Article information
Abstract
Endoscopic and endobronchial ultrasound are complementary techniques. When combined, they allow for nearly complete mediastinal staging in lung cancer. Each technique has inherent strengths and weaknesses, but when used simultaneously they become far more powerful, to the extent that mediastinoscopy–a more expensive and invasive procedure-is expected to decline in use as the application of endoscopic and endobronchial ultrasound becomes more widespread. The incorporation of these ultrasound techniques has been shown to lead to fewer thoracotomies, benefiting patients and also society, given that costs are thereby reduced. We reflect on recent developments in the field, discuss current debates, and propose a view of what the future holds in store.
Keywords:
Cancer staging
Non-small cell lung cancer
Endobronchial ultrasound
Endoscopic ultrasound
Fine-needle aspiration
Left upper lobe
Positive emission tomography
Transbronchial needle aspiration
Resumen
La utrasonografía endoscópica y la endobronquial son métodos complementarios. Combinadas, permiten una estadificación mediastínica casi completa del cáncer de pulmón sin cirugía. Son más potentes cuando se utilizan simultáneamente, ya que cada una de ellas tiene puntos fuertes y puntos débiles. Es de esperar que con la utilización de ambas se reduzca el uso de la mediastinoscopia (un proceso más caro e invasivo). Se ha demostrado que el empleo de ambas técnicas conduce a la realización de menos toracotomías, lo que beneficia no sólo a los pacientes, sino también a la sociedad, ya que se ahorran costes. En el artículo se realiza también una reflexión sobre los avances más recientes en este ámbito, se examinan los debates actuales al respecto y se presenta una perspectiva para el futuro.
Palabras clave:
Estadificación del cáncer
Cáncer de pulmón no microcítico
Ultrasonografía endobronquial
Ultrasonografía endoscópica
Punción aspirativa con aguja fina
Lóbulo superior izquierdo
Tomografía por emisión de positrones
Aspiración transbronquial con aguja
Full text is only aviable in PDF
References
[1.]
A. Alberg, J. Ford, J. Samet.
Epidemiology of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition).
Chest, 132 (2007), pp. 29-55
[2.]
R. Huxley, K. Jamrozik, T. Lam, F. Barzi, A. Ansary-Moghaddam, C. Jiang, et al.
Impact of smoking and smoking cessation on lung cancer mortality in the Asia-Pacific Region.
Am J Epidemiol, 165 (2007), pp. 1280-1286
[3.]
F. Bray, J. Tyczynski, D. Parkin.
Going up or coming down? The changing phases of the lung cancer epidemic from 1967 to 1999 in the 15 European Union countries.
Eur J Cancer, 40 (2004), pp. 96-125
[4.]
C. Bosetti, M. Malvezzi, L. Chatenoud, E. Negri, F. Levi, C. La Vecchia.
Trends in cancer mortality in the Americas, 1970-2000.
Ann Oncol, 16 (2005), pp. 489-511
[5.]
M. Rivera, A. Mehta.
Initial diagnosis of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition).
Chest, 132 (2007), pp. 131-148
[6.]
A. Arroliga, R. Matthay.
The role of bronchoscopy in lung cancer.
Clin Chest Med, 14 (1993), pp. 87-98
[7.]
A. Fritscher-Ravens, N. Soehendra, L. Schirrow, P. Sriram, A. Meyer, H. Hauber, et al.
Role of transesophageal endosonography-guided fine-needle aspiration in the diagnosis of lung cancer.
Chest, 117 (2000), pp. 339-345
[8.]
K. Khoo, K. Ho, B. Nilsson, T. Lim.
EUS-guided FNA immediately after unrevealing transbronchial needle aspiration in the evaluation of mediastinal lymphadenopathy: a prospective study.
Gastrointest Endosc, 63 (2006), pp. 215-220
[9.]
A. Hernández, M. Kahaleh, J. Olazagasti, D. Jones, T. Daniel, E. Stelow, et al.
EUSFNA as the initial diagnostic modality in centrally located primary lung cancers.
J Clin Gastroenterol, 41 (2007), pp. 657-660
[10.]
P. Singh, B. Camazine, Y. Jadhav, R. Gupta, P. Mukhopadhyay, A. Khan, et al.
Endoscopic ultrasound as a first test for diagnosis and staging of lung cancer: a prospective study.
Am J Respir Crit Care Med, 175 (2007), pp. 345-354
[11.]
H. Schrötter.
Klinik der Bronchoskopie.
Fischer, (1906),
[12.]
C. Jackson, C.L. Jackson.
Bronchoesophagology.
Saunders, (1950),
[13.]
E. Schiepatti.
Mediastinal lymph node puncture through the tracheal carina.
Surg Gynecol Obstet, 107 (1958), pp. 243-246
[14.]
K. Wang, R. Brower, E. Haponik, S. Siegelman.
Flexible transbronchial needle aspiration for staging of bronchogenic carcinoma.
Chest, 84 (1983), pp. 571-576
[15.]
E. Haponik, D. Shure.
Underutilization of transbronchial needle aspiration: experiences of current pulmonary fellows.
Chest, 112 (1997), pp. 251-253
[16.]
A. Dasgupta, A. Mehta.
Transbronchial needle aspiration. An underused diagnostic technique.
Clin Chest Med, 20 (1999), pp. 39-51
[17.]
A. Fernández-Villar, F. Iglesias, M. Mosteiro, D. Corbacho, A. González, P. Blanco, et al.
Factores predictores del resultado de la punción-aspiración transtraqueal de adenopatías mediastínicas neoplásicas.
Arch Bronconeumol, 41 (2005), pp. 434-438
[18.]
M. Wiersema, M. Kochman, A. Chak, H. Cramer, K. Kesler.
Real-time endoscopic ultrasound-guided fine-needle aspiration of a mediastinal lymph node.
Gastrointest Endosc, 39 (1993), pp. 429-431
[19.]
M. Wiersema, M. Kochman, H. Cramer, L. Wiersema.
Preoperative staging of non-small cell lung cancer: transesophageal US-guided fine-needle aspiration biopsy of mediastinal lymph nodes.
Radiology, 190 (1994), pp. 239-242
[20.]
K. Yasufuku, P. Chhajed, Y. Sekine, T. Nakajima, M. Chiyo, A. Iyoda, et al.
EBUS using a new convex probe: a preliminary study on surgically resected specimens.
Oncol Rep, 11 (2004), pp. 293-296
[21.]
G. Silvestri, M. Gould, M. Margolis, L. Tanoue, D. McCrory, E. Toloza, et al.
Noninvasive staging of non-small cell lung cancer: ACCP evidenced-based clinical practice guidelines (2nd edition).
Chest, 132 (2007), pp. 178-201
[22.]
N. Al-Sarraf, R. Aziz, K. Gately, J. Lucey, L. Wilson, E. McGovern, et al.
Pattern and predictors of occult mediastinal lymph node involvement in non-small cell lung cancer patients with negative mediastinal uptake on positron emission tomography.
Eur J Cardiothorac Surg, 33 (2008), pp. 104-109
[23.]
F. Detterbeck, M. Jantz, M. Wallace, J. Vansteenkiste, G. Silvestri.
Invasive mediastinal staging of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition).
Chest, 132 (2007), pp. 202-220
[24.]
C. Micames, D. McCrory, D. Pavey, P. Jowell, F. Gress.
Endoscopic ultrasoundguided fine-needle aspiration for non-small cell lung cancer staging: a systematic review and metaanalysis.
Chest, 131 (2007), pp. 539-548
[25.]
F. Gress, T. Savides, A. Sandler, K. Kesler, D. Conces, O. Cummings, et al.
Endoscopic ultrasonography, fine-needle aspiration biopsy guided by endoscopic ultrasonography, and computed tomography in the preoperative staging of non-small-cell lung cancer: a comparison study.
Ann Intern Med, 127 (1997), pp. 604-612
[26.]
D. Williams, A. Sahai, L. Aabakken, I. Penman, A. Van Velse, J. Webb, et al.
Endoscopic ultrasound guided fine needle aspiration biopsy: a large single centre experience.
Gut, 44 (1999), pp. 720-726
[27.]
M. Wallace, G. Silvestri, A. Sahai, R. Hawes, B. Hoffman, V. Durkalski, et al.
Endoscopic ultrasound-guided fine needle aspiration for staging patients with carcinoma of the lung.
Ann Thorac Surg, 72 (2001), pp. 1861-1867
[28.]
S. Larsen, M. Krasnik, P. Vilmann, G. Jacobsen, J. Pedersen, P. Faurschou, et al.
Endoscopic ultrasound guided biopsy of mediastinal lesions has a major impact on patient management.
Thorax, 57 (2002), pp. 98-103
[29.]
T. Savides, A. Perricone.
Impact of EUS-guided FNA of enlarged mediastinal lymph nodes on subsequent thoracic surgery rates.
Gastrointest Endosc, 60 (2004), pp. 340-346
[30.]
G. Caddy, M. Conron, G. Wright, P. Desmond, D. Hart, R. Chen.
The accuracy of EUS-FNA in assessing mediastinal lymphadenopathy and staging patients with NSCLC.
Eur Respir J, 25 (2005), pp. 410-415
[31.]
J. Annema, M. Versteegh, M. Veseliç, P. Voigt, K. Rabe.
Endoscopic ultrasoundguided fine-needle aspiration in the diagnosis and staging of lung cancer and its impact on surgical staging.
J Clin Oncol, 23 (2005), pp. 8357-8361
[32.]
A. Fritscher-Ravens, K. Bohuslavizki, L. Brandt, C. Bobrowski, C. Lund, W. Knöfel, et al.
Mediastinal lymph node involvement in potentially resectable lung cancer: comparison of CT, positron emission tomography, and endoscopic ultrasonography with and without fine-needle aspiration.
Chest, 123 (2003), pp. 442-451
[33.]
M. Wallace, J. Ravenel, M. Block, M. Fraig, G. Silvestri, S. Wildi, et al.
Endoscopic ultrasound in lung cancer patients with a normal mediastinum on computed tomography.
Ann Thorac Surg, 77 (2004), pp. 1763-1768
[34.]
J. LeBlanc, B. Devereaux, T. Imperiale, K. Kesler, J. DeWitt, O. Cummings, et al.
Endoscopic ultrasound in non-small cell lung cancer and negative mediastinum on computed tomography.
Am J Respir Crit Care Med, 171 (2005), pp. 177-182
[35.]
S. Smulders, F. Smeenk, M. Janssen-Heijnen, P. Wielders, D. De Munck, P. Postmus.
Surgical mediastinal staging in daily practice.
Lung Cancer, 47 (2005), pp. 243-251
[36.]
V. Rusch.
Mediastinoscopy: an endangered species?.
J Clin Oncol, 23 (2005), pp. 8283-8285
[37.]
S. Larsen, P. Vilmann, M. Krasnik, A. Dirksen, P. Clementsen, B. Skov, et al.
Endoscopic ultrasound guided biopsy versus mediastinoscopy for analysis of paratracheal and subcarinal lymph nodes in lung cancer staging.
Lung Cancer, 48 (2005), pp. 85-92
[38.]
M. Eloubeidi, A. Tamhane, V. Chen, R. Cerfolio.
Endoscopic ultrasound-guided fine-needle aspiration in patients with non-small cell lung cancer and prior negative mediastinoscopy.
Ann Thorac Surg, 80 (2005), pp. 1231-1239
[39.]
M.T. Soria, A. Ginés, J. Belda, M. Solé, M. Pellisé, J.M. Bordas.
Utilidad de la punción aspirativa con aguja fina guiada por ultrasonografía endoscópica (USE-PAAF) en el diagnóstico de extensión del cáncer de pulmón de células no pequeñas.
Arch Bronconeumol, 38 (2002), pp. 536-541
[40.]
R. Cerfolio, A. Bryant, M. Eloubeidi.
Accessing the aortopulmonary window (#5) and the paraaortic (#6) lymph nodes in patients with non-small cell lung cancer.
Ann Thorac Surg, 84 (2007), pp. 940-945
[41.]
H. Kramer, J. Van Putten, W. Post, H. Van Dullemen, A. Bongaerts, J. Pruim, et al.
Oesophageal endoscopic ultrasound with fine needle aspiration improves and simplifies the staging of lung cancer.
Thorax, 59 (2004), pp. 596-601
[42.]
J. DeWitt, M. Alsatie, J. LeBlanc, L. McHenry, S. Sherman.
Endoscopic ultrasoundguided fine-needle aspiration of left adrenal gland masses.
Endoscopy, 39 (2007), pp. 65-71
[43.]
R. Cerfolio, A. Bryant, B. Ojha.
Restaging patients with N2 (stage IIIa) nonsmall cell lung cancer after neoadjuvant chemoradiotherapy: a prospective study.
J Thorac Cardiovasc Surg, 131 (2006), pp. 1229-1235
[44.]
T. Hurter, P. Hanrath.
Endobronchial sonography: feasibility and preliminary results.
Thorax, 47 (1992), pp. 565-567
[45.]
K. Yasufuku, T. Nakajima, M. Chiyo, Y. Sekine, K. Shibuya, T. Fujisawa.
Endobronchial ultrasonography: current status and future directions.
J Thorac Oncol, 2 (2007), pp. 970-979
[46.]
A. Ernst, G. Silvestri, D. Johnstone.
Interventional pulmonary procedures: Guidelines from the American College of Chest Physicians.
Chest, 123 (2003), pp. 1693-1717
[47.]
K. Yasufuku, M. Chiyo, Y. Sekine, P. Chhajed, K. Shibuya, T. Iizasa, et al.
Realtime endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal and hilar lymph nodes.
Chest, 126 (2004), pp. 122-128
[48.]
K. Yasufuku, M. Chiyo, E. Koh, Y. Moriya, A. Iyoda, Y. Sekine, et al.
Endobronchial ultrasound guided transbronchial needle aspiration for staging of lung cancer.
Lung Cancer, 50 (2005), pp. 347-354
[49.]
F. Herth, R. Eberhardt, P. Vilmann, M. Krasnik, A. Ernst.
Real-time endobronchial ultrasound guided transbronchial needle aspiration for sampling mediastinal lymph nodes.
Thorax, 61 (2006), pp. 795-798
[50.]
F. Herth, A. Ernst, R. Eberhardt, P. Vilmann, H. Dienemann, M. Krasnik.
Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically normal mediastinum.
Eur Respir J, 28 (2006), pp. 910-914
[51.]
F. Herth, R. Eberhardt, M. Krasnik, A. Ernst.
Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically and PET normal mediastinum in patients with lung cancer.
Chest, 133 (2008), pp. 887-891
[52.]
F. Sheski, P. Mathur.
Endobronchial ultrasound.
Chest, 133 (2008), pp. 264-270
[53.]
R. Kaplan, D. Robbins, J. Romagnuolo, R. Hawes, B. Hoffman.
The use of a linear ultrasound bronchoscope for transesophageal staging of lung and esophageal cancers [resumen].
Gastrointestinal Endoscopy, 63 (2006), pp. AB265
[54.]
M. Wallace, J. Pascual, M. Raimondo, T. Woodward, B. McComb, J. Crook, et al.
Minimally invasive endoscopic staging of suspected lung cancer.
JAMA, 299 (2008), pp. 540-546
[55.]
R. Rintoul, K. Skwarski, J. Murchison, W. Wallace, W. Walker, I. Penman.
Endobronchial and endoscopic ultrasound-guided real-time fine-needle aspiration for mediastinal staging.
Eur Respir J, 25 (2005), pp. 416-421
[56.]
F. Herth, W. Lunn, R. Eberhardt, H. Becker, A. Ernst.
Transbronchial versus transesophageal ultrasound-guided aspiration of enlarged mediastinal lymph nodes.
Am J Respir Crit Care Med, 171 (2005), pp. 1164-1167
[57.]
P. Goldstraw, J. Crowley, K. Chansky, D. Giroux, P. Groome, R. Rami-Porta, et al.
The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours.
J Thorac Oncol, 2 (2007), pp. 706-714
[58.]
G. Silvestri.
A seismic shift in staging.
J Thorac Oncol, 2 (2007), pp. 682-683
[59.]
L. Hernández, J. Geenen, M. Schmalz, M. Catalano.
The underutilization of EUSguided FNA in the lymph-node staging of non-small-cell lung cancer: perceptions of chest physicians in Wisconsin.
Gastrointest Endosc, 62 (2005), pp. 517-520
[60.]
P. Walsh, D. Williams.
Mediastinal adenopathy: finding the answer with endoscopic ultrasound-guided fine-needle aspiration biopsy.
Intern Med J, 35 (2005), pp. 392-398
[61.]
J. Annema, K. Rabe.
State of the art lecture: EUS and EBUS in pulmonary medicine.
Endoscopy, 38 (2006), pp. 118-122
[62.]
S. Janes, S. Spiro.
Esophageal endoscopic ultrasound/endobronchial ultrasound-guided fine needle aspiration: a new dawn for the respiratory physician?.
Am J Respir Crit Care Med, 175 (2007), pp. 297-299
[63.]
J. Annema, K. Rabe.
Why respiratory physicians should learn and implement EUS-FNA.
Am J Respir Crit Care Med, 176 (2007), pp. 99
[64.]
B. Hoffman, A. Chong, S. Faias.
A combined training program in EUS-FNA and bronchoscopic ultrasound-guided FNA for evaluation of the mediastinum [resumen].
Gastrointest Endosc, 61 (2005), pp. AB282
Copyright © 2009. Sociedad Española de Neumología y Cirugía Torácica
