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Multidisciplinary approach to thoracic tissue sampling.

Quint LE - Cancer Imaging (2010)

Bottom Line: When choosing the best method to undertake a biopsy of a lesion in the lung or mediastinum, it is important to consider the entire range of possible options, such as surgical, bronchoscopic/endoscopic, and radiologic techniques.Features to be considered include the anatomic location of the lesion, the amount of tissue needed, cost, availability of specific techniques, safety and risks, and expected diagnostic yield/accuracy.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, University of Michigan Health System, Ann Arbor, MI 48109, USA.

ABSTRACT
When choosing the best method to undertake a biopsy of a lesion in the lung or mediastinum, it is important to consider the entire range of possible options, such as surgical, bronchoscopic/endoscopic, and radiologic techniques. Features to be considered include the anatomic location of the lesion, the amount of tissue needed, cost, availability of specific techniques, safety and risks, and expected diagnostic yield/accuracy.

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Related in: MedlinePlus

A 64-year-old man with a left upper lobe mass (arrow, a) and a tiny right paratracheal lymph node (arrow, b) at CT. Both lesions were fluorodeoxyglucose (FDG)-avid at positron emission tomography (PET)/CT (arrows, c,d). TBNA of the lymph node was performed with EBUS guidance (e); the green dot indicates the location where the needle emerges from the bronchoscope. Cytologic analysis revealed non-small cell lung cancer, consistent with unresectable, stage N3 disease. (Figure 2e is courtesy of Douglas Arenberg, MD.)
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Figure 2: A 64-year-old man with a left upper lobe mass (arrow, a) and a tiny right paratracheal lymph node (arrow, b) at CT. Both lesions were fluorodeoxyglucose (FDG)-avid at positron emission tomography (PET)/CT (arrows, c,d). TBNA of the lymph node was performed with EBUS guidance (e); the green dot indicates the location where the needle emerges from the bronchoscope. Cytologic analysis revealed non-small cell lung cancer, consistent with unresectable, stage N3 disease. (Figure 2e is courtesy of Douglas Arenberg, MD.)

Mentions: Mediastinal lymph nodes may be sampled using TBNA; this is sometimes called a Wang needle biopsy. With this procedure, a needle is passed through the wall of the central airway into the adjacent lymph node. For lymph nodes touching or nearly touching the outer airway wall, the biopsy can be done blindly, i.e. using only internal airway anatomic landmarks for guidance. This technique is commonly performed for bulky subcarinal and lower paratracheal lymph nodes, usually yielding a cytological specimen, and with sensitivity and NPV approaching ∼75%. For lesions that do not touch the outer wall of the airway and/or are not bulky, EBUS may facilitate TBNA by providing real-time ultrasound guidance during needle insertion; accessible lymph node regions include the upper and lower paratracheal, subcarinal and hilar stations[6]. Successful sampling of small lymph nodes may be accomplished using TBNA with EBUS, and sensitivity and NPV approach approximately 88% (Fig. 2)[7]. Advantages of TBNA with EBUS over mediastinoscopy include: the ability to restage the mediastinum after previous chemoradiotherapy or previous mediastinoscopy (with mediastinal adhesions); the ability to reach posterior subcarinal lymph nodes and hilar lymph nodes; decreased morbidity due to the use of sedation rather than general anesthesia; and substantially lower costs (see charges for bronchoscopic lung biopsy techniques, above).Figure 2


Multidisciplinary approach to thoracic tissue sampling.

Quint LE - Cancer Imaging (2010)

A 64-year-old man with a left upper lobe mass (arrow, a) and a tiny right paratracheal lymph node (arrow, b) at CT. Both lesions were fluorodeoxyglucose (FDG)-avid at positron emission tomography (PET)/CT (arrows, c,d). TBNA of the lymph node was performed with EBUS guidance (e); the green dot indicates the location where the needle emerges from the bronchoscope. Cytologic analysis revealed non-small cell lung cancer, consistent with unresectable, stage N3 disease. (Figure 2e is courtesy of Douglas Arenberg, MD.)
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2967143&req=5

Figure 2: A 64-year-old man with a left upper lobe mass (arrow, a) and a tiny right paratracheal lymph node (arrow, b) at CT. Both lesions were fluorodeoxyglucose (FDG)-avid at positron emission tomography (PET)/CT (arrows, c,d). TBNA of the lymph node was performed with EBUS guidance (e); the green dot indicates the location where the needle emerges from the bronchoscope. Cytologic analysis revealed non-small cell lung cancer, consistent with unresectable, stage N3 disease. (Figure 2e is courtesy of Douglas Arenberg, MD.)
Mentions: Mediastinal lymph nodes may be sampled using TBNA; this is sometimes called a Wang needle biopsy. With this procedure, a needle is passed through the wall of the central airway into the adjacent lymph node. For lymph nodes touching or nearly touching the outer airway wall, the biopsy can be done blindly, i.e. using only internal airway anatomic landmarks for guidance. This technique is commonly performed for bulky subcarinal and lower paratracheal lymph nodes, usually yielding a cytological specimen, and with sensitivity and NPV approaching ∼75%. For lesions that do not touch the outer wall of the airway and/or are not bulky, EBUS may facilitate TBNA by providing real-time ultrasound guidance during needle insertion; accessible lymph node regions include the upper and lower paratracheal, subcarinal and hilar stations[6]. Successful sampling of small lymph nodes may be accomplished using TBNA with EBUS, and sensitivity and NPV approach approximately 88% (Fig. 2)[7]. Advantages of TBNA with EBUS over mediastinoscopy include: the ability to restage the mediastinum after previous chemoradiotherapy or previous mediastinoscopy (with mediastinal adhesions); the ability to reach posterior subcarinal lymph nodes and hilar lymph nodes; decreased morbidity due to the use of sedation rather than general anesthesia; and substantially lower costs (see charges for bronchoscopic lung biopsy techniques, above).Figure 2

Bottom Line: When choosing the best method to undertake a biopsy of a lesion in the lung or mediastinum, it is important to consider the entire range of possible options, such as surgical, bronchoscopic/endoscopic, and radiologic techniques.Features to be considered include the anatomic location of the lesion, the amount of tissue needed, cost, availability of specific techniques, safety and risks, and expected diagnostic yield/accuracy.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, University of Michigan Health System, Ann Arbor, MI 48109, USA.

ABSTRACT
When choosing the best method to undertake a biopsy of a lesion in the lung or mediastinum, it is important to consider the entire range of possible options, such as surgical, bronchoscopic/endoscopic, and radiologic techniques. Features to be considered include the anatomic location of the lesion, the amount of tissue needed, cost, availability of specific techniques, safety and risks, and expected diagnostic yield/accuracy.

Show MeSH
Related in: MedlinePlus