THE MEDIASTINUM IN NSCLC PATIENTS WITH NO PROOF OF MEDIASTINAL

From january 2004 to could 2007, ebus-tbna was used
to sample 156 lymph nodes ( five to ten mm in size ) in 97 nsclc
patients. mean diameter of punctured lymph nodes was seven. nine mm.
the sensitivity, specificity, and npv of ebus-tbna in detecting
malignancy were 89%, 100%, and 98. 9%, respectively. this
demonstrates that ebus-tbna could be an correct means that of staging
the mediastinum in nsclc patients with no proof of mediastinal
involvement on ct and pet scans.
in lightweight of the promising knowledge that are printed on
the use of ebus-tbna for mln staging in nsclc patients,
direct comparison with mediastinoscopy ( the gold commonplace )
is necessary to establish the appropriate clinical approach to
mediastinal staging in patients with nsclc. so so much, a study
by ernst et al. sixty five is that the no more than one to draw such a comparison.
included within the study were 66 patients with suspected nsclc
and mediastinal adenopathy ( 1 cm ) on ct scan that was confined
to lymph node stations two, four, or seven. biopsies from 120 lymph
nodes ( mean size fifteen mm, vary ten to 21 ) within these 66 patients
were obtained by each ebus-tbna and mediastinoscopy. in
a per lymph node analysis, ebus-tbna had a better overall
diagnostic yield ( 91% ) than mediastinoscopy ( 78% ). specifically,
ebus-tbna had a statistically significant ( p 0. 05 ) higher
diagnostic yield than mediastinoscopy in subcarinal ( 98% vs.
78% ) and malignant ( 86% vs. 66% ) lymph nodes. there was
additionally a trend toward obtaining a definite histologic diagnosis with
ebus-tbna ( 59% ) compared with mediastinoscopy ( 47% ),
other then this didn't reach statistical significance. overall, the sensitivity,
specificity, and npv of ebus-tbna were 87%, 100%,
and 78%, respectively. the sensitivity, specificity, and npv of
mediastinoscopy were 68%, 100%, and 59%, respectively.
complementary use of transesophageal mln sampling
any improves staging of aortic window, paraesophageal ln
stations and adrenals, still a lot of cumbersome to be tackled
employing alternative surgical approaches. thirteen, seventeen current screening
efforts could increasingly confront clinicians with subcentimeter’s
lesions within the lung parenchyma, and therefore the potential role for
ebus for obtaining diagnosis are pusblihsed. twelve, 20
for daily follow, the use of bronchial needle aspiration by
bronchoscopists is frequently underutilized, ensuing from lack
of awareness of its potential for correct and safely sampling
nodal stations based mostly on the proximity of several necessary nodal
stations to the central airways. experts’ opinion herein and
recent yankee school of chest physicians ( accp ) guidelines
have addressed this is oftensue in details. half dozen, thirteen, 66 it's obvious that
scalene, aortic, paraesophageal nodes, left adrenal, need eus
and alternative measures.