Jean Faber

Endobronchial ultrasound and value of PET for prediction of pathological results of mediastinal hot spots in lung cancer patients

SUMMARY In the staging of lung cancer with positron emission tomography (PET) positive mediastinal lymph nodes, tissue sampling is required. The performance of transbronchial needle aspiration (TBNA) using linear endobronchial ultrasound (real-time EBUS-TBNA) under local anaesthesia and the value of PET for prediction of pathological results were assessed in that setting. The number of eluded surgical procedures was evaluated. All consecutive patients with suspected/proven lung cancers and FDG-PET positive mediastinal adenopathy were included. If no diagnosis was reached, further surgical sampling was required. Lymph node SUVmax (maximum standardized uptake value) was assessed in patients whose PET was performed in the leading centre. One hundred and six patients were included. The average number of TBNA samples per patient was 4.9+/-1.1. The prevalence of lymph node metastasis was 58%. Sensitivity, accuracy and negative predictive value of EBUS-TBNA in the staging of mediastinal hot spots were 95, 97 and 91%. Patients without malignant lymph node involvement showed lower SUVmax (respective median values of 3.7 and 10.0; p<0.0001). Surgical procedures were eluded in 56% of the patients. Real-time EBUS-TBNA should be preferred over mediastinoscopy as the first step procedure in the staging of PET mediastinal hot spots in lung cancer patients. In case of negative EBUS, surgical staging procedure should be undertaken. The addition of SUVmax cut-off may allow further refinement but needs validation.

Endobronchial ultrasound and positron emission tomography positive mediastinal lymph nodes

Positron emission tomography with 18F-fluoro-2-deoxy-d-glucose (FDG-PET) is more accurate than computed tomography for staging of mediastinal (hilar) lymph nodes. In the case of positive findings, tissue sampling of lymph nodes is required. The diagnostic/staging yield of transbronchial needle aspiration (TBNA) following endobronchial ultrasound (EBUS) localisation was assessed in this particular clinical setting. The number of avoided surgical procedures was evaluated. All consecutive patients referred for staging and/or diagnosis of mediastinal FDG-PET positive lesions were included. Data were prospectively collected. TBNA sampling of lymph nodes was performed after EBUS localisation. If no diagnosis was reached, further surgical sampling or adequate follow-up was performed. From January 2003 to June 2004, 33 patients were included. The average number of TBNA samples per patient was 4.2±1.5. Cytological or histological diagnoses were obtained in 27 (82%) of the patients, of which 78% were obtained after previous EBUS localisation. In 25 (76%) of the 33 patients, surgical staging procedures were suppressed. In conclusion, transbronchial needle aspiration after endobronchial ultrasound localisation should be considered as a primary method of evaluation of lymph nodes positive by positron emission tomography with 18F-fluoro-2-deoxy-d-glucose, and may replace the majority of surgical mediastinal staging/diagnostic procedures.

Échographie endobronchique et ganglions TEP positives dans le cancer broncho-pulmonaire

INTRODUCTION In bronchial carcinoma when positron emission tomography with 18-fluorodeoxyglucose (FDG-PET) shows increased emission in the mediastinal lymph nodes, confirmation by tissue biopsy is necessary. In this particular situation we have evaluated the use of real time lymph node aspiration under endobronchial ultrasound control. METHODS Consecutive patients referred for staging and/or diagnosis of PET positive mediastinal nodes in the setting of suspected or confirmed bronchial carcinoma were included. The results of lymph node aspiration, performed under local anaesthesia in out-patients, were collected and if non-diagnostic surgical exploration was performed. RESULTS 20 patients were studied between December 2004 and September 2005. The average number of ultrasound guided needle aspirations per patient was 4.8 +/- 1.2. Cytological or histological confirmation of malignancy was obtained by needle biopsy in 12 patients. The 8 negative cases were confirmed by surgical biopsy. In this preliminary series the sensitivity, specificity and negative predictive value of ultrasound guided aspiration of PET positive nodes was 100%. CONCLUSION Endobronchial ultrasound with needle aspiration should be considered a primary method of investigation of PET positive mediastinal lymph nodes.Resume Introduction Dans le cancer broncho-pulmonaire, lorsque la tomographie en emission de positons au 18-fluorodesoxyglucose (TEP-FDG) montre une captation accrue au niveau ganglionnaire mediastinal, une confirmation par un prelevement tissulaire est necessaire. Nous avons evalue dans cette presentation particuliere la ponction ganglionnaire sous controle echographique endobronchique en temps reel. Methodes Les patients adresses consecutivement pour le bilan et/ou le diagnostic de ganglions TEP positifs dans le cadre d’un cancer broncho-pulmonaire suspecte ou confirme ont ete inclus. Les resultats des ponctions des ganglions, realisees sous anesthesie locale, en ambulatoire, ont ete collectes et en l’absence de diagnostic, une exploration chirurgicale etait requise. Resultats Entre decembre 2004 et septembre 2005, 20 patients ont ete inclus. Le nombre moyen de ponctions ganglionnaires sous controle echographique par patient etait de 4,8 =/- 1,2. Chez 12 patients, la confirmation cytologique ou histologique d’atteinte neoplasique etait obtenue par l’aiguille. Les 8 observations negatives etaient confirmees par l’exploration chirurgicale. Dans cette serie preliminaire, la sensibilite, specificite et valeur predictive negative de la ponction echo-guidee des ganglions TEP positifs etaient de 100 %, 100 % et 100 %. Conclusions L’echographie endobronchique avec ponction doit etre consideree comme une technique primaire d’exploration des ganglions TEP positifs.

Fluorescence bronchoscopy in high-risk patients: A comparison of LIFE and Pentax systems

Abstract:Autofluorescence bronchoscopy (AB) enhances the bronchoscopists ability to detect bronchial preneoplastic lesions and early lung cancers. We undertook a study to compare the worldwide distributed lung imaging fluorescence endoscope system (LIFE; Xillix Technologies Corporation, Richmond, B