reflection objectives: To determine the exhibition performance characteristics of transbronchial needle aspiration (TBNA).

reflection objectives: To determine the exhibition performance characteristics of transbronchial needle aspiration (TBNA), transthoracic needle aspiration (TRNA), endoscopic ultrasound-guided needle aspiration (EUS-NA), and mediastinoscopy in staging non-small enclosed space lung cancer (NSCLC). Design, setting, and participants: Systematic search of MEDLINE, HealthStar, and Cochrane Library databases to July 2001 and print bibliographies. Included were studies comparing staging comes of TBNA, TTNA, EUS-NA, or mediastinoscopy against either tissue histologic confirmation or long-term clinical follow-up ([greater than or equal to] 1 year). Patients included were those with NSCLC or small solitary abode; squalid lung cancer.

Measurement and results: For patients with lung cancer, the pond ed sensitivity for TBNA was 076 the plashed specificity was 0.96, and the negative predictive value (NPV) was 071 For TTNA, the plashed sensitivity was 0.91, with an NPV of 078 EUS-NA had a loched sensitivity of 0.88, a pond ed specificity of 0.91, and an NPV of 077 For standard cervical mediastinoscopy, the plashed sensitivity was 0.81, with an NPV of 091 The addition of either fill outed cervical mediastinoscopy or anterior mediastinotomy to standard cervical mediastinoscopy appeared to improve the sensitivity of any of the courses alone.

Conclusions: Invasive clinical staging of NSCLC can be performed effectively by way of TBNA, TTNA, EUS-NA, or mediastinoscopy. Selection of the appropriate application of mind is dependent on the quality of suspicion for metastatic disease, the patient's comorbid illnesses, and the availability and performance characteristics of procedural options.

lock opener words: biopsy needle; false-negative rates; lung neoplasm; lymphatic metastasis; mediastinoscopy; predictive value of tests; sensitivity and specificity

Abbreviations: CI = confidence interval; EUS-NA = endoscopic ultrasound-guided needle aspiration; NPV = negative predictive value; NSCLC = non-small solitary abode; squalid lung cancer; PPV= positive predictive value; SCLC = small small cavity lung cancer; TBNA = transbronchial needle aspiration; TTNA = transthoracic needle aspiration

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The primary aim of intrathoracic staging in nonsmall small cavity lung cancer (NSCLC) is the evaluation of mediastinal lymph node involvement. Accurate assessment of mediastinal lymph node status affects a patient's prognosis and treatment plan, as the appearance of mediastinal lymph node involvement indicates the port of stage IIIA or IIIB lung cancer. This put in mind ofs either inoperability and/or the ne for treatment by way of chemotherapy and/or radio therapy. newly induction therapy followed by surgery has been indicateed for stage IIIA NSCLC. (1-3) Since mediastinal lymph node involvement is set in 30 to 44% of patients with newly diagnosed lung cancer, testing is required to empire in or rule out as it was disease.

Noninvasive techniques to evaluate mediastinal nodes rely onward either lymph node size (CT endoscopic ultrasound) or metabolism (positron emission tomography) to expose cancerous involvement. However, while noninvasive ordeals can identify nodes suspicious for cancer, they do not provide definitive tissue diagnosis and many times are not sufficient for initiation of nonsurgical treatment. Thus, invasive examples are often required to further evaluate nonresectability.

Invasive techniques utilize needle biopsy or surgical spread biopsy to obtain tissue samples to confirm the diagnosis of metastatic disease. Needle biopsy techniques include transbronchial needle aspiration (TBNA), transthoracic needle aspiration (TRNA), and endoscopic ultrasound-gnided needle aspiration (EUS-NA). Surgical explain biopsy can be performed through standard cervical mediastinoscopy, extended cervical mediastinoscopy, or anterior mediastinotomy.

TBNA is performed with the aid of bronchoscopy A needle catheter is passed end the working channel of the bronchoscope and guided to the area of the tracheobronchial tree overlying the mediastinal lymph node of interest. The needle catheter, which arises in varying gauges, is then advanced within the tracheal or carinal wall into the mediastinal lymph node, and an aspiration biopsy obtained. Larger-gauge needle may be used in an attempt to obtain a "core" of tissue for histologic examination. Several passes may be performed until an adequate specimen is obtained. Bedside or on-site cytopathologic examination of needle aspiration specimens may improve the yield of TBNA, as the rapid evaluation of gathered specimens would give the interventionalist feedback as to the ne for further aspirations. This technique is limited by means of being a blind biopsy and at the difficulty of sampling more than a small in number nodal stations. Guidance by emerging imaging techniques, like as real-time CT-fluoroscopy, endobronchial ultrasound, and virtual bronchoscopy (using three-dimensional images rebuilded from routine helical CT scans), may improve the yield of TBNA and are in subordination to investigation. The main complications of TBNA include those inherent to bronchoscopy like as laryngospasm, and those specific to the biopsy, similar as endobronchial bleeding.

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