Problema de Salud AUGE N°81
Cáncer de pulmón en persona de 15 años y más
Recomendación – Dg2 / Juicio del Panel y Evidencia
Dg.2.En personas mayores de 15 años con diagnóstico de cáncer pulmonar en proceso de etapificación, el Ministerio de Salud SUGIERE realizar ecobroncoscopia (EBUS) por sobre mediastinoscopia.
Comentarios del Panel de Expertos:
►La implementación de EBUS implica comprar equipamiento y mantención anual del mismo, para lograr cobertura a lo largo del territorio nacional.
►En la actualidad en Chile se necesita capacitar a especialistas porque la técnica es operador dependiente y requiere al menos 50 procedimientos supervisados, de tal modo que se obtenga muestra histológica suficiente para la caracterización de la enfermedad.
►En algunos casos, el material obtenido por EBUS puede ser insuficiente y no permite la caracterización molecular.
►En caso que la EBUS no permita el diagnóstico, se debe plantear la etapificación con mediastinoscopía.
►El costo de EBUS constituye una barrera de acceso en la actualidad.
El panel de expertos analizó y debatió cada uno de las preguntas de la “Tabla de la evidencia a la decisión”, considerando tanto la evidencia de investigación, experiencia clínica, conocimiento de gestión o experiencia de los pacientes. Una vez consensuada la postura del panel respecto a las preguntas, emitieron un juicio seleccionando la opción de respuesta que mejor representaba la opinión del conjunto (destacada con color). Finalmente cuando el panel emitió su juicio sobre todas las preguntas, se emitió la recomendación.
A continuación se presenta la “Tabla de la evidencia a la decisión” con el resumen de los juicios, la evidencia de investigación evaluada, consideraciones adicionales y comentarios planteados por el panel.
1.- ¿El problema es una prioridad?
| No | Probablemente no | Probablemente sí | Sí | Varía | No lo sé |
|---|
El problema ha sido definido como prioritario en el marco de las Garantías Explícitas en Salud (GES), régimen integral de salud que prioriza un grupo de patologías o problemas de salud, garantizando el acceso a tratamiento oportuno y de calidad.
2.- ¿Qué tan precisa es este test?
| Muy imprecisa | Imprecisa | Precisa | Muy precisa | Varía | No lo sé |
|---|
Precisa: En la mayoría de los casos, la prueba es capaz de diferenciar en forma confiable quienes padecen y no padecen la enfermedad o condición. De todos modos, el panel destaca que existe la posibilidad de subestadiaje.
Evidencia de investigación
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Ecobroncoscopía comparado con mediastinoscopía para etapificación de cáncer pulmonar. |
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Pacientes |
Personas mayores de 15 años con diagnóstico de cáncer pulmonar en proceso de etapificación. |
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Test |
Ecobroncoscopia (EBUS). |
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Comparación |
Mediastinoscopía. |
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Impacto diagnóstico |
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Desenlaces |
Efecto |
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Morbilidad o mortalidad |
No se identificaron estudios evaluando el impacto, por lo que el desenlace se estimó en base a la exactitud diagnóstica del test, y de las consecuencias esperadas a partir de cada resultado. |
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Exactitud diagnóstica |
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Gold standard |
Mediastinoscopía. |
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Desenlaces |
Prevalencia hipotética 40%* |
Certeza de la evidencia (GRADE)** |
Mensajes clave en términos sencillos |
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| Sensibilidad: 80,3% (IC 95% de 73,7 a 85,9%) Especificidad: 100% (IC 95% de 98,7 a 100%) LR (+): No calculable, pero muy grande (Por especificidad de 100%) LR (-): 0,20 (IC 95% de 0,15 a 0,27) 465 pacientes (4 estudios [22, 24, 30, 38]) Población hipotética de 1000 personas con 400 enfermos con compromiso mediastínico y 600 sin compromiso mediastínico. |
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Pacientes con compromiso mediastínico (verdaderos positivos) |
321 (295 a 344) |
⊕⊕⊕◯1 Moderada |
El test de EBUS probablemente detecta correctamente a 321 de los 400 pacientes con compromiso mediastínico (verdaderos positivos). |
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|
Pacientes incorrectamente clasificados de no tener compromiso mediastínico (falsos negativos) |
79 (56 a 105) |
⊕⊕⊕◯1 Moderada |
El test de EBUS probablemente clasifica incorrectamente a 79 de los 400 pacientes con compromiso mediastínico (falsos negativos). |
||
|
Pacientes sin compromiso mediastínico (verdaderos negativos) |
600 (592 a 600) |
⊕⊕⊕◯1 Moderada |
El test de EBUS probablemente detecta correctamente a 600 de los 600 pacientes sin compromiso mediastínico (verdaderos negativos). |
||
|
Pacientes incorrectamente clasificados como con compromiso mediastínico (falsos positivos) |
0 (0 a 8) |
⊕⊕⊕◯1 Moderada |
El test de EBUS probablemente clasifica incorrectamente a 0 de los 600 pacientes sin compromiso mediastínico (falsos positivos). |
||
IC: Intervalo de confianza del 95%.
GRADE: grados de evidencia del GRADE Working Group.
*La prevalencia corresponde al promedio de prevalencia de los estudios.
** Certeza de exactitud diagnóstica.
1 Se disminuyó un nivel de certeza de la evidencia por inconsistencia sobre 80% en sensibilidad.
Fecha de elaboración de la tabla: Octubre, 2018.
Referencias
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2. Dhooria S, Aggarwal AN, Gupta D, Behera D, Agarwal R. Utility and Safety of Endoscopic Ultrasound With Bronchoscope-Guided Fine-Needle Aspiration in Mediastinal Lymph Node Sampling: Systematic Review and Meta-Analysis. Respiratory care. 2015;60(7):1040-50.
3. Dong X, Qiu X, Liu Q, Jia J. Endobronchial ultrasound-guided transbronchial needle aspiration in the mediastinal staging of non-small cell lung cancer: a meta-analysis. The Annals of thoracic surgery. 2013;96(4):1502-1507.
4. El-Osta H, Jani P, Mansour A, Rascoe P, Jafri S. Endobronchial Ultrasound for Nodal Staging of Non-Small Cell Lung Cancer Patients with Radiologically Normal Mediastinum: A Meta-Analysis. Annals of the American Thoracic Society. 2018;15(7):864-874.
5. Gu P, Zhao YZ, Jiang LY, Zhang W, Xin Y, Han BH. Endobronchial ultrasound-guided transbronchial needle aspiration for staging of lung cancer: a systematic review and meta-analysis. European journal of cancer (Oxford, England : 1990). 2009;45(8):1389-96.
6. Korevaar DA, Crombag LM, Cohen JF, Spijker R, Bossuyt PM, Annema JT. Added value of combined endobronchial and oesophageal endosonography for mediastinal nodal staging in lung cancer: a systematic review and meta-analysis. The Lancet. Respiratory medicine. 2016;4(12):960-968.
7. Labarca G, Aravena C, Ortega F, Arenas A, Majid A, Folch E, Mehta HJ, Jantz MA, Fernandez-Bussy S. Minimally Invasive Methods for Staging in Lung Cancer: Systematic Review and Meta-Analysis. Pulmonary medicine. 2016;2016(no pagination):1024709.
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18. Hauer J, Szlubowski A, Żanowska K, Rudnicka-Sosin L, Trybalski Ł, Grochowski Z, Gil T, Włodarczyk J, Warmus J, Kocoń P, Smęder T, Kużdżał J. Minimally invasive strategy for mediastinal staging of patients with lung cancer. Polskie Archiwum Medycyny Wewnetrznej. 2015;125(12):910-3.
19. Herth FJ, Eberhardt R, Krasnik M, Ernst A. Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically and positron emission tomography-normal mediastinum in patients with lung cancer. Chest. 2008;133(4):887-91.
20. Herth FJ, Eberhardt R, Vilmann P, Krasnik M, Ernst A. Real-time endobronchial ultrasound guided transbronchial needle aspiration for sampling mediastinal lymph nodes. Thorax. 2006;61(9):795-8.
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25. Jamil, Laith H, De Frutos, Noelia Cubero, Gill, Kanwar R, Gross, Seth A, Pascual, Jorge M, Raimondo, Massimo, Woodward, Timothy A, Crook, Julia, Odell, John, Wallace, Michael B. Accuracy of EUS, EBUS, and combined EUS/EBUS for non-small cell lung cancer evaluation in patients with a negative CT and PET of the mediastinum. Gastrointestinal Endoscopy. 2009;69(5):AB325.
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27. Krasnik M, Vilmann P, Larsen SS, Jacobsen GK. Preliminary experience with a new method of endoscopic transbronchial real time ultrasound guided biopsy for diagnosis of mediastinal and hilar lesions. Thorax. 2003;58(12):1083-6.
28. Laurence Crombag, Jos Stigt, Christophe Dooms, Kurt Tournoy, Olga Schuurbiers, Daniel Korevaar, Jouke Annema. Added value of EUS-B to EBUS for lung cancer staging. Eur Respir J. 2015;46(s59):PA772.
29. Lee HS, Lee GK, Lee HS, Kim MS, Lee JM, Kim HY, Nam BH, Zo JI, Hwangbo B. Real-time endobronchial ultrasound-guided transbronchial needle aspiration in mediastinal staging of non-small cell lung cancer: how many aspirations per target lymph node station?. Chest. 2008;134(2):368-74.
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54. Yasufuku K, Chiyo M, Sekine Y, Chhajed PN, Shibuya K, Iizasa T, Fujisawa T. Real-time endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal and hilar lymph nodes. Chest. 2004;126(1):122-8.
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2. Dhooria S, Aggarwal AN, Gupta D, Behera D, Agarwal R. Utility and Safety of Endoscopic Ultrasound With Bronchoscope-Guided Fine-Needle Aspiration in Mediastinal Lymph Node Sampling: Systematic Review and Meta-Analysis. Respiratory care. 2015;60(7):1040-50.
3. Dong X, Qiu X, Liu Q, Jia J. Endobronchial ultrasound-guided transbronchial needle aspiration in the mediastinal staging of non-small cell lung cancer: a meta-analysis. The Annals of thoracic surgery. 2013;96(4):1502-1507.
4. El-Osta H, Jani P, Mansour A, Rascoe P, Jafri S. Endobronchial Ultrasound for Nodal Staging of Non-Small Cell Lung Cancer Patients with Radiologically Normal Mediastinum: A Meta-Analysis. Annals of the American Thoracic Society. 2018;15(7):864-874.
5. Gu P, Zhao YZ, Jiang LY, Zhang W, Xin Y, Han BH. Endobronchial ultrasound-guided transbronchial needle aspiration for staging of lung cancer: a systematic review and meta-analysis. European journal of cancer (Oxford, England : 1990). 2009;45(8):1389-96.
6. Korevaar DA, Crombag LM, Cohen JF, Spijker R, Bossuyt PM, Annema JT. Added value of combined endobronchial and oesophageal endosonography for mediastinal nodal staging in lung cancer: a systematic review and meta-analysis. The Lancet. Respiratory medicine. 2016;4(12):960-968.
7. Labarca G, Aravena C, Ortega F, Arenas A, Majid A, Folch E, Mehta HJ, Jantz MA, Fernandez-Bussy S. Minimally Invasive Methods for Staging in Lung Cancer: Systematic Review and Meta-Analysis. Pulmonary medicine. 2016;2016(no pagination):1024709.
8. Varela-Lema L, Fernández-Villar A, Ruano-Ravina A. Effectiveness and safety of endobronchial ultrasound-transbronchial needle aspiration: a systematic review. The European respiratory journal. 2009;33(5):1156-64.
9. Zhang R, Ying K, Shi L, Zhang L, Zhou L. Combined endobronchial and endoscopic ultrasound-guided fine needle aspiration for mediastinal lymph node staging of lung cancer: A meta-analysis. European journal of cancer (Oxford, England : 1990). 2013;49(8):1860-7.
10. ASTER. Annema JT, van Meerbeeck JP, Rintoul RC, Dooms C, Deschepper E, Dekkers OM, De Leyn P, Braun J, Carroll NR, Praet M, de Ryck F, Vansteenkiste J, Vermassen F, Versteegh MI, Veseliç M, Nicholson AG, Rabe KF, Tournoy KG. Mediastinoscopy vs endosonography for mediastinal nodal staging of lung cancer: a randomized trial. JAMA : the journal of the American Medical Association. 2010;304(20):2245-52.
11. Kang HJ, Hwangbo B, Lee GK, Nam BH, Lee HS, Kim MS, Lee JM, Zo JI, Lee HS, Han JY. EBUS-centred versus EUS-centred mediastinal staging in lung cancer: a randomised controlled trial. Thorax. 2014;69(3):261-8.
12. Araya T, Demura Y, Kasahara K, Matsuoka H, Yamamura K, Nishitsuji M, Nishi K. Usefulness of transesophageal bronchoscopic ultrasound-guided fine-needle aspiration in the pathologic and molecular diagnosis of lung cancer lesions adjacent to the esophagus. Journal of bronchology & interventional pulmonology. 2013;20(2):121-6.
13. Bauwens O, Dusart M, Pierard P, Faber J, Prigogine T, Duysinx B, Nguyen B, Paesmans M, Sculier JP, Ninane V. Endobronchial ultrasound and value of PET for prediction of pathological results of mediastinal hot spots in lung cancer patients. Lung cancer (Amsterdam, Netherlands). 2008;61(3):356-61.
14. Bugalho A, Ferreira D, Eberhardt R, Dias SS, Videira PA, Herth FJ, Carreiro L. Diagnostic value of endobronchial and endoscopic ultrasound-guided fine needle aspiration for accessible lung cancer lesions after non-diagnostic conventional techniques: a prospective study. BMC cancer. 2013;13:130.
15. Edwards, T, Al-Najjar, H, Crosbie, P, Martin, J, Booton, R, Evison, M. 85P: Performance of EBUS-TBNA in NSCLC mediastinal staging stratified according to ACCP radiographic groups on CT. Journal of Thoracic Oncology. 2016;11(4):S92.
16. Ernst A, Anantham D, Eberhardt R, Krasnik M, Herth FJ. Diagnosis of mediastinal adenopathy-real-time endobronchial ultrasound guided needle aspiration versus mediastinoscopy. Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer. 2008;3(6):577-82.
17. Gupta K, Mallery S. Small-caliber endobronchial ultrasonic videoscope: successful transesophageal and transgastric FNA after failed passage of a standard ultrasonic endoscope. Gastrointestinal endoscopy. 2007;66(3):574-7.
18. Hauer J, Szlubowski A, Żanowska K, Rudnicka-Sosin L, Trybalski Ł, Grochowski Z, Gil T, Włodarczyk J, Warmus J, Kocoń P, Smęder T, Kużdżał J. Minimally invasive strategy for mediastinal staging of patients with lung cancer. Polskie Archiwum Medycyny Wewnetrznej. 2015;125(12):910-3.
19. Herth FJ, Eberhardt R, Krasnik M, Ernst A. Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically and positron emission tomography-normal mediastinum in patients with lung cancer. Chest. 2008;133(4):887-91.
20. Herth FJ, Eberhardt R, Vilmann P, Krasnik M, Ernst A. Real-time endobronchial ultrasound guided transbronchial needle aspiration for sampling mediastinal lymph nodes. Thorax. 2006;61(9):795-8.
21. Herth FJ, Ernst A, Eberhardt R, Vilmann P, Dienemann H, Krasnik M. Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically normal mediastinum. The European respiratory journal. 2006;28(5):910-4.
22. Herth FJ, Krasnik M, Kahn N, Eberhardt R, Ernst A. Combined endoscopic-endobronchial ultrasound-guided fine-needle aspiration of mediastinal lymph nodes through a single bronchoscope in 150 patients with suspected lung cancer. Chest. 2010;138(4):790-4.
23. Hwangbo B, Kim SK, Lee HS, Lee HS, Kim MS, Lee JM, Kim HY, Lee GK, Nam BH, Zo JI. Application of endobronchial ultrasound-guided transbronchial needle aspiration following integrated PET/CT in mediastinal staging of potentially operable non-small cell lung cancer. Chest. 2009;135(5):1280-7.
24. Hwangbo B, Lee GK, Lee HS, Lim KY, Lee SH, Kim HY, Lee HS, Kim MS, Lee JM, Nam BH, Zo JI. Transbronchial and transesophageal fine-needle aspiration using an ultrasound bronchoscope in mediastinal staging of potentially operable lung cancer. Chest. 2010;138(4):795-802.
25. Jamil, Laith H, De Frutos, Noelia Cubero, Gill, Kanwar R, Gross, Seth A, Pascual, Jorge M, Raimondo, Massimo, Woodward, Timothy A, Crook, Julia, Odell, John, Wallace, Michael B. Accuracy of EUS, EBUS, and combined EUS/EBUS for non-small cell lung cancer evaluation in patients with a negative CT and PET of the mediastinum. Gastrointestinal Endoscopy. 2009;69(5):AB325.
26. Jhun BW, Park HY, Jeon K, Koh WJ, Suh GY, Chung MP, Kim H, Kwon OJ, Han J, Um SW. Nodal stations and diagnostic performances of endobronchial ultrasound-guided transbronchial needle aspiration in patients with non-small cell lung cancer. Journal of Korean medical science. 2012;27(1):46-51.
27. Krasnik M, Vilmann P, Larsen SS, Jacobsen GK. Preliminary experience with a new method of endoscopic transbronchial real time ultrasound guided biopsy for diagnosis of mediastinal and hilar lesions. Thorax. 2003;58(12):1083-6.
28. Laurence Crombag, Jos Stigt, Christophe Dooms, Kurt Tournoy, Olga Schuurbiers, Daniel Korevaar, Jouke Annema. Added value of EUS-B to EBUS for lung cancer staging. Eur Respir J. 2015;46(s59):PA772.
29. Lee HS, Lee GK, Lee HS, Kim MS, Lee JM, Kim HY, Nam BH, Zo JI, Hwangbo B. Real-time endobronchial ultrasound-guided transbronchial needle aspiration in mediastinal staging of non-small cell lung cancer: how many aspirations per target lymph node station?. Chest. 2008;134(2):368-74.
30. Lee KJ, Suh GY, Chung MP, Kim H, Kwon OJ, Han J, Um SW. Combined endobronchial and transesophageal approach of an ultrasound bronchoscope for mediastinal staging of lung cancer. PloS one. 2014;9(3):e91893.
31. Lee BE, Kletsman E, Rutledge JR, Korst RJ. Utility of endobronchial ultrasound-guided mediastinal lymph node biopsy in patients with non-small cell lung cancer. The Journal of thoracic and cardiovascular surgery. 2012;143(3):585-90.
32. Liberman M, Sampalis J, Duranceau A, Thiffault V, Hadjeres R, Ferraro P. Endosonographic mediastinal lymph node staging of lung cancer. Chest. 2014;146(2):389-97.
33. Monsó E, Andreo F, Rosell A, Cuellar P, Castellà E, Llatjós M. [Usefulness of endobronchial ultrasonography with real-time needle aspiration for lung cancer staging]. Medicina clinica. 2007;128(13):481-5.
34. Nakajima T, Yasufuku K, Iyoda A, Yoshida S, Suzuki M, Sekine Y, Shibuya K, Hiroshima K, Nakatani Y, Fujisawa T. The evaluation of lymph node metastasis by endobronchial ultrasound-guided transbronchial needle aspiration: crucial for selection of surgical candidates with metastatic lung tumors. The Journal of thoracic and cardiovascular surgery. 2007;134(6):1485-90.
35. Naur TMH, Konge L, Clementsen PF. Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Staging of Patients with Non-Small Cell Lung Cancer without Mediastinal Involvement at Positron Emission Tomography-Computed Tomography. Respiration; international review of thoracic diseases. 2017;94(3):279-284.
36. Ohnishi R, Yasuda I, Kato T, Tanaka T, Kaneko Y, Suzuki T, Yasuda S, Sano K, Doi S, Nakashima M, Hara T, Tsurumi H, Murakami N, Moriwaki H. Combined endobronchial and endoscopic ultrasound-guided fine needle aspiration for mediastinal nodal staging of lung cancer. Endoscopy. 2011;43(12):1082-9.
37. Okamoto H, Watanabe K, Nagatomo A, Kunikane H, Aono H, Yamagata T, Kase M. Endobronchial ultrasonography for mediastinal and hilar lymph node metastases of lung cancer. Chest. 2002;121(5):1498-506.
38. Oki M, Saka H, Ando M, Kitagawa C, Kogure Y, Seki Y. Endoscopic ultrasound-guided fine needle aspiration and endobronchial ultrasound-guided transbronchial needle aspiration: Are two better than one in mediastinal staging of non-small cell lung cancer?. The Journal of thoracic and cardiovascular surgery. 2014;148(4):1169-77.
39. Oki M, Saka H, Kitagawa C, Kogure Y, Murata N, Adachi T, Ichihara S, Moritani S. Transesophageal bronchoscopic ultrasound-guided fine needle aspiration for diagnosis of sarcoidosis. Respiration; international review of thoracic diseases. 2013;85(2):137-43.
40. Ong P, Grosu H, Eapen GA, Rodriguez M, Lazarus D, Ost D, Jimenez CA, Morice R, Bandi V, Tamara L, Cornwell L, Green L, Zhu A, Casal RF. Endobronchial ultrasound-guided transbronchial needle aspiration for systematic nodal staging of lung cancer in patients with N0 disease by computed tomography and integrated positron emission tomography-computed tomography. Annals of the American Thoracic Society. 2015;12(3):415-9.
41. Pierard PE, Faber J, Bauwens O. Evaulation of a new tool in mediastinal staging of lung cancer: real-time guided needle aspiration using endobronchial ultrasound (EBUS-NA). Chest. 2006;
42. Plat G, Pierard P, Haller A, Hutsebaut J, Faber J, Dusart M, Eisendrath P, Sculier JP, Ninane V. Endobronchial ultrasound and positron emission tomography positive mediastinal lymph nodes. The European respiratory journal. 2006;27(2):276-81.
43. Rintoul RC, Skwarski KM, Murchison JT, Wallace WA, Walker WS, Penman ID. Endobronchial and endoscopic ultrasound-guided real-time fine-needle aspiration for mediastinal staging. The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology. 2005;25(3):416-21.
44. Shingyoji M, Nakajima T, Yoshino M, Yoshida Y, Ashinuma H, Itakura M, Tatsumi K, Iizasa T. Endobronchial ultrasonography for positron emission tomography and computed tomography-negative lymph node staging in non-small cell lung cancer. The Annals of thoracic surgery. 2014;98(5):1762-7.
45. Skwarski KM, McCafferty J, Wood F. Minimally invasive staging in lung cancer by real time endobronchial ultrasound FNA (EBUS). Chest. 2007;:591-592.
46. Szlubowski A, Soja J, Kocon P, Talar P, Czajkowski W, Rudnicka-Sosin L, Cmiel A, Kuzdzal J. A comparison of the combined ultrasound of the mediastinum by use of a single ultrasound bronchoscope versus ultrasound bronchoscope plus ultrasound gastroscope in lung cancer staging: a prospective trial. Interactive cardiovascular and thoracic surgery. 2012;15(3):442-6; discussion 446.
47. Szlubowski A, Zieliński M, Soja J, Annema JT, Sośnicki W, Jakubiak M, Pankowski J, Cmiel A. A combined approach of endobronchial and endoscopic ultrasound-guided needle aspiration in the radiologically normal mediastinum in non-small-cell lung cancer staging–a prospective trial. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 2010;37(5):1175-9.
48. Szlubowski A, Zieliński M, Soja J, Filarecka A, Orzechowski S, Pankowski J, Obrochta A, Jakubiak M, Węgrzyn J, Cmiel A. Accurate and safe mediastinal restaging by combined endobronchial and endoscopic ultrasound-guided needle aspiration performed by single ultrasound bronchoscope. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 2014;46(2):262-6.
49. Taverner J, Cheang MY, Antippa P, See K, Irving LB, Steinfort DP. Negative EBUS-TBNA Predicts Very Low Prevalence of Mediastinal Disease in Staging of Non-Small Cell Lung Cancer. Journal of bronchology & interventional pulmonology. 2016;23(2):177-80.
50. Vilmann P, Krasnik M, Larsen SS, Jacobsen GK, Clementsen P. Transesophageal endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) biopsy: a combined approach in the evaluation of mediastinal lesions. Endoscopy. 2005;37(9):833-9.
51. Vincent BD, El-Bayoumi E, Hoffman B, Doelken P, DeRosimo J, Reed C, Silvestri GA. Real-time endobronchial ultrasound-guided transbronchial lymph node aspiration. The Annals of thoracic surgery. 2008;85(1):224-30.
52. Wallace MB, Pascual JM, Raimondo M, Woodward TA, McComb BL, Crook JE, Johnson MM, Al-Haddad MA, Gross SA, Pungpapong S, Hardee JN, Odell JA. Minimally invasive endoscopic staging of suspected lung cancer. JAMA : the journal of the American Medical Association. 2008;299(5):540-6.
53. Yasufuku K, Chiyo M, Koh E, Moriya Y, Iyoda A, Sekine Y, Shibuya K, Iizasa T, Fujisawa T. Endobronchial ultrasound guided transbronchial needle aspiration for staging of lung cancer. Lung cancer (Amsterdam, Netherlands). 2005;50(3):347-54.
54. Yasufuku K, Chiyo M, Sekine Y, Chhajed PN, Shibuya K, Iizasa T, Fujisawa T. Real-time endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal and hilar lymph nodes. Chest. 2004;126(1):122-8.
55. Yasufuku K, Nakajima T, Motoori K, Sekine Y, Shibuya K, Hiroshima K, Fujisawa T. Comparison of endobronchial ultrasound, positron emission tomography, and CT for lymph node staging of lung cancer. Chest. 2006;130(3):710-8.
56. Yasufuku K, Nakajima T, Waddell T, Keshavjee S, Yoshino I. Endobronchial ultrasound-guided transbronchial needle aspiration for differentiating N0 versus N1 lung cancer. The Annals of thoracic surgery. 2013;96(5):1756-60.
57. Yasufuku K, Pierre A, Darling G, de Perrot M, Waddell T, Johnston M, da Cunha Santos G, Geddie W, Boerner S, Le LW, Keshavjee S. A prospective controlled trial of endobronchial ultrasound-guided transbronchial needle aspiration compared with mediastinoscopy for mediastinal lymph node staging of lung cancer. The Journal of thoracic and cardiovascular surgery. 2011;142(6):1393-400.e1.
58. Ye T, Hu H, Luo X, Chen H. The role of endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) for qualitative diagnosis of mediastinal and hilar lymphadenopathy: a prospective analysis. BMC cancer. 2011;11:100.
Búsqueda y Síntesis de Evidencia
Búsqueda y síntesis de evidencia de efectos deseables e indeseables
3.- ¿Qué tan significativos son los efectos deseables anticipados?
| Triviales | Pequeños | Moderados | Grandes | Varía | No lo sé |
|---|
Grandes: El panel de expertos de la Guía estimó que los efectos deseables de «realizar ecobroncoscopia (EBUS)» en comparación a «realizar mediastinoscopia» son grandes. El panel destaca que EBUS tiene baja tasa de complicaciones. Además, es seguro e implica menor morbilidad.
Evidencia de investigación
Efectos deseables del uso de EBUS [22, 24, 30, 38]:
• El test de EBUS probablemente detecta correctamente a 321 de los 400 pacientes con compromiso mediastínico (verdaderos positivos).
• El test de EBUS probablemente detecta correctamente a 600 de los 600 pacientes sin compromiso mediastínico (verdaderos negativos).
Referencias
1. Adams K, Shah PL, Edmonds L, Lim E. Test performance of endobronchial ultrasound and transbronchial needle aspiration biopsy for mediastinal staging in patients with lung cancer: systematic review and meta-analysis. Thorax. 2009;64(9):757-62.
2. Dhooria S, Aggarwal AN, Gupta D, Behera D, Agarwal R. Utility and Safety of Endoscopic Ultrasound With Bronchoscope-Guided Fine-Needle Aspiration in Mediastinal Lymph Node Sampling: Systematic Review and Meta-Analysis. Respiratory care. 2015;60(7):1040-50.
3. Dong X, Qiu X, Liu Q, Jia J. Endobronchial ultrasound-guided transbronchial needle aspiration in the mediastinal staging of non-small cell lung cancer: a meta-analysis. The Annals of thoracic surgery. 2013;96(4):1502-1507.
4. El-Osta H, Jani P, Mansour A, Rascoe P, Jafri S. Endobronchial Ultrasound for Nodal Staging of Non-Small Cell Lung Cancer Patients with Radiologically Normal Mediastinum: A Meta-Analysis. Annals of the American Thoracic Society. 2018;15(7):864-874.
5. Gu P, Zhao YZ, Jiang LY, Zhang W, Xin Y, Han BH. Endobronchial ultrasound-guided transbronchial needle aspiration for staging of lung cancer: a systematic review and meta-analysis. European journal of cancer (Oxford, England : 1990). 2009;45(8):1389-96.
6. Korevaar DA, Crombag LM, Cohen JF, Spijker R, Bossuyt PM, Annema JT. Added value of combined endobronchial and oesophageal endosonography for mediastinal nodal staging in lung cancer: a systematic review and meta-analysis. The Lancet. Respiratory medicine. 2016;4(12):960-968.
7. Labarca G, Aravena C, Ortega F, Arenas A, Majid A, Folch E, Mehta HJ, Jantz MA, Fernandez-Bussy S. Minimally Invasive Methods for Staging in Lung Cancer: Systematic Review and Meta-Analysis. Pulmonary medicine. 2016;2016(no pagination):1024709.
8. Varela-Lema L, Fernández-Villar A, Ruano-Ravina A. Effectiveness and safety of endobronchial ultrasound-transbronchial needle aspiration: a systematic review. The European respiratory journal. 2009;33(5):1156-64.
9. Zhang R, Ying K, Shi L, Zhang L, Zhou L. Combined endobronchial and endoscopic ultrasound-guided fine needle aspiration for mediastinal lymph node staging of lung cancer: A meta-analysis. European journal of cancer (Oxford, England : 1990). 2013;49(8):1860-7.
10. ASTER. Annema JT, van Meerbeeck JP, Rintoul RC, Dooms C, Deschepper E, Dekkers OM, De Leyn P, Braun J, Carroll NR, Praet M, de Ryck F, Vansteenkiste J, Vermassen F, Versteegh MI, Veseliç M, Nicholson AG, Rabe KF, Tournoy KG. Mediastinoscopy vs endosonography for mediastinal nodal staging of lung cancer: a randomized trial. JAMA : the journal of the American Medical Association. 2010;304(20):2245-52.
11. Kang HJ, Hwangbo B, Lee GK, Nam BH, Lee HS, Kim MS, Lee JM, Zo JI, Lee HS, Han JY. EBUS-centred versus EUS-centred mediastinal staging in lung cancer: a randomised controlled trial. Thorax. 2014;69(3):261-8.
12. Araya T, Demura Y, Kasahara K, Matsuoka H, Yamamura K, Nishitsuji M, Nishi K. Usefulness of transesophageal bronchoscopic ultrasound-guided fine-needle aspiration in the pathologic and molecular diagnosis of lung cancer lesions adjacent to the esophagus. Journal of bronchology & interventional pulmonology. 2013;20(2):121-6.
13. Bauwens O, Dusart M, Pierard P, Faber J, Prigogine T, Duysinx B, Nguyen B, Paesmans M, Sculier JP, Ninane V. Endobronchial ultrasound and value of PET for prediction of pathological results of mediastinal hot spots in lung cancer patients. Lung cancer (Amsterdam, Netherlands). 2008;61(3):356-61.
14. Bugalho A, Ferreira D, Eberhardt R, Dias SS, Videira PA, Herth FJ, Carreiro L. Diagnostic value of endobronchial and endoscopic ultrasound-guided fine needle aspiration for accessible lung cancer lesions after non-diagnostic conventional techniques: a prospective study. BMC cancer. 2013;13:130.
15. Edwards, T, Al-Najjar, H, Crosbie, P, Martin, J, Booton, R, Evison, M. 85P: Performance of EBUS-TBNA in NSCLC mediastinal staging stratified according to ACCP radiographic groups on CT. Journal of Thoracic Oncology. 2016;11(4):S92.
16. Ernst A, Anantham D, Eberhardt R, Krasnik M, Herth FJ. Diagnosis of mediastinal adenopathy-real-time endobronchial ultrasound guided needle aspiration versus mediastinoscopy. Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer. 2008;3(6):577-82.
17. Gupta K, Mallery S. Small-caliber endobronchial ultrasonic videoscope: successful transesophageal and transgastric FNA after failed passage of a standard ultrasonic endoscope. Gastrointestinal endoscopy. 2007;66(3):574-7.
18. Hauer J, Szlubowski A, Żanowska K, Rudnicka-Sosin L, Trybalski Ł, Grochowski Z, Gil T, Włodarczyk J, Warmus J, Kocoń P, Smęder T, Kużdżał J. Minimally invasive strategy for mediastinal staging of patients with lung cancer. Polskie Archiwum Medycyny Wewnetrznej. 2015;125(12):910-3.
19. Herth FJ, Eberhardt R, Krasnik M, Ernst A. Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically and positron emission tomography-normal mediastinum in patients with lung cancer. Chest. 2008;133(4):887-91.
20. Herth FJ, Eberhardt R, Vilmann P, Krasnik M, Ernst A. Real-time endobronchial ultrasound guided transbronchial needle aspiration for sampling mediastinal lymph nodes. Thorax. 2006;61(9):795-8.
21. Herth FJ, Ernst A, Eberhardt R, Vilmann P, Dienemann H, Krasnik M. Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically normal mediastinum. The European respiratory journal. 2006;28(5):910-4.
22. Herth FJ, Krasnik M, Kahn N, Eberhardt R, Ernst A. Combined endoscopic-endobronchial ultrasound-guided fine-needle aspiration of mediastinal lymph nodes through a single bronchoscope in 150 patients with suspected lung cancer. Chest. 2010;138(4):790-4.
23. Hwangbo B, Kim SK, Lee HS, Lee HS, Kim MS, Lee JM, Kim HY, Lee GK, Nam BH, Zo JI. Application of endobronchial ultrasound-guided transbronchial needle aspiration following integrated PET/CT in mediastinal staging of potentially operable non-small cell lung cancer. Chest. 2009;135(5):1280-7.
24. Hwangbo B, Lee GK, Lee HS, Lim KY, Lee SH, Kim HY, Lee HS, Kim MS, Lee JM, Nam BH, Zo JI. Transbronchial and transesophageal fine-needle aspiration using an ultrasound bronchoscope in mediastinal staging of potentially operable lung cancer. Chest. 2010;138(4):795-802.
25. Jamil, Laith H, De Frutos, Noelia Cubero, Gill, Kanwar R, Gross, Seth A, Pascual, Jorge M, Raimondo, Massimo, Woodward, Timothy A, Crook, Julia, Odell, John, Wallace, Michael B. Accuracy of EUS, EBUS, and combined EUS/EBUS for non-small cell lung cancer evaluation in patients with a negative CT and PET of the mediastinum. Gastrointestinal Endoscopy. 2009;69(5):AB325.
26. Jhun BW, Park HY, Jeon K, Koh WJ, Suh GY, Chung MP, Kim H, Kwon OJ, Han J, Um SW. Nodal stations and diagnostic performances of endobronchial ultrasound-guided transbronchial needle aspiration in patients with non-small cell lung cancer. Journal of Korean medical science. 2012;27(1):46-51.
27. Krasnik M, Vilmann P, Larsen SS, Jacobsen GK. Preliminary experience with a new method of endoscopic transbronchial real time ultrasound guided biopsy for diagnosis of mediastinal and hilar lesions. Thorax. 2003;58(12):1083-6.
28. Laurence Crombag, Jos Stigt, Christophe Dooms, Kurt Tournoy, Olga Schuurbiers, Daniel Korevaar, Jouke Annema. Added value of EUS-B to EBUS for lung cancer staging. Eur Respir J. 2015;46(s59):PA772.
29. Lee HS, Lee GK, Lee HS, Kim MS, Lee JM, Kim HY, Nam BH, Zo JI, Hwangbo B. Real-time endobronchial ultrasound-guided transbronchial needle aspiration in mediastinal staging of non-small cell lung cancer: how many aspirations per target lymph node station?. Chest. 2008;134(2):368-74.
30. Lee KJ, Suh GY, Chung MP, Kim H, Kwon OJ, Han J, Um SW. Combined endobronchial and transesophageal approach of an ultrasound bronchoscope for mediastinal staging of lung cancer. PloS one. 2014;9(3):e91893.
31. Lee BE, Kletsman E, Rutledge JR, Korst RJ. Utility of endobronchial ultrasound-guided mediastinal lymph node biopsy in patients with non-small cell lung cancer. The Journal of thoracic and cardiovascular surgery. 2012;143(3):585-90.
32. Liberman M, Sampalis J, Duranceau A, Thiffault V, Hadjeres R, Ferraro P. Endosonographic mediastinal lymph node staging of lung cancer. Chest. 2014;146(2):389-97.
33. Monsó E, Andreo F, Rosell A, Cuellar P, Castellà E, Llatjós M. [Usefulness of endobronchial ultrasonography with real-time needle aspiration for lung cancer staging]. Medicina clinica. 2007;128(13):481-5.
34. Nakajima T, Yasufuku K, Iyoda A, Yoshida S, Suzuki M, Sekine Y, Shibuya K, Hiroshima K, Nakatani Y, Fujisawa T. The evaluation of lymph node metastasis by endobronchial ultrasound-guided transbronchial needle aspiration: crucial for selection of surgical candidates with metastatic lung tumors. The Journal of thoracic and cardiovascular surgery. 2007;134(6):1485-90.
35. Naur TMH, Konge L, Clementsen PF. Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Staging of Patients with Non-Small Cell Lung Cancer without Mediastinal Involvement at Positron Emission Tomography-Computed Tomography. Respiration; international review of thoracic diseases. 2017;94(3):279-284.
36. Ohnishi R, Yasuda I, Kato T, Tanaka T, Kaneko Y, Suzuki T, Yasuda S, Sano K, Doi S, Nakashima M, Hara T, Tsurumi H, Murakami N, Moriwaki H. Combined endobronchial and endoscopic ultrasound-guided fine needle aspiration for mediastinal nodal staging of lung cancer. Endoscopy. 2011;43(12):1082-9.
37. Okamoto H, Watanabe K, Nagatomo A, Kunikane H, Aono H, Yamagata T, Kase M. Endobronchial ultrasonography for mediastinal and hilar lymph node metastases of lung cancer. Chest. 2002;121(5):1498-506.
38. Oki M, Saka H, Ando M, Kitagawa C, Kogure Y, Seki Y. Endoscopic ultrasound-guided fine needle aspiration and endobronchial ultrasound-guided transbronchial needle aspiration: Are two better than one in mediastinal staging of non-small cell lung cancer?. The Journal of thoracic and cardiovascular surgery. 2014;148(4):1169-77.
39. Oki M, Saka H, Kitagawa C, Kogure Y, Murata N, Adachi T, Ichihara S, Moritani S. Transesophageal bronchoscopic ultrasound-guided fine needle aspiration for diagnosis of sarcoidosis. Respiration; international review of thoracic diseases. 2013;85(2):137-43.
40. Ong P, Grosu H, Eapen GA, Rodriguez M, Lazarus D, Ost D, Jimenez CA, Morice R, Bandi V, Tamara L, Cornwell L, Green L, Zhu A, Casal RF. Endobronchial ultrasound-guided transbronchial needle aspiration for systematic nodal staging of lung cancer in patients with N0 disease by computed tomography and integrated positron emission tomography-computed tomography. Annals of the American Thoracic Society. 2015;12(3):415-9.
41. Pierard PE, Faber J, Bauwens O. Evaulation of a new tool in mediastinal staging of lung cancer: real-time guided needle aspiration using endobronchial ultrasound (EBUS-NA). Chest. 2006;
42. Plat G, Pierard P, Haller A, Hutsebaut J, Faber J, Dusart M, Eisendrath P, Sculier JP, Ninane V. Endobronchial ultrasound and positron emission tomography positive mediastinal lymph nodes. The European respiratory journal. 2006;27(2):276-81.
43. Rintoul RC, Skwarski KM, Murchison JT, Wallace WA, Walker WS, Penman ID. Endobronchial and endoscopic ultrasound-guided real-time fine-needle aspiration for mediastinal staging. The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology. 2005;25(3):416-21.
44. Shingyoji M, Nakajima T, Yoshino M, Yoshida Y, Ashinuma H, Itakura M, Tatsumi K, Iizasa T. Endobronchial ultrasonography for positron emission tomography and computed tomography-negative lymph node staging in non-small cell lung cancer. The Annals of thoracic surgery. 2014;98(5):1762-7.
45. Skwarski KM, McCafferty J, Wood F. Minimally invasive staging in lung cancer by real time endobronchial ultrasound FNA (EBUS). Chest. 2007;:591-592.
46. Szlubowski A, Soja J, Kocon P, Talar P, Czajkowski W, Rudnicka-Sosin L, Cmiel A, Kuzdzal J. A comparison of the combined ultrasound of the mediastinum by use of a single ultrasound bronchoscope versus ultrasound bronchoscope plus ultrasound gastroscope in lung cancer staging: a prospective trial. Interactive cardiovascular and thoracic surgery. 2012;15(3):442-6; discussion 446.
47. Szlubowski A, Zieliński M, Soja J, Annema JT, Sośnicki W, Jakubiak M, Pankowski J, Cmiel A. A combined approach of endobronchial and endoscopic ultrasound-guided needle aspiration in the radiologically normal mediastinum in non-small-cell lung cancer staging–a prospective trial. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 2010;37(5):1175-9.
48. Szlubowski A, Zieliński M, Soja J, Filarecka A, Orzechowski S, Pankowski J, Obrochta A, Jakubiak M, Węgrzyn J, Cmiel A. Accurate and safe mediastinal restaging by combined endobronchial and endoscopic ultrasound-guided needle aspiration performed by single ultrasound bronchoscope. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 2014;46(2):262-6.
49. Taverner J, Cheang MY, Antippa P, See K, Irving LB, Steinfort DP. Negative EBUS-TBNA Predicts Very Low Prevalence of Mediastinal Disease in Staging of Non-Small Cell Lung Cancer. Journal of bronchology & interventional pulmonology. 2016;23(2):177-80.
50. Vilmann P, Krasnik M, Larsen SS, Jacobsen GK, Clementsen P. Transesophageal endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) biopsy: a combined approach in the evaluation of mediastinal lesions. Endoscopy. 2005;37(9):833-9.
51. Vincent BD, El-Bayoumi E, Hoffman B, Doelken P, DeRosimo J, Reed C, Silvestri GA. Real-time endobronchial ultrasound-guided transbronchial lymph node aspiration. The Annals of thoracic surgery. 2008;85(1):224-30.
52. Wallace MB, Pascual JM, Raimondo M, Woodward TA, McComb BL, Crook JE, Johnson MM, Al-Haddad MA, Gross SA, Pungpapong S, Hardee JN, Odell JA. Minimally invasive endoscopic staging of suspected lung cancer. JAMA : the journal of the American Medical Association. 2008;299(5):540-6.
53. Yasufuku K, Chiyo M, Koh E, Moriya Y, Iyoda A, Sekine Y, Shibuya K, Iizasa T, Fujisawa T. Endobronchial ultrasound guided transbronchial needle aspiration for staging of lung cancer. Lung cancer (Amsterdam, Netherlands). 2005;50(3):347-54.
54. Yasufuku K, Chiyo M, Sekine Y, Chhajed PN, Shibuya K, Iizasa T, Fujisawa T. Real-time endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal and hilar lymph nodes. Chest. 2004;126(1):122-8.
55. Yasufuku K, Nakajima T, Motoori K, Sekine Y, Shibuya K, Hiroshima K, Fujisawa T. Comparison of endobronchial ultrasound, positron emission tomography, and CT for lymph node staging of lung cancer. Chest. 2006;130(3):710-8.
56. Yasufuku K, Nakajima T, Waddell T, Keshavjee S, Yoshino I. Endobronchial ultrasound-guided transbronchial needle aspiration for differentiating N0 versus N1 lung cancer. The Annals of thoracic surgery. 2013;96(5):1756-60.
57. Yasufuku K, Pierre A, Darling G, de Perrot M, Waddell T, Johnston M, da Cunha Santos G, Geddie W, Boerner S, Le LW, Keshavjee S. A prospective controlled trial of endobronchial ultrasound-guided transbronchial needle aspiration compared with mediastinoscopy for mediastinal lymph node staging of lung cancer. The Journal of thoracic and cardiovascular surgery. 2011;142(6):1393-400.e1.
58. Ye T, Hu H, Luo X, Chen H. The role of endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) for qualitative diagnosis of mediastinal and hilar lymphadenopathy: a prospective analysis. BMC cancer. 2011;11:100.
2. Dhooria S, Aggarwal AN, Gupta D, Behera D, Agarwal R. Utility and Safety of Endoscopic Ultrasound With Bronchoscope-Guided Fine-Needle Aspiration in Mediastinal Lymph Node Sampling: Systematic Review and Meta-Analysis. Respiratory care. 2015;60(7):1040-50.
3. Dong X, Qiu X, Liu Q, Jia J. Endobronchial ultrasound-guided transbronchial needle aspiration in the mediastinal staging of non-small cell lung cancer: a meta-analysis. The Annals of thoracic surgery. 2013;96(4):1502-1507.
4. El-Osta H, Jani P, Mansour A, Rascoe P, Jafri S. Endobronchial Ultrasound for Nodal Staging of Non-Small Cell Lung Cancer Patients with Radiologically Normal Mediastinum: A Meta-Analysis. Annals of the American Thoracic Society. 2018;15(7):864-874.
5. Gu P, Zhao YZ, Jiang LY, Zhang W, Xin Y, Han BH. Endobronchial ultrasound-guided transbronchial needle aspiration for staging of lung cancer: a systematic review and meta-analysis. European journal of cancer (Oxford, England : 1990). 2009;45(8):1389-96.
6. Korevaar DA, Crombag LM, Cohen JF, Spijker R, Bossuyt PM, Annema JT. Added value of combined endobronchial and oesophageal endosonography for mediastinal nodal staging in lung cancer: a systematic review and meta-analysis. The Lancet. Respiratory medicine. 2016;4(12):960-968.
7. Labarca G, Aravena C, Ortega F, Arenas A, Majid A, Folch E, Mehta HJ, Jantz MA, Fernandez-Bussy S. Minimally Invasive Methods for Staging in Lung Cancer: Systematic Review and Meta-Analysis. Pulmonary medicine. 2016;2016(no pagination):1024709.
8. Varela-Lema L, Fernández-Villar A, Ruano-Ravina A. Effectiveness and safety of endobronchial ultrasound-transbronchial needle aspiration: a systematic review. The European respiratory journal. 2009;33(5):1156-64.
9. Zhang R, Ying K, Shi L, Zhang L, Zhou L. Combined endobronchial and endoscopic ultrasound-guided fine needle aspiration for mediastinal lymph node staging of lung cancer: A meta-analysis. European journal of cancer (Oxford, England : 1990). 2013;49(8):1860-7.
10. ASTER. Annema JT, van Meerbeeck JP, Rintoul RC, Dooms C, Deschepper E, Dekkers OM, De Leyn P, Braun J, Carroll NR, Praet M, de Ryck F, Vansteenkiste J, Vermassen F, Versteegh MI, Veseliç M, Nicholson AG, Rabe KF, Tournoy KG. Mediastinoscopy vs endosonography for mediastinal nodal staging of lung cancer: a randomized trial. JAMA : the journal of the American Medical Association. 2010;304(20):2245-52.
11. Kang HJ, Hwangbo B, Lee GK, Nam BH, Lee HS, Kim MS, Lee JM, Zo JI, Lee HS, Han JY. EBUS-centred versus EUS-centred mediastinal staging in lung cancer: a randomised controlled trial. Thorax. 2014;69(3):261-8.
12. Araya T, Demura Y, Kasahara K, Matsuoka H, Yamamura K, Nishitsuji M, Nishi K. Usefulness of transesophageal bronchoscopic ultrasound-guided fine-needle aspiration in the pathologic and molecular diagnosis of lung cancer lesions adjacent to the esophagus. Journal of bronchology & interventional pulmonology. 2013;20(2):121-6.
13. Bauwens O, Dusart M, Pierard P, Faber J, Prigogine T, Duysinx B, Nguyen B, Paesmans M, Sculier JP, Ninane V. Endobronchial ultrasound and value of PET for prediction of pathological results of mediastinal hot spots in lung cancer patients. Lung cancer (Amsterdam, Netherlands). 2008;61(3):356-61.
14. Bugalho A, Ferreira D, Eberhardt R, Dias SS, Videira PA, Herth FJ, Carreiro L. Diagnostic value of endobronchial and endoscopic ultrasound-guided fine needle aspiration for accessible lung cancer lesions after non-diagnostic conventional techniques: a prospective study. BMC cancer. 2013;13:130.
15. Edwards, T, Al-Najjar, H, Crosbie, P, Martin, J, Booton, R, Evison, M. 85P: Performance of EBUS-TBNA in NSCLC mediastinal staging stratified according to ACCP radiographic groups on CT. Journal of Thoracic Oncology. 2016;11(4):S92.
16. Ernst A, Anantham D, Eberhardt R, Krasnik M, Herth FJ. Diagnosis of mediastinal adenopathy-real-time endobronchial ultrasound guided needle aspiration versus mediastinoscopy. Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer. 2008;3(6):577-82.
17. Gupta K, Mallery S. Small-caliber endobronchial ultrasonic videoscope: successful transesophageal and transgastric FNA after failed passage of a standard ultrasonic endoscope. Gastrointestinal endoscopy. 2007;66(3):574-7.
18. Hauer J, Szlubowski A, Żanowska K, Rudnicka-Sosin L, Trybalski Ł, Grochowski Z, Gil T, Włodarczyk J, Warmus J, Kocoń P, Smęder T, Kużdżał J. Minimally invasive strategy for mediastinal staging of patients with lung cancer. Polskie Archiwum Medycyny Wewnetrznej. 2015;125(12):910-3.
19. Herth FJ, Eberhardt R, Krasnik M, Ernst A. Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically and positron emission tomography-normal mediastinum in patients with lung cancer. Chest. 2008;133(4):887-91.
20. Herth FJ, Eberhardt R, Vilmann P, Krasnik M, Ernst A. Real-time endobronchial ultrasound guided transbronchial needle aspiration for sampling mediastinal lymph nodes. Thorax. 2006;61(9):795-8.
21. Herth FJ, Ernst A, Eberhardt R, Vilmann P, Dienemann H, Krasnik M. Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically normal mediastinum. The European respiratory journal. 2006;28(5):910-4.
22. Herth FJ, Krasnik M, Kahn N, Eberhardt R, Ernst A. Combined endoscopic-endobronchial ultrasound-guided fine-needle aspiration of mediastinal lymph nodes through a single bronchoscope in 150 patients with suspected lung cancer. Chest. 2010;138(4):790-4.
23. Hwangbo B, Kim SK, Lee HS, Lee HS, Kim MS, Lee JM, Kim HY, Lee GK, Nam BH, Zo JI. Application of endobronchial ultrasound-guided transbronchial needle aspiration following integrated PET/CT in mediastinal staging of potentially operable non-small cell lung cancer. Chest. 2009;135(5):1280-7.
24. Hwangbo B, Lee GK, Lee HS, Lim KY, Lee SH, Kim HY, Lee HS, Kim MS, Lee JM, Nam BH, Zo JI. Transbronchial and transesophageal fine-needle aspiration using an ultrasound bronchoscope in mediastinal staging of potentially operable lung cancer. Chest. 2010;138(4):795-802.
25. Jamil, Laith H, De Frutos, Noelia Cubero, Gill, Kanwar R, Gross, Seth A, Pascual, Jorge M, Raimondo, Massimo, Woodward, Timothy A, Crook, Julia, Odell, John, Wallace, Michael B. Accuracy of EUS, EBUS, and combined EUS/EBUS for non-small cell lung cancer evaluation in patients with a negative CT and PET of the mediastinum. Gastrointestinal Endoscopy. 2009;69(5):AB325.
26. Jhun BW, Park HY, Jeon K, Koh WJ, Suh GY, Chung MP, Kim H, Kwon OJ, Han J, Um SW. Nodal stations and diagnostic performances of endobronchial ultrasound-guided transbronchial needle aspiration in patients with non-small cell lung cancer. Journal of Korean medical science. 2012;27(1):46-51.
27. Krasnik M, Vilmann P, Larsen SS, Jacobsen GK. Preliminary experience with a new method of endoscopic transbronchial real time ultrasound guided biopsy for diagnosis of mediastinal and hilar lesions. Thorax. 2003;58(12):1083-6.
28. Laurence Crombag, Jos Stigt, Christophe Dooms, Kurt Tournoy, Olga Schuurbiers, Daniel Korevaar, Jouke Annema. Added value of EUS-B to EBUS for lung cancer staging. Eur Respir J. 2015;46(s59):PA772.
29. Lee HS, Lee GK, Lee HS, Kim MS, Lee JM, Kim HY, Nam BH, Zo JI, Hwangbo B. Real-time endobronchial ultrasound-guided transbronchial needle aspiration in mediastinal staging of non-small cell lung cancer: how many aspirations per target lymph node station?. Chest. 2008;134(2):368-74.
30. Lee KJ, Suh GY, Chung MP, Kim H, Kwon OJ, Han J, Um SW. Combined endobronchial and transesophageal approach of an ultrasound bronchoscope for mediastinal staging of lung cancer. PloS one. 2014;9(3):e91893.
31. Lee BE, Kletsman E, Rutledge JR, Korst RJ. Utility of endobronchial ultrasound-guided mediastinal lymph node biopsy in patients with non-small cell lung cancer. The Journal of thoracic and cardiovascular surgery. 2012;143(3):585-90.
32. Liberman M, Sampalis J, Duranceau A, Thiffault V, Hadjeres R, Ferraro P. Endosonographic mediastinal lymph node staging of lung cancer. Chest. 2014;146(2):389-97.
33. Monsó E, Andreo F, Rosell A, Cuellar P, Castellà E, Llatjós M. [Usefulness of endobronchial ultrasonography with real-time needle aspiration for lung cancer staging]. Medicina clinica. 2007;128(13):481-5.
34. Nakajima T, Yasufuku K, Iyoda A, Yoshida S, Suzuki M, Sekine Y, Shibuya K, Hiroshima K, Nakatani Y, Fujisawa T. The evaluation of lymph node metastasis by endobronchial ultrasound-guided transbronchial needle aspiration: crucial for selection of surgical candidates with metastatic lung tumors. The Journal of thoracic and cardiovascular surgery. 2007;134(6):1485-90.
35. Naur TMH, Konge L, Clementsen PF. Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Staging of Patients with Non-Small Cell Lung Cancer without Mediastinal Involvement at Positron Emission Tomography-Computed Tomography. Respiration; international review of thoracic diseases. 2017;94(3):279-284.
36. Ohnishi R, Yasuda I, Kato T, Tanaka T, Kaneko Y, Suzuki T, Yasuda S, Sano K, Doi S, Nakashima M, Hara T, Tsurumi H, Murakami N, Moriwaki H. Combined endobronchial and endoscopic ultrasound-guided fine needle aspiration for mediastinal nodal staging of lung cancer. Endoscopy. 2011;43(12):1082-9.
37. Okamoto H, Watanabe K, Nagatomo A, Kunikane H, Aono H, Yamagata T, Kase M. Endobronchial ultrasonography for mediastinal and hilar lymph node metastases of lung cancer. Chest. 2002;121(5):1498-506.
38. Oki M, Saka H, Ando M, Kitagawa C, Kogure Y, Seki Y. Endoscopic ultrasound-guided fine needle aspiration and endobronchial ultrasound-guided transbronchial needle aspiration: Are two better than one in mediastinal staging of non-small cell lung cancer?. The Journal of thoracic and cardiovascular surgery. 2014;148(4):1169-77.
39. Oki M, Saka H, Kitagawa C, Kogure Y, Murata N, Adachi T, Ichihara S, Moritani S. Transesophageal bronchoscopic ultrasound-guided fine needle aspiration for diagnosis of sarcoidosis. Respiration; international review of thoracic diseases. 2013;85(2):137-43.
40. Ong P, Grosu H, Eapen GA, Rodriguez M, Lazarus D, Ost D, Jimenez CA, Morice R, Bandi V, Tamara L, Cornwell L, Green L, Zhu A, Casal RF. Endobronchial ultrasound-guided transbronchial needle aspiration for systematic nodal staging of lung cancer in patients with N0 disease by computed tomography and integrated positron emission tomography-computed tomography. Annals of the American Thoracic Society. 2015;12(3):415-9.
41. Pierard PE, Faber J, Bauwens O. Evaulation of a new tool in mediastinal staging of lung cancer: real-time guided needle aspiration using endobronchial ultrasound (EBUS-NA). Chest. 2006;
42. Plat G, Pierard P, Haller A, Hutsebaut J, Faber J, Dusart M, Eisendrath P, Sculier JP, Ninane V. Endobronchial ultrasound and positron emission tomography positive mediastinal lymph nodes. The European respiratory journal. 2006;27(2):276-81.
43. Rintoul RC, Skwarski KM, Murchison JT, Wallace WA, Walker WS, Penman ID. Endobronchial and endoscopic ultrasound-guided real-time fine-needle aspiration for mediastinal staging. The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology. 2005;25(3):416-21.
44. Shingyoji M, Nakajima T, Yoshino M, Yoshida Y, Ashinuma H, Itakura M, Tatsumi K, Iizasa T. Endobronchial ultrasonography for positron emission tomography and computed tomography-negative lymph node staging in non-small cell lung cancer. The Annals of thoracic surgery. 2014;98(5):1762-7.
45. Skwarski KM, McCafferty J, Wood F. Minimally invasive staging in lung cancer by real time endobronchial ultrasound FNA (EBUS). Chest. 2007;:591-592.
46. Szlubowski A, Soja J, Kocon P, Talar P, Czajkowski W, Rudnicka-Sosin L, Cmiel A, Kuzdzal J. A comparison of the combined ultrasound of the mediastinum by use of a single ultrasound bronchoscope versus ultrasound bronchoscope plus ultrasound gastroscope in lung cancer staging: a prospective trial. Interactive cardiovascular and thoracic surgery. 2012;15(3):442-6; discussion 446.
47. Szlubowski A, Zieliński M, Soja J, Annema JT, Sośnicki W, Jakubiak M, Pankowski J, Cmiel A. A combined approach of endobronchial and endoscopic ultrasound-guided needle aspiration in the radiologically normal mediastinum in non-small-cell lung cancer staging–a prospective trial. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 2010;37(5):1175-9.
48. Szlubowski A, Zieliński M, Soja J, Filarecka A, Orzechowski S, Pankowski J, Obrochta A, Jakubiak M, Węgrzyn J, Cmiel A. Accurate and safe mediastinal restaging by combined endobronchial and endoscopic ultrasound-guided needle aspiration performed by single ultrasound bronchoscope. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 2014;46(2):262-6.
49. Taverner J, Cheang MY, Antippa P, See K, Irving LB, Steinfort DP. Negative EBUS-TBNA Predicts Very Low Prevalence of Mediastinal Disease in Staging of Non-Small Cell Lung Cancer. Journal of bronchology & interventional pulmonology. 2016;23(2):177-80.
50. Vilmann P, Krasnik M, Larsen SS, Jacobsen GK, Clementsen P. Transesophageal endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) biopsy: a combined approach in the evaluation of mediastinal lesions. Endoscopy. 2005;37(9):833-9.
51. Vincent BD, El-Bayoumi E, Hoffman B, Doelken P, DeRosimo J, Reed C, Silvestri GA. Real-time endobronchial ultrasound-guided transbronchial lymph node aspiration. The Annals of thoracic surgery. 2008;85(1):224-30.
52. Wallace MB, Pascual JM, Raimondo M, Woodward TA, McComb BL, Crook JE, Johnson MM, Al-Haddad MA, Gross SA, Pungpapong S, Hardee JN, Odell JA. Minimally invasive endoscopic staging of suspected lung cancer. JAMA : the journal of the American Medical Association. 2008;299(5):540-6.
53. Yasufuku K, Chiyo M, Koh E, Moriya Y, Iyoda A, Sekine Y, Shibuya K, Iizasa T, Fujisawa T. Endobronchial ultrasound guided transbronchial needle aspiration for staging of lung cancer. Lung cancer (Amsterdam, Netherlands). 2005;50(3):347-54.
54. Yasufuku K, Chiyo M, Sekine Y, Chhajed PN, Shibuya K, Iizasa T, Fujisawa T. Real-time endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal and hilar lymph nodes. Chest. 2004;126(1):122-8.
55. Yasufuku K, Nakajima T, Motoori K, Sekine Y, Shibuya K, Hiroshima K, Fujisawa T. Comparison of endobronchial ultrasound, positron emission tomography, and CT for lymph node staging of lung cancer. Chest. 2006;130(3):710-8.
56. Yasufuku K, Nakajima T, Waddell T, Keshavjee S, Yoshino I. Endobronchial ultrasound-guided transbronchial needle aspiration for differentiating N0 versus N1 lung cancer. The Annals of thoracic surgery. 2013;96(5):1756-60.
57. Yasufuku K, Pierre A, Darling G, de Perrot M, Waddell T, Johnston M, da Cunha Santos G, Geddie W, Boerner S, Le LW, Keshavjee S. A prospective controlled trial of endobronchial ultrasound-guided transbronchial needle aspiration compared with mediastinoscopy for mediastinal lymph node staging of lung cancer. The Journal of thoracic and cardiovascular surgery. 2011;142(6):1393-400.e1.
58. Ye T, Hu H, Luo X, Chen H. The role of endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) for qualitative diagnosis of mediastinal and hilar lymphadenopathy: a prospective analysis. BMC cancer. 2011;11:100.
Búsqueda y Síntesis de Evidencia
Búsqueda y síntesis de evidencia de efectos deseables e indeseables
4.- ¿Qué tan significativos son los efectos indeseables anticipados?
| Grandes | Moderados | Pequeños | Triviales | Varía | No lo sé |
|---|
Pequeños: El panel de expertos de la Guía estimó que los efectos indeseables de «realizar ecobroncoscopia (EBUS)» en comparación a «realizar mediastinoscopia» son pequeños, considerando la evidencia, experiencia clínica, conocimiento de gestión o experiencia de las personas con la condición o problema de salud. De todos modos, cabe destacar que en algunos casos, el material obtenido por EBUS puede ser insuficiente y no permite el diagnóstico molecular. En caso que el EBUS no sea diagnóstico se debe plantear la etapificación con mediastinoscopía.
Evidencia de investigación
Efectos indeseables del uso de EBUS [22, 24, 30, 38]:
• El test de EBUS probablemente clasifica incorrectamente a 79 de los 400 pacientes con compromiso mediastínico (falsos negativos).
• El test de EBUS probablemente clasifica incorrectamente a 0 de los 600 pacientes sin compromiso mediastínico (falsos positivos).
Referencias
1. Adams K, Shah PL, Edmonds L, Lim E. Test performance of endobronchial ultrasound and transbronchial needle aspiration biopsy for mediastinal staging in patients with lung cancer: systematic review and meta-analysis. Thorax. 2009;64(9):757-62.
2. Dhooria S, Aggarwal AN, Gupta D, Behera D, Agarwal R. Utility and Safety of Endoscopic Ultrasound With Bronchoscope-Guided Fine-Needle Aspiration in Mediastinal Lymph Node Sampling: Systematic Review and Meta-Analysis. Respiratory care. 2015;60(7):1040-50.
3. Dong X, Qiu X, Liu Q, Jia J. Endobronchial ultrasound-guided transbronchial needle aspiration in the mediastinal staging of non-small cell lung cancer: a meta-analysis. The Annals of thoracic surgery. 2013;96(4):1502-1507.
4. El-Osta H, Jani P, Mansour A, Rascoe P, Jafri S. Endobronchial Ultrasound for Nodal Staging of Non-Small Cell Lung Cancer Patients with Radiologically Normal Mediastinum: A Meta-Analysis. Annals of the American Thoracic Society. 2018;15(7):864-874.
5. Gu P, Zhao YZ, Jiang LY, Zhang W, Xin Y, Han BH. Endobronchial ultrasound-guided transbronchial needle aspiration for staging of lung cancer: a systematic review and meta-analysis. European journal of cancer (Oxford, England : 1990). 2009;45(8):1389-96.
6. Korevaar DA, Crombag LM, Cohen JF, Spijker R, Bossuyt PM, Annema JT. Added value of combined endobronchial and oesophageal endosonography for mediastinal nodal staging in lung cancer: a systematic review and meta-analysis. The Lancet. Respiratory medicine. 2016;4(12):960-968.
7. Labarca G, Aravena C, Ortega F, Arenas A, Majid A, Folch E, Mehta HJ, Jantz MA, Fernandez-Bussy S. Minimally Invasive Methods for Staging in Lung Cancer: Systematic Review and Meta-Analysis. Pulmonary medicine. 2016;2016(no pagination):1024709.
8. Varela-Lema L, Fernández-Villar A, Ruano-Ravina A. Effectiveness and safety of endobronchial ultrasound-transbronchial needle aspiration: a systematic review. The European respiratory journal. 2009;33(5):1156-64.
9. Zhang R, Ying K, Shi L, Zhang L, Zhou L. Combined endobronchial and endoscopic ultrasound-guided fine needle aspiration for mediastinal lymph node staging of lung cancer: A meta-analysis. European journal of cancer (Oxford, England : 1990). 2013;49(8):1860-7.
10. ASTER. Annema JT, van Meerbeeck JP, Rintoul RC, Dooms C, Deschepper E, Dekkers OM, De Leyn P, Braun J, Carroll NR, Praet M, de Ryck F, Vansteenkiste J, Vermassen F, Versteegh MI, Veseliç M, Nicholson AG, Rabe KF, Tournoy KG. Mediastinoscopy vs endosonography for mediastinal nodal staging of lung cancer: a randomized trial. JAMA : the journal of the American Medical Association. 2010;304(20):2245-52.
11. Kang HJ, Hwangbo B, Lee GK, Nam BH, Lee HS, Kim MS, Lee JM, Zo JI, Lee HS, Han JY. EBUS-centred versus EUS-centred mediastinal staging in lung cancer: a randomised controlled trial. Thorax. 2014;69(3):261-8.
12. Araya T, Demura Y, Kasahara K, Matsuoka H, Yamamura K, Nishitsuji M, Nishi K. Usefulness of transesophageal bronchoscopic ultrasound-guided fine-needle aspiration in the pathologic and molecular diagnosis of lung cancer lesions adjacent to the esophagus. Journal of bronchology & interventional pulmonology. 2013;20(2):121-6.
13. Bauwens O, Dusart M, Pierard P, Faber J, Prigogine T, Duysinx B, Nguyen B, Paesmans M, Sculier JP, Ninane V. Endobronchial ultrasound and value of PET for prediction of pathological results of mediastinal hot spots in lung cancer patients. Lung cancer (Amsterdam, Netherlands). 2008;61(3):356-61.
14. Bugalho A, Ferreira D, Eberhardt R, Dias SS, Videira PA, Herth FJ, Carreiro L. Diagnostic value of endobronchial and endoscopic ultrasound-guided fine needle aspiration for accessible lung cancer lesions after non-diagnostic conventional techniques: a prospective study. BMC cancer. 2013;13:130.
15. Edwards, T, Al-Najjar, H, Crosbie, P, Martin, J, Booton, R, Evison, M. 85P: Performance of EBUS-TBNA in NSCLC mediastinal staging stratified according to ACCP radiographic groups on CT. Journal of Thoracic Oncology. 2016;11(4):S92.
16. Ernst A, Anantham D, Eberhardt R, Krasnik M, Herth FJ. Diagnosis of mediastinal adenopathy-real-time endobronchial ultrasound guided needle aspiration versus mediastinoscopy. Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer. 2008;3(6):577-82.
17. Gupta K, Mallery S. Small-caliber endobronchial ultrasonic videoscope: successful transesophageal and transgastric FNA after failed passage of a standard ultrasonic endoscope. Gastrointestinal endoscopy. 2007;66(3):574-7.
18. Hauer J, Szlubowski A, Żanowska K, Rudnicka-Sosin L, Trybalski Ł, Grochowski Z, Gil T, Włodarczyk J, Warmus J, Kocoń P, Smęder T, Kużdżał J. Minimally invasive strategy for mediastinal staging of patients with lung cancer. Polskie Archiwum Medycyny Wewnetrznej. 2015;125(12):910-3.
19. Herth FJ, Eberhardt R, Krasnik M, Ernst A. Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically and positron emission tomography-normal mediastinum in patients with lung cancer. Chest. 2008;133(4):887-91.
20. Herth FJ, Eberhardt R, Vilmann P, Krasnik M, Ernst A. Real-time endobronchial ultrasound guided transbronchial needle aspiration for sampling mediastinal lymph nodes. Thorax. 2006;61(9):795-8.
21. Herth FJ, Ernst A, Eberhardt R, Vilmann P, Dienemann H, Krasnik M. Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically normal mediastinum. The European respiratory journal. 2006;28(5):910-4.
22. Herth FJ, Krasnik M, Kahn N, Eberhardt R, Ernst A. Combined endoscopic-endobronchial ultrasound-guided fine-needle aspiration of mediastinal lymph nodes through a single bronchoscope in 150 patients with suspected lung cancer. Chest. 2010;138(4):790-4.
23. Hwangbo B, Kim SK, Lee HS, Lee HS, Kim MS, Lee JM, Kim HY, Lee GK, Nam BH, Zo JI. Application of endobronchial ultrasound-guided transbronchial needle aspiration following integrated PET/CT in mediastinal staging of potentially operable non-small cell lung cancer. Chest. 2009;135(5):1280-7.
24. Hwangbo B, Lee GK, Lee HS, Lim KY, Lee SH, Kim HY, Lee HS, Kim MS, Lee JM, Nam BH, Zo JI. Transbronchial and transesophageal fine-needle aspiration using an ultrasound bronchoscope in mediastinal staging of potentially operable lung cancer. Chest. 2010;138(4):795-802.
25. Jamil, Laith H, De Frutos, Noelia Cubero, Gill, Kanwar R, Gross, Seth A, Pascual, Jorge M, Raimondo, Massimo, Woodward, Timothy A, Crook, Julia, Odell, John, Wallace, Michael B. Accuracy of EUS, EBUS, and combined EUS/EBUS for non-small cell lung cancer evaluation in patients with a negative CT and PET of the mediastinum. Gastrointestinal Endoscopy. 2009;69(5):AB325.
26. Jhun BW, Park HY, Jeon K, Koh WJ, Suh GY, Chung MP, Kim H, Kwon OJ, Han J, Um SW. Nodal stations and diagnostic performances of endobronchial ultrasound-guided transbronchial needle aspiration in patients with non-small cell lung cancer. Journal of Korean medical science. 2012;27(1):46-51.
27. Krasnik M, Vilmann P, Larsen SS, Jacobsen GK. Preliminary experience with a new method of endoscopic transbronchial real time ultrasound guided biopsy for diagnosis of mediastinal and hilar lesions. Thorax. 2003;58(12):1083-6.
28. Laurence Crombag, Jos Stigt, Christophe Dooms, Kurt Tournoy, Olga Schuurbiers, Daniel Korevaar, Jouke Annema. Added value of EUS-B to EBUS for lung cancer staging. Eur Respir J. 2015;46(s59):PA772.
29. Lee HS, Lee GK, Lee HS, Kim MS, Lee JM, Kim HY, Nam BH, Zo JI, Hwangbo B. Real-time endobronchial ultrasound-guided transbronchial needle aspiration in mediastinal staging of non-small cell lung cancer: how many aspirations per target lymph node station?. Chest. 2008;134(2):368-74.
30. Lee KJ, Suh GY, Chung MP, Kim H, Kwon OJ, Han J, Um SW. Combined endobronchial and transesophageal approach of an ultrasound bronchoscope for mediastinal staging of lung cancer. PloS one. 2014;9(3):e91893.
31. Lee BE, Kletsman E, Rutledge JR, Korst RJ. Utility of endobronchial ultrasound-guided mediastinal lymph node biopsy in patients with non-small cell lung cancer. The Journal of thoracic and cardiovascular surgery. 2012;143(3):585-90.
32. Liberman M, Sampalis J, Duranceau A, Thiffault V, Hadjeres R, Ferraro P. Endosonographic mediastinal lymph node staging of lung cancer. Chest. 2014;146(2):389-97.
33. Monsó E, Andreo F, Rosell A, Cuellar P, Castellà E, Llatjós M. [Usefulness of endobronchial ultrasonography with real-time needle aspiration for lung cancer staging]. Medicina clinica. 2007;128(13):481-5.
34. Nakajima T, Yasufuku K, Iyoda A, Yoshida S, Suzuki M, Sekine Y, Shibuya K, Hiroshima K, Nakatani Y, Fujisawa T. The evaluation of lymph node metastasis by endobronchial ultrasound-guided transbronchial needle aspiration: crucial for selection of surgical candidates with metastatic lung tumors. The Journal of thoracic and cardiovascular surgery. 2007;134(6):1485-90.
35. Naur TMH, Konge L, Clementsen PF. Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Staging of Patients with Non-Small Cell Lung Cancer without Mediastinal Involvement at Positron Emission Tomography-Computed Tomography. Respiration; international review of thoracic diseases. 2017;94(3):279-284.
36. Ohnishi R, Yasuda I, Kato T, Tanaka T, Kaneko Y, Suzuki T, Yasuda S, Sano K, Doi S, Nakashima M, Hara T, Tsurumi H, Murakami N, Moriwaki H. Combined endobronchial and endoscopic ultrasound-guided fine needle aspiration for mediastinal nodal staging of lung cancer. Endoscopy. 2011;43(12):1082-9.
37. Okamoto H, Watanabe K, Nagatomo A, Kunikane H, Aono H, Yamagata T, Kase M. Endobronchial ultrasonography for mediastinal and hilar lymph node metastases of lung cancer. Chest. 2002;121(5):1498-506.
38. Oki M, Saka H, Ando M, Kitagawa C, Kogure Y, Seki Y. Endoscopic ultrasound-guided fine needle aspiration and endobronchial ultrasound-guided transbronchial needle aspiration: Are two better than one in mediastinal staging of non-small cell lung cancer?. The Journal of thoracic and cardiovascular surgery. 2014;148(4):1169-77.
39. Oki M, Saka H, Kitagawa C, Kogure Y, Murata N, Adachi T, Ichihara S, Moritani S. Transesophageal bronchoscopic ultrasound-guided fine needle aspiration for diagnosis of sarcoidosis. Respiration; international review of thoracic diseases. 2013;85(2):137-43.
40. Ong P, Grosu H, Eapen GA, Rodriguez M, Lazarus D, Ost D, Jimenez CA, Morice R, Bandi V, Tamara L, Cornwell L, Green L, Zhu A, Casal RF. Endobronchial ultrasound-guided transbronchial needle aspiration for systematic nodal staging of lung cancer in patients with N0 disease by computed tomography and integrated positron emission tomography-computed tomography. Annals of the American Thoracic Society. 2015;12(3):415-9.
41. Pierard PE, Faber J, Bauwens O. Evaulation of a new tool in mediastinal staging of lung cancer: real-time guided needle aspiration using endobronchial ultrasound (EBUS-NA). Chest. 2006;
42. Plat G, Pierard P, Haller A, Hutsebaut J, Faber J, Dusart M, Eisendrath P, Sculier JP, Ninane V. Endobronchial ultrasound and positron emission tomography positive mediastinal lymph nodes. The European respiratory journal. 2006;27(2):276-81.
43. Rintoul RC, Skwarski KM, Murchison JT, Wallace WA, Walker WS, Penman ID. Endobronchial and endoscopic ultrasound-guided real-time fine-needle aspiration for mediastinal staging. The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology. 2005;25(3):416-21.
44. Shingyoji M, Nakajima T, Yoshino M, Yoshida Y, Ashinuma H, Itakura M, Tatsumi K, Iizasa T. Endobronchial ultrasonography for positron emission tomography and computed tomography-negative lymph node staging in non-small cell lung cancer. The Annals of thoracic surgery. 2014;98(5):1762-7.
45. Skwarski KM, McCafferty J, Wood F. Minimally invasive staging in lung cancer by real time endobronchial ultrasound FNA (EBUS). Chest. 2007;:591-592.
46. Szlubowski A, Soja J, Kocon P, Talar P, Czajkowski W, Rudnicka-Sosin L, Cmiel A, Kuzdzal J. A comparison of the combined ultrasound of the mediastinum by use of a single ultrasound bronchoscope versus ultrasound bronchoscope plus ultrasound gastroscope in lung cancer staging: a prospective trial. Interactive cardiovascular and thoracic surgery. 2012;15(3):442-6; discussion 446.
47. Szlubowski A, Zieliński M, Soja J, Annema JT, Sośnicki W, Jakubiak M, Pankowski J, Cmiel A. A combined approach of endobronchial and endoscopic ultrasound-guided needle aspiration in the radiologically normal mediastinum in non-small-cell lung cancer staging–a prospective trial. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 2010;37(5):1175-9.
48. Szlubowski A, Zieliński M, Soja J, Filarecka A, Orzechowski S, Pankowski J, Obrochta A, Jakubiak M, Węgrzyn J, Cmiel A. Accurate and safe mediastinal restaging by combined endobronchial and endoscopic ultrasound-guided needle aspiration performed by single ultrasound bronchoscope. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 2014;46(2):262-6.
49. Taverner J, Cheang MY, Antippa P, See K, Irving LB, Steinfort DP. Negative EBUS-TBNA Predicts Very Low Prevalence of Mediastinal Disease in Staging of Non-Small Cell Lung Cancer. Journal of bronchology & interventional pulmonology. 2016;23(2):177-80.
50. Vilmann P, Krasnik M, Larsen SS, Jacobsen GK, Clementsen P. Transesophageal endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) biopsy: a combined approach in the evaluation of mediastinal lesions. Endoscopy. 2005;37(9):833-9.
51. Vincent BD, El-Bayoumi E, Hoffman B, Doelken P, DeRosimo J, Reed C, Silvestri GA. Real-time endobronchial ultrasound-guided transbronchial lymph node aspiration. The Annals of thoracic surgery. 2008;85(1):224-30.
52. Wallace MB, Pascual JM, Raimondo M, Woodward TA, McComb BL, Crook JE, Johnson MM, Al-Haddad MA, Gross SA, Pungpapong S, Hardee JN, Odell JA. Minimally invasive endoscopic staging of suspected lung cancer. JAMA : the journal of the American Medical Association. 2008;299(5):540-6.
53. Yasufuku K, Chiyo M, Koh E, Moriya Y, Iyoda A, Sekine Y, Shibuya K, Iizasa T, Fujisawa T. Endobronchial ultrasound guided transbronchial needle aspiration for staging of lung cancer. Lung cancer (Amsterdam, Netherlands). 2005;50(3):347-54.
54. Yasufuku K, Chiyo M, Sekine Y, Chhajed PN, Shibuya K, Iizasa T, Fujisawa T. Real-time endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal and hilar lymph nodes. Chest. 2004;126(1):122-8.
55. Yasufuku K, Nakajima T, Motoori K, Sekine Y, Shibuya K, Hiroshima K, Fujisawa T. Comparison of endobronchial ultrasound, positron emission tomography, and CT for lymph node staging of lung cancer. Chest. 2006;130(3):710-8.
56. Yasufuku K, Nakajima T, Waddell T, Keshavjee S, Yoshino I. Endobronchial ultrasound-guided transbronchial needle aspiration for differentiating N0 versus N1 lung cancer. The Annals of thoracic surgery. 2013;96(5):1756-60.
57. Yasufuku K, Pierre A, Darling G, de Perrot M, Waddell T, Johnston M, da Cunha Santos G, Geddie W, Boerner S, Le LW, Keshavjee S. A prospective controlled trial of endobronchial ultrasound-guided transbronchial needle aspiration compared with mediastinoscopy for mediastinal lymph node staging of lung cancer. The Journal of thoracic and cardiovascular surgery. 2011;142(6):1393-400.e1.
58. Ye T, Hu H, Luo X, Chen H. The role of endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) for qualitative diagnosis of mediastinal and hilar lymphadenopathy: a prospective analysis. BMC cancer. 2011;11:100.
2. Dhooria S, Aggarwal AN, Gupta D, Behera D, Agarwal R. Utility and Safety of Endoscopic Ultrasound With Bronchoscope-Guided Fine-Needle Aspiration in Mediastinal Lymph Node Sampling: Systematic Review and Meta-Analysis. Respiratory care. 2015;60(7):1040-50.
3. Dong X, Qiu X, Liu Q, Jia J. Endobronchial ultrasound-guided transbronchial needle aspiration in the mediastinal staging of non-small cell lung cancer: a meta-analysis. The Annals of thoracic surgery. 2013;96(4):1502-1507.
4. El-Osta H, Jani P, Mansour A, Rascoe P, Jafri S. Endobronchial Ultrasound for Nodal Staging of Non-Small Cell Lung Cancer Patients with Radiologically Normal Mediastinum: A Meta-Analysis. Annals of the American Thoracic Society. 2018;15(7):864-874.
5. Gu P, Zhao YZ, Jiang LY, Zhang W, Xin Y, Han BH. Endobronchial ultrasound-guided transbronchial needle aspiration for staging of lung cancer: a systematic review and meta-analysis. European journal of cancer (Oxford, England : 1990). 2009;45(8):1389-96.
6. Korevaar DA, Crombag LM, Cohen JF, Spijker R, Bossuyt PM, Annema JT. Added value of combined endobronchial and oesophageal endosonography for mediastinal nodal staging in lung cancer: a systematic review and meta-analysis. The Lancet. Respiratory medicine. 2016;4(12):960-968.
7. Labarca G, Aravena C, Ortega F, Arenas A, Majid A, Folch E, Mehta HJ, Jantz MA, Fernandez-Bussy S. Minimally Invasive Methods for Staging in Lung Cancer: Systematic Review and Meta-Analysis. Pulmonary medicine. 2016;2016(no pagination):1024709.
8. Varela-Lema L, Fernández-Villar A, Ruano-Ravina A. Effectiveness and safety of endobronchial ultrasound-transbronchial needle aspiration: a systematic review. The European respiratory journal. 2009;33(5):1156-64.
9. Zhang R, Ying K, Shi L, Zhang L, Zhou L. Combined endobronchial and endoscopic ultrasound-guided fine needle aspiration for mediastinal lymph node staging of lung cancer: A meta-analysis. European journal of cancer (Oxford, England : 1990). 2013;49(8):1860-7.
10. ASTER. Annema JT, van Meerbeeck JP, Rintoul RC, Dooms C, Deschepper E, Dekkers OM, De Leyn P, Braun J, Carroll NR, Praet M, de Ryck F, Vansteenkiste J, Vermassen F, Versteegh MI, Veseliç M, Nicholson AG, Rabe KF, Tournoy KG. Mediastinoscopy vs endosonography for mediastinal nodal staging of lung cancer: a randomized trial. JAMA : the journal of the American Medical Association. 2010;304(20):2245-52.
11. Kang HJ, Hwangbo B, Lee GK, Nam BH, Lee HS, Kim MS, Lee JM, Zo JI, Lee HS, Han JY. EBUS-centred versus EUS-centred mediastinal staging in lung cancer: a randomised controlled trial. Thorax. 2014;69(3):261-8.
12. Araya T, Demura Y, Kasahara K, Matsuoka H, Yamamura K, Nishitsuji M, Nishi K. Usefulness of transesophageal bronchoscopic ultrasound-guided fine-needle aspiration in the pathologic and molecular diagnosis of lung cancer lesions adjacent to the esophagus. Journal of bronchology & interventional pulmonology. 2013;20(2):121-6.
13. Bauwens O, Dusart M, Pierard P, Faber J, Prigogine T, Duysinx B, Nguyen B, Paesmans M, Sculier JP, Ninane V. Endobronchial ultrasound and value of PET for prediction of pathological results of mediastinal hot spots in lung cancer patients. Lung cancer (Amsterdam, Netherlands). 2008;61(3):356-61.
14. Bugalho A, Ferreira D, Eberhardt R, Dias SS, Videira PA, Herth FJ, Carreiro L. Diagnostic value of endobronchial and endoscopic ultrasound-guided fine needle aspiration for accessible lung cancer lesions after non-diagnostic conventional techniques: a prospective study. BMC cancer. 2013;13:130.
15. Edwards, T, Al-Najjar, H, Crosbie, P, Martin, J, Booton, R, Evison, M. 85P: Performance of EBUS-TBNA in NSCLC mediastinal staging stratified according to ACCP radiographic groups on CT. Journal of Thoracic Oncology. 2016;11(4):S92.
16. Ernst A, Anantham D, Eberhardt R, Krasnik M, Herth FJ. Diagnosis of mediastinal adenopathy-real-time endobronchial ultrasound guided needle aspiration versus mediastinoscopy. Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer. 2008;3(6):577-82.
17. Gupta K, Mallery S. Small-caliber endobronchial ultrasonic videoscope: successful transesophageal and transgastric FNA after failed passage of a standard ultrasonic endoscope. Gastrointestinal endoscopy. 2007;66(3):574-7.
18. Hauer J, Szlubowski A, Żanowska K, Rudnicka-Sosin L, Trybalski Ł, Grochowski Z, Gil T, Włodarczyk J, Warmus J, Kocoń P, Smęder T, Kużdżał J. Minimally invasive strategy for mediastinal staging of patients with lung cancer. Polskie Archiwum Medycyny Wewnetrznej. 2015;125(12):910-3.
19. Herth FJ, Eberhardt R, Krasnik M, Ernst A. Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically and positron emission tomography-normal mediastinum in patients with lung cancer. Chest. 2008;133(4):887-91.
20. Herth FJ, Eberhardt R, Vilmann P, Krasnik M, Ernst A. Real-time endobronchial ultrasound guided transbronchial needle aspiration for sampling mediastinal lymph nodes. Thorax. 2006;61(9):795-8.
21. Herth FJ, Ernst A, Eberhardt R, Vilmann P, Dienemann H, Krasnik M. Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically normal mediastinum. The European respiratory journal. 2006;28(5):910-4.
22. Herth FJ, Krasnik M, Kahn N, Eberhardt R, Ernst A. Combined endoscopic-endobronchial ultrasound-guided fine-needle aspiration of mediastinal lymph nodes through a single bronchoscope in 150 patients with suspected lung cancer. Chest. 2010;138(4):790-4.
23. Hwangbo B, Kim SK, Lee HS, Lee HS, Kim MS, Lee JM, Kim HY, Lee GK, Nam BH, Zo JI. Application of endobronchial ultrasound-guided transbronchial needle aspiration following integrated PET/CT in mediastinal staging of potentially operable non-small cell lung cancer. Chest. 2009;135(5):1280-7.
24. Hwangbo B, Lee GK, Lee HS, Lim KY, Lee SH, Kim HY, Lee HS, Kim MS, Lee JM, Nam BH, Zo JI. Transbronchial and transesophageal fine-needle aspiration using an ultrasound bronchoscope in mediastinal staging of potentially operable lung cancer. Chest. 2010;138(4):795-802.
25. Jamil, Laith H, De Frutos, Noelia Cubero, Gill, Kanwar R, Gross, Seth A, Pascual, Jorge M, Raimondo, Massimo, Woodward, Timothy A, Crook, Julia, Odell, John, Wallace, Michael B. Accuracy of EUS, EBUS, and combined EUS/EBUS for non-small cell lung cancer evaluation in patients with a negative CT and PET of the mediastinum. Gastrointestinal Endoscopy. 2009;69(5):AB325.
26. Jhun BW, Park HY, Jeon K, Koh WJ, Suh GY, Chung MP, Kim H, Kwon OJ, Han J, Um SW. Nodal stations and diagnostic performances of endobronchial ultrasound-guided transbronchial needle aspiration in patients with non-small cell lung cancer. Journal of Korean medical science. 2012;27(1):46-51.
27. Krasnik M, Vilmann P, Larsen SS, Jacobsen GK. Preliminary experience with a new method of endoscopic transbronchial real time ultrasound guided biopsy for diagnosis of mediastinal and hilar lesions. Thorax. 2003;58(12):1083-6.
28. Laurence Crombag, Jos Stigt, Christophe Dooms, Kurt Tournoy, Olga Schuurbiers, Daniel Korevaar, Jouke Annema. Added value of EUS-B to EBUS for lung cancer staging. Eur Respir J. 2015;46(s59):PA772.
29. Lee HS, Lee GK, Lee HS, Kim MS, Lee JM, Kim HY, Nam BH, Zo JI, Hwangbo B. Real-time endobronchial ultrasound-guided transbronchial needle aspiration in mediastinal staging of non-small cell lung cancer: how many aspirations per target lymph node station?. Chest. 2008;134(2):368-74.
30. Lee KJ, Suh GY, Chung MP, Kim H, Kwon OJ, Han J, Um SW. Combined endobronchial and transesophageal approach of an ultrasound bronchoscope for mediastinal staging of lung cancer. PloS one. 2014;9(3):e91893.
31. Lee BE, Kletsman E, Rutledge JR, Korst RJ. Utility of endobronchial ultrasound-guided mediastinal lymph node biopsy in patients with non-small cell lung cancer. The Journal of thoracic and cardiovascular surgery. 2012;143(3):585-90.
32. Liberman M, Sampalis J, Duranceau A, Thiffault V, Hadjeres R, Ferraro P. Endosonographic mediastinal lymph node staging of lung cancer. Chest. 2014;146(2):389-97.
33. Monsó E, Andreo F, Rosell A, Cuellar P, Castellà E, Llatjós M. [Usefulness of endobronchial ultrasonography with real-time needle aspiration for lung cancer staging]. Medicina clinica. 2007;128(13):481-5.
34. Nakajima T, Yasufuku K, Iyoda A, Yoshida S, Suzuki M, Sekine Y, Shibuya K, Hiroshima K, Nakatani Y, Fujisawa T. The evaluation of lymph node metastasis by endobronchial ultrasound-guided transbronchial needle aspiration: crucial for selection of surgical candidates with metastatic lung tumors. The Journal of thoracic and cardiovascular surgery. 2007;134(6):1485-90.
35. Naur TMH, Konge L, Clementsen PF. Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Staging of Patients with Non-Small Cell Lung Cancer without Mediastinal Involvement at Positron Emission Tomography-Computed Tomography. Respiration; international review of thoracic diseases. 2017;94(3):279-284.
36. Ohnishi R, Yasuda I, Kato T, Tanaka T, Kaneko Y, Suzuki T, Yasuda S, Sano K, Doi S, Nakashima M, Hara T, Tsurumi H, Murakami N, Moriwaki H. Combined endobronchial and endoscopic ultrasound-guided fine needle aspiration for mediastinal nodal staging of lung cancer. Endoscopy. 2011;43(12):1082-9.
37. Okamoto H, Watanabe K, Nagatomo A, Kunikane H, Aono H, Yamagata T, Kase M. Endobronchial ultrasonography for mediastinal and hilar lymph node metastases of lung cancer. Chest. 2002;121(5):1498-506.
38. Oki M, Saka H, Ando M, Kitagawa C, Kogure Y, Seki Y. Endoscopic ultrasound-guided fine needle aspiration and endobronchial ultrasound-guided transbronchial needle aspiration: Are two better than one in mediastinal staging of non-small cell lung cancer?. The Journal of thoracic and cardiovascular surgery. 2014;148(4):1169-77.
39. Oki M, Saka H, Kitagawa C, Kogure Y, Murata N, Adachi T, Ichihara S, Moritani S. Transesophageal bronchoscopic ultrasound-guided fine needle aspiration for diagnosis of sarcoidosis. Respiration; international review of thoracic diseases. 2013;85(2):137-43.
40. Ong P, Grosu H, Eapen GA, Rodriguez M, Lazarus D, Ost D, Jimenez CA, Morice R, Bandi V, Tamara L, Cornwell L, Green L, Zhu A, Casal RF. Endobronchial ultrasound-guided transbronchial needle aspiration for systematic nodal staging of lung cancer in patients with N0 disease by computed tomography and integrated positron emission tomography-computed tomography. Annals of the American Thoracic Society. 2015;12(3):415-9.
41. Pierard PE, Faber J, Bauwens O. Evaulation of a new tool in mediastinal staging of lung cancer: real-time guided needle aspiration using endobronchial ultrasound (EBUS-NA). Chest. 2006;
42. Plat G, Pierard P, Haller A, Hutsebaut J, Faber J, Dusart M, Eisendrath P, Sculier JP, Ninane V. Endobronchial ultrasound and positron emission tomography positive mediastinal lymph nodes. The European respiratory journal. 2006;27(2):276-81.
43. Rintoul RC, Skwarski KM, Murchison JT, Wallace WA, Walker WS, Penman ID. Endobronchial and endoscopic ultrasound-guided real-time fine-needle aspiration for mediastinal staging. The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology. 2005;25(3):416-21.
44. Shingyoji M, Nakajima T, Yoshino M, Yoshida Y, Ashinuma H, Itakura M, Tatsumi K, Iizasa T. Endobronchial ultrasonography for positron emission tomography and computed tomography-negative lymph node staging in non-small cell lung cancer. The Annals of thoracic surgery. 2014;98(5):1762-7.
45. Skwarski KM, McCafferty J, Wood F. Minimally invasive staging in lung cancer by real time endobronchial ultrasound FNA (EBUS). Chest. 2007;:591-592.
46. Szlubowski A, Soja J, Kocon P, Talar P, Czajkowski W, Rudnicka-Sosin L, Cmiel A, Kuzdzal J. A comparison of the combined ultrasound of the mediastinum by use of a single ultrasound bronchoscope versus ultrasound bronchoscope plus ultrasound gastroscope in lung cancer staging: a prospective trial. Interactive cardiovascular and thoracic surgery. 2012;15(3):442-6; discussion 446.
47. Szlubowski A, Zieliński M, Soja J, Annema JT, Sośnicki W, Jakubiak M, Pankowski J, Cmiel A. A combined approach of endobronchial and endoscopic ultrasound-guided needle aspiration in the radiologically normal mediastinum in non-small-cell lung cancer staging–a prospective trial. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 2010;37(5):1175-9.
48. Szlubowski A, Zieliński M, Soja J, Filarecka A, Orzechowski S, Pankowski J, Obrochta A, Jakubiak M, Węgrzyn J, Cmiel A. Accurate and safe mediastinal restaging by combined endobronchial and endoscopic ultrasound-guided needle aspiration performed by single ultrasound bronchoscope. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 2014;46(2):262-6.
49. Taverner J, Cheang MY, Antippa P, See K, Irving LB, Steinfort DP. Negative EBUS-TBNA Predicts Very Low Prevalence of Mediastinal Disease in Staging of Non-Small Cell Lung Cancer. Journal of bronchology & interventional pulmonology. 2016;23(2):177-80.
50. Vilmann P, Krasnik M, Larsen SS, Jacobsen GK, Clementsen P. Transesophageal endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) biopsy: a combined approach in the evaluation of mediastinal lesions. Endoscopy. 2005;37(9):833-9.
51. Vincent BD, El-Bayoumi E, Hoffman B, Doelken P, DeRosimo J, Reed C, Silvestri GA. Real-time endobronchial ultrasound-guided transbronchial lymph node aspiration. The Annals of thoracic surgery. 2008;85(1):224-30.
52. Wallace MB, Pascual JM, Raimondo M, Woodward TA, McComb BL, Crook JE, Johnson MM, Al-Haddad MA, Gross SA, Pungpapong S, Hardee JN, Odell JA. Minimally invasive endoscopic staging of suspected lung cancer. JAMA : the journal of the American Medical Association. 2008;299(5):540-6.
53. Yasufuku K, Chiyo M, Koh E, Moriya Y, Iyoda A, Sekine Y, Shibuya K, Iizasa T, Fujisawa T. Endobronchial ultrasound guided transbronchial needle aspiration for staging of lung cancer. Lung cancer (Amsterdam, Netherlands). 2005;50(3):347-54.
54. Yasufuku K, Chiyo M, Sekine Y, Chhajed PN, Shibuya K, Iizasa T, Fujisawa T. Real-time endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal and hilar lymph nodes. Chest. 2004;126(1):122-8.
55. Yasufuku K, Nakajima T, Motoori K, Sekine Y, Shibuya K, Hiroshima K, Fujisawa T. Comparison of endobronchial ultrasound, positron emission tomography, and CT for lymph node staging of lung cancer. Chest. 2006;130(3):710-8.
56. Yasufuku K, Nakajima T, Waddell T, Keshavjee S, Yoshino I. Endobronchial ultrasound-guided transbronchial needle aspiration for differentiating N0 versus N1 lung cancer. The Annals of thoracic surgery. 2013;96(5):1756-60.
57. Yasufuku K, Pierre A, Darling G, de Perrot M, Waddell T, Johnston M, da Cunha Santos G, Geddie W, Boerner S, Le LW, Keshavjee S. A prospective controlled trial of endobronchial ultrasound-guided transbronchial needle aspiration compared with mediastinoscopy for mediastinal lymph node staging of lung cancer. The Journal of thoracic and cardiovascular surgery. 2011;142(6):1393-400.e1.
58. Ye T, Hu H, Luo X, Chen H. The role of endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) for qualitative diagnosis of mediastinal and hilar lymphadenopathy: a prospective analysis. BMC cancer. 2011;11:100.
Búsqueda y Síntesis de Evidencia
Búsqueda y síntesis de evidencia de efectos deseables e indeseables
5.- ¿Cuál es la certeza general de la evidencia sobre la precisión de la prueba?
| Muy baja | Baja | Moderada | Alta | Ningún estudio incluido |
|---|
Moderada: Existe confianza respecto del efecto de «realizar ecobroncoscopia (EBUS)» en comparación a «realizar mediastinoscopia».
Evidencia de investigación
|
Resultado |
Diseño de estudio |
Precisión de la prueba |
|
Verdaderos positivos |
Estudio de exactitud de casos y controles |
⨁⨁⨁◯ |
|
Falsos negativos |
||
|
Verdaderos negativos |
Estudio de exactitud de casos y controles |
⨁⨁⨁◯ |
|
Falsos positivos |
a. Se disminuyó un nivel de certeza de la evidencia por inconsistencia sobre 80% en sensibilidad.
6.- ¿Cuál es certeza general de la evidencia sobre efectos de la prueba?
| Muy baja | Baja | Moderada | Alta | Ningún estudio incluido |
|---|
Baja: Existe cierta incertidumbre respecto del efecto de «inactivo» en comparación a «inactivo». Se disminuye un nivel de certeza de la evidencia respecto al ítem 5, dado que no se identificaron estudios que evaluaran el efecto de realizar EBUS en los desenlaces de salud para los pacientes con cáncer de pulmón (impacto diagnóstico).
7.- ¿Hay incertidumbre importante o variabilidad sobre qué tanto valora la gente los desenlaces principales?
| Incertidumbre o variabilidad importantes | Posiblemente hay incertidumbre o variabilidad importantes | Probablemente no hay incertidumbre ni variabilidad importantes | No hay variabilidad o incertidumbre importante |
|---|
No hay variabilidad o incertidumbre importante: En función de la evidencia de investigación, experiencia clínica, conocimiento de gestión o experiencia de las personas con la condición o problema de salud, el panel de expertos de la Guía consideró que no existe incertidumbre o variabilidad importante respecto a lo que escogería una persona informada de los efectos deseables e indeseables de «realizar ecobroncoscopia (EBUS)» y «realizar mediastinoscopia». A pesar de que la evidencia presentada no evalúa las preferencias de los pacientes respecto a EBUS vs mediastinoscopia, el panel indica que los pacientes optaría a EBUS dado que es menos invasivo.
Evidencia de investigación
Se identificaron dos estudios que medían la disposición de los pacientes a repetir «endosonografía bronquial» bajo sedación consciente leve:
Estudio inglés (1) observó que 61 de los 70 participantes que se sometieron a EBUS declararon que definitivamente o probablemente lo repetirían nuevamente en caso de ser necesario. Consistentemente estudio australiano (2) observó una muy alta satisfacción de los pacientes respecto al procedimiento, donde el 40 de 41 pacientes indicaron que «definitivamente volverían» a realizarse EBUS en el futuro si fuera necesario, y sólo un paciente (2%) que reportó que «probablemente» regresaría a realizarse tal procedimiento.
Referencias
1. Jeyabalan A, Medford ARL. Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: Patient Satisfaction under Light Conscious Sedation. Respiration [Internet]. 2014 [cited 2018 Dec 5];88(3):244–50. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25170748
2. Steinfort DP, Irving LB. Patient satisfaction during endobronchial ultrasound-guided transbronchial needle aspiration performed under conscious sedation. Respir Care [Internet]. 2010 Jun [cited 2018 Dec 5];55(6):702–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20507652
2. Steinfort DP, Irving LB. Patient satisfaction during endobronchial ultrasound-guided transbronchial needle aspiration performed under conscious sedation. Respir Care [Internet]. 2010 Jun [cited 2018 Dec 5];55(6):702–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20507652
Búsqueda y Síntesis de Evidencia
Búsqueda y síntesis de evidencia de valores y preferencias de los pacientes
8.- El balance entre efectos deseables e indeseables favorece la intervención o la comparación?
| Favorece la comparación | Probablemente favorece la comparación | No favorece la intervención ni la comparación | Probablemente favorece la intervención | Favorece la intervención | Varía | No lo sé |
|---|
Favorece la intervención: Considerando que la intervención es «realizar ecobroncoscopia (EBUS)» y la comparación es «realizar mediastinoscopia», el panel de expertos de la Guía opinó que el balance entre efectos deseables e indeseables claramente favorece «realizar ecobroncoscopia (EBUS)».
9.- ¿Qué tan grandes son los recursos necesarios (costos)?
| Costos extensos | Costos moderados | Costos y ahorros despreciables | Ahorros moderados | Ahorros extensos | Varía | No lo sé |
|---|
Ahorros extensos: El panel de expertos de la Guía consideró que al «realizar ecobroncoscopia (EBUS)» se generan ahorros grandes si es que se compara con los costos de «realizar mediastinoscopia», en función de los antecedentes, experiencia clínica, conocimiento de gestión o experiencia de los pacientes. Realizar EBUS implicaría ahorros, dado que es menos invasiva, y por lo tanto, requiere intervenciones menos complejas para su realización que la mediastinoscopia. Aunque en su implementación requeriría una importante inversión inicial, ésta se recupera rápidamente en los centros de alto volumen. Por otro lado, cabe destacar que esta intervención no cuenta con código FONASA, por lo tanto, las personas con seguro privado deben pagar el 100% de su valor.
10.- ¿La costo-efectividad de la intervención beneficia la intervención o la comparación?
| Favorece la comparación | Probablemente favorece la comparación | No favorece la intervención ni la comparación | Probablemente favorece la intervención | Favorece la intervención | Varía | Ningún estudio incluido |
|---|
Probablemente favorece la intervención: Considerando que la intervención es «realizar ecobroncoscopia (EBUS)» y la comparación es «realizar mediastinoscopia», el panel de expertos de la Guía opinó que probablemente la alternativa más costo-efectiva es «realizar ecobroncoscopia (EBUS)». El realizar EBUS disminuir las cirugías fútiles posteriores en comparación media, lo cual podría implicar una mayor costo efectividad a favor del EBUS. Además, EBUS reduce los tiempos de diagnósticos e intervención.
Evidencia de investigación
Se identificó un estudio canadiense que evaluó la rentabilidad de varios modos de estadificación mediastínica en el cáncer de pulmón no microcítico (CPNM) en un sistema de atención médica de pagador único. Se observó que el ICER fue de ∼$26.000/año de vida ajustado por calidad (QALY) para la estadificación EBUS-TBNA, seguido ∼$1.400.000/QALY para EBUS-TBNA seguido de mediastinoscopia. La estrategia de mediastinoscopia fue dominada (1).
Basándose en un umbral de disposición a pagar de $ 80.000/QALY, el estudio concluye que es poco probable que la estadificación mediastínica invasiva en el CPCNP sea rentable en pacientes clínicos N0 si pN2 <2,5%. En pacientes con probabilidad de metástasis mediastínicas entre el 2,5% y el 57%, la EBUS-TBNA es rentable como la única modalidad de estadificación. La mediastinoscopia confirmatoria debe considerarse en pacientes de alto riesgo (pN2> 57%) en caso de EBUS-TBNA negativa (1).
Referencias
1. Czarnecka-Kujawa K, Rochau U, Siebert U, Atenafu E, Darling G, Waddell TK, et al. Cost-effectiveness of mediastinal lymph node staging in non–small cell lung cancer. J Thorac Cardiovasc Surg [Internet]. 2017 Jun [cited 2019 May 3];153(6):1567–78. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28283236
Búsqueda y Síntesis de Evidencia
Informe de Búsqueda y síntesis de costo-efectividad
11.- ¿Cuál sería el impacto en equidad en salud?
| Reducido | Probablemente reducido | Probablemente ningún impacto | Probablemente aumentado | Aumentado | Varía | No lo sé |
|---|
Reducida: El panel de expertos de la Guía consideró que la equidad en salud se reduciría si se recomendase «realizar ecobroncoscopia (EBUS)», dado que identificó grupos o contextos que actualmente tiene barreras de acceso importantes, ya sea en términos económicos, geográficos u otros.
Dado que este procedimiento, al momento de hacer los juicios, no se encuentra codificado por FONASA no existe cobertura ni el seguro de salud público y privado.
Ademas sólo se encuentra disponible en Santiago y Puerto Montt.
12.- ¿La intervención es aceptable para las partes interesadas?
| No | Probablemente no | Probablemente sí | Sí | Varía | No lo sé |
|---|
Sí: El panel de expertos de la Guía consideró que «realizar ecobroncoscopia (EBUS)» SÍ es aceptable para las partes interesadas (profesionales de la salud, gestores de centros de salud, directivos de centros de salud, pacientes, cuidadores, seguros de salud, otros).
EBUS es aceptable por lo pacientes y por los clínicos, sin embargo podría haber cierta reticencia al modificar el procedimiento habitual en la actualidad.
13.- ¿Es factible implementar la intervención?
| No | Probablemente no | Probablemente sí | Sí | Varía | No lo sé |
|---|
Probablemente sí: El panel de expertos de la Guía consideró que «realizar ecobroncoscopia (EBUS)» probablemente SÍ es factible implementar, contemplando la capacidad de la red asistencial, los recursos humanos disponibles a nivel país, recursos financieros, etc.
La implementación de EBUS implica la comprar equipamiento y mantención anual del mismo, para lograr cobertura a lo largo del territorio nacional.
Además en la actualidad se requiere capacitar a especialistas porque la técnica es operador dependiente y requiere al menos 50 procedimientos supervisados.
Tanto el operador como los materiales deben ser los adecuados para obtener muestra histológica suficiente para la caracterización de la enfermedad.
El panel indica, que dado lo anteriormente descrito, la realización de EBUS probablemente se restrinja a centros de alto volumen de atención.