Special Approaches for Obtaining Specimens for Cancer Diagnosis

a) Endoscopic ultrasound-guided transesophageal fine-needle aspiration (EUS-FNA).

b) Transpleural techniques for NSCLC diagnosis.

Ad a) EUS-FNA: Ryan et al. (2001) reported briefly on the methods of lung cancer biopsy. The authors emphasize the possibility of using EUS-FNA biopsy of mediastinal nodes. The sensitivity in the diagnosis of carcinoma in lymph nodes was more than 90% in their own studies, with no complications.

In an earlier study by Gress et al. (1997) EUS-FNA had a specificity of 96% for nodal involvement, compared with 49% for CT.

In addition, Serna et al. (1998) recorded a sensitivity of 86% for EUS-FNA, compared with 100% for mediastinoscopy, but the authors emphasized that both methods had both a specificity and a positive predictive value of 100%.

Fig. 22. Broncho-aorto-pulmonary situs: preoperative staging should perhaps be performed with a view to ascertaining whether or not the lesion is operable. Use of mediastinoscopy MRI-Sinerem imaging, PET, etc. might allow clearer planning of any operation

Fig. 22. Broncho-aorto-pulmonary situs: preoperative staging should perhaps be performed with a view to ascertaining whether or not the lesion is operable. Use of mediastinoscopy MRI-Sinerem imaging, PET, etc. might allow clearer planning of any operation

Table 15. Comparison of relapse rates after transpleural and transbronchial diagnosis of lung cancer

Transpleural technique

Transbronchial technique

Relapse rate total

Transpleural transbronchial

Transpleural transbronchial distant vs local

Survival transpleural vs transbronchial (%)

n = 45

n =194

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