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Angela Fiorella

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    P2.13 - Staging (ID 315)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Staging
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.13-12 - Endobronchial Ultrasound for Diagnosis and Staging of Lung Cancer: Our Experience (Now Available) (ID 2593)

      10:15 - 18:15  |  Author(s): Angela Fiorella

      • Abstract
      • Slides


      Surgical treatment of non-small cell lung cancer (NSCLC) can only be achieved in 20-25% of affected patients. Staging, deriving from the TNM classification, is the most relevant element for the selection of patients and N parameter is an essential prognostic factor. In recent years, in order to assess the N parameter with an endoscopic approach, ultrasound probes of small size have been assembled at the tip of the videobronchoscope (EBUS: Endobronchial Ultrasonography), allowing to perform real-time, ultrasound guided, transbronchial needle aspiration (TBNA) and/or transbronchial needle biopsies (TBNB) of hilar and mediastinal lymph nodes. This invasive examination of the tracheo-bronchial tree is nowadays of primary importance for the diagnosis and staging of lung cancer. We report our experience with this innovative endoscopic technique.


      We retrospectively analyzed data of patients submitted to EBUS-TBNA/TBNB at our Section of Thoracic Surgery, from September 2008 to December 2018, considering the following factors: gender, EBUS-TBNA/TBNB positivity/negativity, duration of the procedure, number of samples taken from each lymph node station, complications related to the procedure.


      EBUS was performed in 131 patients (95 men, 36 women) and repeated twice in 5/131 patients, for a total number of 136 EBUS procedures. Ultrasound evidence of lymph nodes was positive in 120/136 cases, in which TBNA/TBNB was performed, with the following cyto/histopathological results: positivity in 61 cases (51%), negativity in 23 cases (19%), inadequate material for diagnosis in 28 cases (23%), suspect/doubt in 6 cases (5%), no results in 2 cases (2%). Mean duration of the procedure was 30 minutes (range 15-60 minutes) and mean number of samples for each lymph node station was 3. No intra- or postprocedure complications were observed. Only 19 on 36 cases without diagnosis could undergo diagnostic surgery with the following results: 9 sarcoidosis, 6 lung cancer, 1 lymphoma, 1 epitelioid hemangioendotelioma, 1 paraganglioma, 1 antracosis.


      In our experience, EBUS-TBNA/TBNB resulted a safe and free from major complications procedure, easily repeatable, in a standardized way, after an adequate "learning curve" and it can avoid more invasive diagnostic technique such as mediastinoscopy. In fact, according to the current guidelines of the ESTS (European Society of Thoracic Surgeons) EBUS-TBNA should be used as the first diagnostic test in patients with hilar-mediastinal lymphadenopathy with or without the presence of a suspect lung mass, in order to obtain both staging and diagnosis.

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