Promising Results for Minimally Invasive Lung Biopsies

A new study suggests that endobronchial and transesophageal endoscopic ultrasound-guided fine-needle aspiration are more sensitive than the more traditional transbronchial needle aspiration.

Researchers at The Mayo Clinic (Jacksonville, FL, USA) hypothesized that not only would the combination of ultrasound-guided endobronchial and transesophageal biopsy procedures be more accurate than transbronchial needle aspiration, but that they would provide complementary and complete staging of the mediastinum, thus eliminating blind spots and achieving near-complete minimally invasive mediastinal staging in patients with suspected lung cancer. The researchers then proceeded to test this assumption by examining 138 patients with suspected lung cancer who met all study criteria.

The researchers found that of the 138 patients with suspected lung cancer in the study, 42 (30%) had malignant lymph nodes. The researchers found that the even the endobronchial procedure alone was more sensitive, detecting 69% of malignant lymph nodes, compared to only 36% detected with blind transbronchial needle aspiration. The combination of the endobronchial and transesophageal procedures also had higher estimated sensitivity and negative predictive value than either method alone. The two procedures also had higher sensitivity and higher negative predictive value for detecting lymph nodes in any mediastinal location and for patients without lymph-node enlargement on chest computerized tomography (CT). The study was published in the February 6, 2008, issue of the Journal of the American Medical Association (JAMA).

"It is a disadvantage that patients require two procedures rather than just one,” said lead author Michael Wallace, M.D. "But we found that all of our 138 patients really benefited from both. Moving forward, it will be interesting to define which patients might be able to have just one procedure.”

Mediastinoscopy (examination of the chest cavity using a lighted tube inserted under the sternum) is considered the current diagnostic standard, however, less invasive methods have emerged as potential alternatives. The researchers pointed out that if mediastinoscopy had been performed only when results from the endobronchial and transesophageal procedures were negative, this surgical procedure would have been avoided in 28% of patients in the study. If the procedures had been used to completely replace mediastinoscopy in all patients, 97% would have been correctly labeled as negative.


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