20 maart 2017: lees ook dit artikel:

https://kanker-actueel.nl/NL/eenvoudige-bloedtest-biomarkertest-op-in-bloed-circulerende-tumorcellen-ziet-half-jaar-eerder-recidief-of-progressie-van-succesvol-behandelde-longkanker-dan-ct-scan-of-pet-scan.html

6 september 2005: Bron: JAMA. 2005 Aug 24;294(8):931-6 en Lung Cancer. 2005 May 27;

Enkele recente studies, waaronder een Nederlandse studie uit Leiden - LUMC bevestigen dat een toevoeging van EUS-FNA = endoscopic ultrasound-guided fine-needle aspiration ( = met een fijne naald onder begeleiding van computer uitgevoerde biopt) aan de diagnose van longkanker een heleboel onnodige longoperaties - tot 40% - kan worden voorkomen door vaststelling van wel of geen lymfklieruitzaaiïngen. Dit kan zowel van belang zijn in positieve zin als in negatieve zin. Want dit kan ook voor de patiënt betekenen dat omdat er uitzaaiïngen zijn in lymfklieren er geen operatie meer wordt uitgevoerd. Punt van verder onderzoek is dat de EUS-FNA methode nog een positief-negatieve misrekening maakt in 2% van de gevallen. Deze diagnsoe techniek voor lymfklieruitzaaiïngen kan ook worden toegepast bij bv. alvleesklierkanker en rectumkanker en darmkanker en leveruitzaaiingen stellen Duitse onderzoekers in een overzichtstudie naar effect en gebruik van EUS-FNA. Achtereenvolgens hier de abstracten van Nederlandse studie, een Deense gerandomiseerde studie en een Duitse overzichtstudie

JAMA. 2005 Aug 24;294(8):931-6.

Endoscopic ultrasound added to mediastinoscopy for preoperative staging of patients with lung cancer. Annema JT, Versteegh MI, Veselic M, Welker L, Mauad T, Sont JK, Willems LN, Rabe KF. Division of Pulmonary Medicine, Leiden University Medical Center, Leiden, The Netherlands. j.t.annema@lumc.nl CONTEXT: Up to 40% of thoracotomies performed for non-small cell lung cancer are unnecessary, predominantly due to inaccurate preoperative detection of lymph node metastases and mediastinal tumor invasion (T4). Mediastinoscopy and the novel, minimally invasive technique of transesophageal ultrasound-guided fine-needle aspiration (EUS-FNA) target different mediastinal lymph node stations. In addition, EUS can identify tumor invasion in neighboring organs if tumors are located adjacent to the esophagus.

OBJECTIVE: To investigate the additional value of EUS-FNA to mediastinoscopy in the preoperative staging of patients with non-small cell lung cancer.

DESIGN, SETTING, AND PATIENTS: Prospective, nonrandomized multicenter trial performed in 1 referral and 5 general hospitals in the Netherlands. During a 3-year period (2000-2003), 107 consecutive patients with potential resectable non-small cell lung cancer underwent preoperative staging by both EUS-FNA and mediastinoscopy. Patients underwent thoracotomy with tumor resection if mediastinoscopy was negative. Surgical-pathological staging was compared with preoperative findings and the added benefit of the combined strategy was assessed.

INTERVENTION: The EUS-FNA examination was performed as an additional staging test to mediastinoscopy in all patients.

MAIN OUTCOME MEASURE: Detection of mediastinal tumor invasion (T4) and lymph node metastases (N2/N3) comparing the combined staging by both EUS-FNA and mediastinoscopy with staging by mediastinoscopy alone.

RESULTS: The combination of EUS-FNA and mediastinoscopy identified more patients with tumor invasion or lymph node metastases (36%; 95% confidence interval , 27%-46%) compared with either mediastinoscopy alone (20%; 95% CI, 13%-29%) or EUS-FNA (28%; 95% CI, 19%-38%) alone. This indicated that 16% of thoracotomies could have been avoided by using EUS-FNA in addition to mediastinoscopy. However, 2% of the EUS-FNA findings were false-positive.

CONCLUSION: These preliminary findings suggest that EUS-FNA, when added to mediastinoscopy, improves the preoperative staging of lung cancer due to the complementary reach of EUS-FNA in detecting mediastinal lymph node metastases and the ability to assess mediastinal tumor invasion.

PMID: 16118383 [PubMed - indexed for MEDLINE]

Hier een artikel uit medscape over bovenstaande Nederlandse studie
,br> Ultrasound-Guided FNA Plus Mediastinoscopy May Improve Lung Cancer Staging NEW YORK (Reuters Health) Aug 23 - A combined work-up with endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and mediastinoscopy is better than either modality alone for staging lung cancer before surgery, new research indicates. This approach has the potential to reduce the number of unnecessary thoracotomies that are performed. At present, up to 40% of thoracotomies are considered unnecessary, representing a failure of preoperative tests to detect lymph node metastases or mediastinal invasion. In theory, detection of such disease could be improved by combining mediastinoscopy with EUS-FNA since both focus on different lymph node stations. To investigate, Dr. Jouke T. Annema, from Leiden University Medical Center in the Netherlands, and colleagues assessed the diagnostic abilities of these modalities alone and combined in 107 patients with potentially resectable lung cancer. All patients with a negative mediastinoscopy underwent thoracotomy with tumor resection. The combined approach identified tumor invasion or lymph node metastases in 36% of patients. By contrast, the detection rates achieved with EUS-FNA and mediastinoscopy alone were only 28% and 20%, respectively. Based on these findings, the authors estimate that adding EUS-FNA to mediastinoscopy could have prevented 16% of thoracotomies. However, they note that 2% of the EUS-FNA results were false positive. "These preliminary findings suggest that EUS-FNA, a novel, minimally invasive staging procedure for lung cancer, may improve the preoperative staging due to the complementary reach of EUS-FNA in detecting mediastinal lymph node metastases and the ability to assess mediastinal tumor invasion," the researchers state. Still, the occurrence of false positive results with EUS-FNA needs to be explored further. JAMA 2005;294:931-936.<br<>br> Een andere Deense gerandomiseerde studie bewijst met dezelfde resultaten dat EUS-FNA zeer zeker zin kan hebben in de diagnose van longkanker en wellicht zou moeten worden aangeraden als standaard procedure bij de diagnose van longkanker en vaststellen van stadium vooraf aan een operatieve ingreep

Lung Cancer. 2005 May 27;

Endoscopic ultrasound guided biopsy performed routinely in lung cancer staging spares futile thoracotomies: Preliminary results from a randomised clinical trial.

Larsen SS, Vilmann P, Krasnik M, Dirksen A, Clementsen P, Maltbaek N, Lassen U, Skov BG, Jacobsen GK.
Department of Surgical Gastroenterology, Gentofte University Hospital, Copenhagen, Denmark.

BACKGROUND:: Up to 45% of operations with curative intent for non-small-cell lung cancer (NSCLC) can be regarded as futile, apparently because the stage of the disease is more advanced than expected preoperatively. During the past decade several studies have evaluated the usefulness of endoscopic ultrasound guided fine needle aspiration biopsy (EUS-FNA) in lung cancer staging with promising results. However, no randomised trials have been performed, in which a staging strategy with EUS-FNA performed in all patients is compared with a conventional workup.

METHODS:: Before surgery (i.e. mediastinoscopy and subsequent thoracotomy) 104 patients from one hospital were randomly assigned to either a conventional workup (CWU), including EUS-FNA only for selected patients, or a strategy where all patients were offered EUS-FNA (routine EUS-FNA) in addition to CWU. Patients were followed up for a median period of 1.3 years (range 0.2-2.4 years). Thoracotomy was regarded as futile if the patient had an explorative thoracotomy without tumour resection or if a resected patient had recurrent disease or died from lung cancer during follow-up. Analysis was by intention to treat.

RESULTS:: Fifty-three patients were randomly assigned to routine EUS-FNA and 51 patients to CWU. EUS-FNA was performed in 50 patients (94%) in the routine EUS-FNA group and in 14 patients (27%) in the CWU group. In the routine EUS-FNA group five patients (9%) had a futile thoracotomy, compared with 13 (25%) in the CWU group, p=0.03.

CONCLUSION:: Addition of routine-EUS-FNA to standard workup in routine clinical practice improved selection of surgically curable patients with NSCLC.

PMID: 16102606 [PubMed - as supplied by publisher]

Ook onderstaande Duitse studie bevestigt de resultaten met EUS-FNA voor diagnose van in lymfklieren uitgezaaide kanker, maar niet alleen bij longkanker maar ook bij darmkanker en alvleesklierkanker enz.

Deutsch Med Wochenschr. 2005 Aug 26;130(34-35):1957-61.

[Endoscopic ultrasound-guided fine-needle aspiration.]

[Article in German]
Schanz S, Kruis W.

Abteilung fur Innere Medizin, Gastroenterologie, Evangelisches Krankenhaus Koln-Kalk.

Summary. Compared with other imaging modalities, EUS has developed into a highly accurate and superior technique for the staging and detection of intestinal tumours and nodal metastases. For better discrimination of neoplastic and inflammatory processes curved linear array echoendoscopes were introduced more than a decade ago to allow fine needle aspiration cytology under visual control. Together with an expert cytopathologist and in skilled hands EUS- FNA should be able to provide a cytologic diagnosis over 80 % of malignant lesions. The most common indications are tumours of the pancreas, esophhageal and lung cancer. It can also be performed in a variety of lymphadenopathies, carcinoma of the rectum, submucosal tumors and lesions of the liver and adrenal gland. Complication rates are lower than in other imaging modalities like CT and Ultrasound. Particularly in lesions with difficult access like in the mediastinum and pelvis, EUS-FNA represents the most accurate and less invasive diagnostic method tissue sampling. This technique considerably improves diagnostic imaging avoiding unnecessary surgery and leading directly to a palliation of the patient. As experience increases, so do the indications for its use. Application of EUS-FNA however should have the potential to influence patient management. PMID: 16123900 [PubMed - in process]

Clinical impact of EUS-FNA of mediastinal lymph nodes in patients with known or suspected lung cancer or mediastinal lymph nodes of unknown etiology.

J Gastrointestin Liver Dis. 2012 Jun;21(2):145-52.

Clinical impact of EUS-FNA of mediastinal lymph nodes in patients with known or suspected lung cancer or mediastinal lymph nodes of unknown etiology.

Srinivasan R, Bhutani MS, Thosani N, Săftoiu A, Rice DC, Ioncică AM, Eapen GA, Gupta P, Jaganmohan S, Artifon EL, Zwischenberger JB.

Source

Division of Gastroenterology, UTMB, Galveston, TX;Department of Gastroenterology Hepatology and Nutrition-Unit, 1466 UT MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston,Texas, USA; Email: manoop.bhutani@mdanderson.org.

Abstract

INTRODUCTION:

Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) of mediastinal lymph nodes (LNs) has emerged as a valuable minimally invasive tool for staging. The objective of this study was to determine the accuracy of EUS-FNA of mediastinal LNs in patients with known or suspected non-small cell lung cancer (NSCLC) or with mediastinal LNs of unknown etiology and review its clinical impact.

METHODS:

A review was performed on 107 consecutive patients. If malignant cells were identified by EUS-FNA, the result was accepted as a true positive. When cytology was non-malignant, results were compared with the final surgical pathology.

RESULTS:

Of 79 patients with known or suspected lung cancer who had mediastinal LNs, 69 patients underwent EUS-FNA. Thirty-two received a definitive diagnosis with EUS-FNA and did not undergo further workup, while 37 patients had benign (33) or non-diagnostic FNAs (4); 26 patients further underwent surgical staging. Sensitivity, specificity, and accuracy for EUS-FNA of mediastinal LNs in patients with known or suspected lung cancer was 82.35%, 100%, and 90% respectively. The negative predictive value was 80% and the positive predictive value was 100%. There were 20 patients with suspicious mediastinal LNs of uncertain etiology, with a definitive diagnosis being made using EGD/EUS-FNA in 95%.

CONCLUSION:

Our data supports the use of EUS-FNA in the work-up of enlarged mediastinal LNs on cross sectional imaging, thus avoiding more invasive mediastinal sampling procedures and potentially futile surgery.