Role of endoscopic fine needle aspiration in morphological verification
of lung cancer
Abstract The lung cancer verificarion is still an important issue. Endosonography from upper GI tract with fine needle (EUS-FNA) is a method which can be used for controlled tissue sampling from primary tumor for morphological study in patients with central lung cancer in case of diagnostic dilemmas as well from locoregionsl and distant metastasis if endosonographic visualization is possible.
Aim. To determine the role of EUS-FNA in the algorithm of lung cancer differential diagnosis between primary and metastatic lesions and compare effectiveness of EUS-FNA with other minimaly invasive methods of biopsy.Designs and methods. 89 patients in whom EUS-FNA was performed for morphological verification of lung cancer from 2011 till 2013 years were enrolled in the study. All patients had either confirmed or suspected mediastinum or upper abdomen lymphadenopathy, presumably distant metastasis. In 46 patients the procedure was used for staging in cases where earlier succseful or unsuccessful attempts of diagnosis verifications with other methods.
Results. In 79 (88.8%) out of 89 patients EUS-FNA was successful in morphological verification of lung cancer in comparison with 67.3% in bronchoscopy group, 62.5% with transbronchial biopsy under ultrusonography, 48.3% with percuteneous biopsy under x-ray methods of visualization and 26% in bronchoalveolar lavage group. No complications with EUS-FNA was observed neither during the procedure or during observation was noted.
Conclusion. EUS-FNA is highly efficient method of obtaining biopsy sample for morphological verification of the diagnosis as well as safe well-tolerated which can be recommended in clinic without need for hospitalization.
Keywords:endoscopic ultrasonography, fine- needle aspiration, morphological verification, lung cancer
Clin. Experiment. Surg. Petrovsky J. 2015. № 4. Р. 63–72.
References
1. Davydov M.I., Acksel E.M. The incedence of oncological diseases in Russia and CIS in 2012. Moscow : Izdatel'skaya gruppa RONTs, 2014: 226 р. (in Russian).
2. Chansky K., Sculier J.P., Crowley J.J. et al. The International Association for the Study of Lung Cancer Staging Project: prognostic factors and pathologic TNM stage in surgically managed non-small cell lung cancer // J. Thorac. Oncol. 2009. Vol. 4. P. 792–801.
3. Howlader N., Noone A.M., Krapcho M. et al. (eds). SEER Cancer Statistics Review, 1975–2008, National Cancer Institute. Bethesda, MD, 2011.
4. Pfister D.G., Johnson D.H., Azzoli C.G. et al. American Society of Clinical Oncology. Treatment of unresectable non-small cell lung cancer guideline: update 2003. J Clin Oncol. 2004; Vol. 22: 330–5310.
5. Annema J.T., Versteegh M.I., Veselic M., еt al. Endoscopic ultrasound-guided fine-needle aspiration in the diagnosis and staging of lung cancer and its impact on surgical staging. J Clin Oncol. 2005; Vol. 23: 8357–61.
6. Oliver T.W. Jr, Bernardino M.E., Miller J.I., et al. Isolated adrenal masses in non-small cell bronchogenic carcinoma. Radiology. 1984; Vol. 153: 217–8.
7. Burdyukov M.S., Nechipay A.M., Jurichev A.N., et al. Guidelines for the implementation of endoscopic ultrasonography from the lumen of the upper gastrointestinal tract mode Convex scan and fine needle puncture under its control. Klinicheskaya endoskopiya [Clinical Endoscopy]. 2012; Vol. 4. (36): 2–27. (in Russian)
8. Colella S., Vilman P., Konge L., Clementsen P.F. Endoscopic ultrasound in the diagnosis and staging of lung cancer. Endosc Ul- trasound. 2014; Vol. 3 (4): 205–12.
9. Silvestri G.A., Gonzalez A.V., Jantz M.A., et al. Methods for staging nonsmall cell lung Cancer: Diagnosis and management of lung cancer. 3rd ed. American College of Chest Physicians evidence-based clinical practiceguidelines. Chest. 2013; Vol. 143: e211S–e50S.
10. Mazzone P., Jain P., Arroliga A.C., Matthay R.A. Bronchoscopy and needle biopsy techniques for diagnosis and staging of lung cancer. Clin Chest Med. 2002; Vol. 23 (1): 137–58.
11. Rivera M.P., Mehta A.C. Initial diagnosis of lung cancer: ACCP evidence-based clinical practice guidelines. 2nd ed. American College of Chest Physicians. Chest. 2007; Vol. 132 (3). Suppl.: 131S–48S.
12. Binesh F., Pirdehghan A., Mirjalili M.R., et al. Comparative assessment of the diagnostic value of transbronchial lung biopsy and bronchoalveolar lavage fluid cytology in lung cancer. Asian Pac J Cancer Prev. 2015; Vol. 16 (1): 201–4.
13. Soja J., Szlubowski A., Wasowski D., Kuzdzal J., et al. Transbronchial needle aspiration as a diagnostic method of mediastinal adenopathy. Przegl Lek. 2005; Vol. 62 (2): 102–4.
14. Kurimoto N., Nakamura H., Miyazawa T. Overview of endobronchial ultrasonography in chest medicine // J. Med. Ultrasound. 2009. Vol. 17. P. 31–43.
15. Annema J.T., van Meerbeeck J.P., Rintoul R.C., et. al. Mediastinoscopy vs endosonography for mediastinal nodal staging of lung cancer: a randomized trial // JAMA. 2010 Nov 24. Vol. 304, N 20. P. 2245–2252.
16. Roberts M.E., Neville E., Berrisford R.G., Antunes G. et al. Management of a malignant pleural effusion: British Thoracic Society Pleural Disease Guideline 2010. BTS Pleural Disease Guideline Group. Thorax. 2010; Vol. 65, suppl. 2: ii32–ii40.
17. Menzies R., Charbonneau M. Thoracoscopy for the diagnosis of pleural disease. Ann Intern Med. 1991; Vol. 114, N 4: 271–6.
18. Boutin C., Viallat J.R., Cargnino P., Farisse P. Thoracoscopy in malignant pleural effusions. Am Rev Respir Dis. 1981; Vol. 124 (5): 588–92.
19. Herth F.J. Nonsurgical staging of the mediastinum: EBUS and EUS. Semin Respir Crit Care Med. 2011; Vol. 32 (1): 62–8.
20. Lemaire A., Nikolic I., Petersen T., et al. Nine-year single center experience with cervical mediastinoscopy: complications and false negative rate. Ann Thorac Surg. 2006; Vol. 82 (4): 1185–9; dis- cussion 1189–90.
21. Schreiber G., McCrory D.C. Performance characteristics of different modalities for diagnosis of suspected lung cancer: summary of published evidence. Chest. 2003; Vol. 123 (1). Suppl: 115S–28S.
22. Tomiyama N., Yasuhara Y., Nakajima Y. et al. CT-guided needle biopsy of lung lesions: a survey of severe complication based on 9783 biopsies in Japan. Eur J Radiol; 2006; Vol. 59 (1): 60–4.
23. Bolliger C.T., Mathur P.N., Beamis J.F., et al. European Respiratory Society/American Thoracic Society ERS/ATS statement on interventional pulmonology. European Respiratory Society/American Thoracic Society. Eur Respir J. 2002; Vol. 19 (2): 356–73.
24. Beslic S., Zukic F., Milisic S. Percutaneous transthoracic CT guided biopsies of lung lesions; fine needle aspiration biopsy versus core biopsy. Radiol Oncol. 2012; Vol. 46 (1): 19–22.
25. Sears D., Hajdu S.I. The cytologic diagnosis of malignant neoplasms in pleural and peritoneal effusions. Acta Cytol. 1987; Vol. 31 (2): 85–97.
26. Billah S., Stewart J., Staerkel G. et al. EGFR and KRAS mutations in lung carcinoma: molecular testing by using cytology specimens // Cancer Cytopathol. 2011. Vol. 119, N 2. P. 111-117.