SESSION TYPE: Endobronchial Ultrasound
PRESENTED ON: Monday, October 22, 2012 at 04:00 PM - 05:30 PM
PURPOSE: Controversies exist over the ideal technique of needle aspiration during EBUS-TBNA for mediastinal staging in lung cancer. Of these, the ideal location within the lymph node to aspirate in order to afford the best yield is poorly understood and to date has not been studied. Specifically, disagreement exists whether the ideal location for TBNA is the center of the node (medullary region) or from the subcapsular area (cortical region). We attempt in this study to evaluate, ex vivo, patterns of metastasis within mediastinal nodes and apply these findings to techniques of EBUS-TBNA.
METHODS: A review was done of all lung cancer resections at the Cleveland Clinc from 2009-2011 for which there were N1 nodal metastases found in pathologic specimens obtained during lung resection and/or lymph node dissection. These nodes were then analyzed for the pattern of distribution of metastatic deposits. The pattern of metastatic distribution within the node was noted to be either complete effacement of the node, subcapsular (cortical) only or medullary only. Only those nodes that had malignant involvement were considered for analysis in the study. A Fisher’s exact was used for statistics (JMP Pro, SAS)
RESULTS: A total of 101 lymph nodes with metastatic involvement were analyzed. Average node size was 8.8mm (2mm to 45mm). 47/101 nodes were effaced with tumor. 49/101 nodes had subcortical involvement only. 5/101 had medullary nodal involvement only. Overall, 96/101 lymph nodes had subcortical metastatic involvement by tumor (p<0.0001).
CONCLUSIONS: The pattern of distribution of metastatic deposits within lymph nodes is either subcapsular or complete effacement in the vast majority of metastasis.
CLINICAL IMPLICATIONS: The above findings suggest the acquisition of tissue during EBUS-TBNA should include adequate subcapsular sampling in order to maximize yield.
DISCLOSURE: The following authors have nothing to disclose: Joseph Cicenia, Jordan Reynolds, Gregory Kotnis, Shijing Jia
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