The role of endosonography-guided fine needle aspiration in preoperative restaging in the era of novel neoadjuvant therapies— a literature review
AME Surgical Journal, cilt.2, 2022 (Scopus)
- Yayın Türü: Makale / Derleme
- Cilt numarası: 2
- Basım Tarihi: 2022
- Doi Numarası: 10.21037/asj-21-104
- Dergi Adı: AME Surgical Journal
- Derginin Tarandığı İndeksler: Scopus
- Anahtar Kelimeler: Bronchoscopy, endoscopic ultrasound-guided fine needle aspiration, endosonography, restaging, lung cancer
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Background and Objective: The objective of this literature review is to assess the role and diagnostic performance of endosonography (endobronchial, endoesophageal, and combined endobronchial and endoesophageal ultrasound)-guided fine-needle aspiration in restaging the mediastinum after neoadjuvant therapy in lung cancer. Currently, mediastinal restaging in lung cancer after neoadjuvant therapy is a challenging and controversial issue, and optimal approach remains unclear. Methods: A search was performed in PubMed and Google for relevant studies, reviews and meta-analyses on diagnostic performances of endosonography-guided fine needle aspiration and other methods in restaging stage III lung cancer after neoadjuvant therapy. The articles published in English language between 1998– 2021 were assessed. Key Content and Findings: The pooled sensitivities of endobronchial ultrasound-, endoesophageal ultrasound-, combined endobronchial and endoesophageal ultrasound-, and overall endosonography-guided fine needle aspirations were 65%, 66–73%, 67%, and 67–70% while their specificities were 98–99%, 96–99%, 94–96%, and 99–100%, respectively. Significant heterogeneity was observed for sensitivity of endosonography-guided fine needle aspiration owing to several factors such as study design, prevalence of N2 disease and pathologic changes in lymph nodes due to neoadjuvant therapy and initial staging procedure. Negative results were confirmed by subsequent surgical approaches whenever feasible. There were no severe complications reported during any endosonography approaches reviewed. Conclusions: Endosonography-guided fine needle aspiration is a safe technique with reasonable sensitivity and high specificity for mediastinal restaging of lung cancer. As an initial rule-in test, a positive result obtained by endosonography-guided fine needle aspiration reliably obviates further evaluation, particularly surgical procedures in approximately 67% of the patients. Combining endobronchial and endoesophageal ultrasonography-guided fine needle aspiration provides higher yields in mediastinal restaging as they are complementary to each other. A negative result by endosonographic restaging requires confirmation by a surgical procedure.