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Ann Thorac Surg 2009;87:373-378. doi:10.1016/j.athoracsur.2008.10.081
© 2009 The Society of Thoracic Surgeons
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Giulio Melloni
Monica Casiraghi
Paola Ciriaco
Angelo Carretta
Lidia Libretti
Piero Zannini
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Right arrow Lung - cancer
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Original Articles: General Thoracic

Transbronchial Needle Aspiration in Lung Cancer Patients Suitable for Operation With Positive Mediastinal Positron Emission Tomography

Giulio Melloni, MD*, Monica Casiraghi, MD, Alessandro Bandiera, MD, Paola Ciriaco, MD, Angelo Carretta, MD, Lidia Libretti, MD, Piero Zannini, MD

Department of Thoracic Surgery, Scientific Institute H San Raffaele, Milan, Italy

Accepted for publication October 28, 2008.

* Address correspondence to Dr Melloni, Unità Operativa di Chirurgia Toracica Ospedale San Raffaele, Via Olgettina 60, Milan, 20132, Italy (Email: giulio.melloni{at}hsr.it).

Background: The objectives of this study were to analyze our experience with transbronchial needle aspiration as a minimally invasive procedure alternative to mediastinoscopy in the preoperative staging of non-small cell lung cancer patients with positive mediastinal positron emission tomography and to propose a staging algorithm that combines performance characteristics of these three methods.

Methods: Fifty-one patients staged N2 or N3 after positron emission tomography imaging underwent transbronchial needle aspiration.

Results: A malignant adenopathy was identified in 26 patients (51%) that were excluded from operation and referred for neoadjuvant chemotherapy or chemoradiotherapy according to the mediastinal status (N2 or N3), as determined on the positron emission tomography image. In the remaining 25 patients (49%), samples were considered adequate negative in 12 patients, inadequate in 11, or inconclusive in 2. These patients underwent mediastinoscopy. Mediastinoscopy showed N2 disease in 19 cases, and the patients received neoadjuvant chemotherapy. In the remaining 6 cases no mediastinal involvement was identified and patients underwent operation. Postoperatively, 5 patients were staged N0 and 1 was staged N2. For transbronchial needle aspiration, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 76%, 100%, 100%, 33%, and 79%, respectively.

Conclusions: Transbronchial needle aspiration avoided a mediastinoscopy in approximately half of lung cancer patients referred for operation with positive mediastinal positron emission tomography, sparing the associated costs and risks of more invasive surgical procedures. The minimally invasive mediastinal staging algorithm that we proposed seems to be efficacious and easily applicable in clinical practice.


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Invited Commentary
Frank Detterbeck
Ann. Thorac. Surg. 2009 87: 378. [Extract] [Full Text] [PDF]



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F. Detterbeck
Invited commentary.
Ann. Thorac. Surg., February 1, 2009; 87(2): 378 - 378.
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