Lemaire A, Merchant F, O'Halloran E, Coleman RE, Harpole DH, et al. A comparative analysis of positron emission tomography and mediastinoscopy in staging non-small cell lung cancer. J Thorac Cardiovasc Surg 2003;126:1900-5.
De Leyn P, Stroobants S, De Wever W, Lerut T, Coosemans W, Decker G, et al. Prospective comparative study of integrated positron emission tomography-computed tomography scan compared with remediastinoscopy in the assessment of residual mediastinal lymph node disease after induction chemotherapy for mediastinoscopy-proven stage IIIA-N2 Non-small-cell lung cancer: a Leuven Lung Cancer Group Study. J Clin Oncol 2006;24:3333-9.
Mateu-Navarro M, Rami-Porta R, Bastus-Piulats R, Cirera- Nogueras L, González-Pont G. Remediastinoscopy after induction chemotherapy in non-small cell lung cancer. Ann Thorac Surg 2000;70:391-5.
Cerfolio RJ, Bryant AS. When is it best to repeat a 2-fluoro- 2-deoxy-D-glucose positron emission tomography/computed tomography scan on patients with non-small cell lung cancer who have received neoadjuvant chemoradiotherapy? Ann Thorac Surg 2007;84:1092-7.
Chin R Jr, McCain TW, Lucia MA, Cappellari JO, Adair NE, Lovato JF, et al. Transbronchial needle aspiration in diagnosing and staging lung cancer: how many aspirates are needed? Am J Respir Crit Care Med 2002;166:377-81.
Diacon AH, Schuurmans MM, Theron J, Brundyn K, Louw M, Wright CA, et al. Transbronchial needle aspirates: how many passes per target site? Eur Respir J 2007;29:112-6.
Stoll LM, Yung RC, Clark DP, Li QK. Cytology of endobronchial ultrasound-guided transbronchial needle aspiration versus conventional transbronchial needle aspiration. Cancer Cytopathol 2010;118:278-86.
Nakajima T, Yasufuku K, Iyoda A, Yoshida S, Suzuki M, Sekine Y, et al. The evaluation of lymph node metastasis by endobronchial ultrasound-guided transbronchial needle aspiration: crucial for selection of surgical candidates with metastatic lung tumors. J Thorac Cardiovasc Surg 2007;134:1485-90.
Hsu LH, Liu CC, Ko JS. Education and experience improve the performance of transbronchial needle aspiration: a learning curve at a cancer center. Chest 2004;125:532-40.