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Background
The role of transbronchial needle aspiration (TBNA) in the diagnosis and staging of lung cancer has been well established. Recently, the efficacy of conventional TBNA in the staging of lung cancer has been enhanced by the use of endobronchial ultrasound (EBUS)-TBNA. Our study sought to evaluate the adequacy of TBNA of International Assoc...
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Major advances in molecular profiling for available targeted treatments and immunotherapy for lung cancer have significantly increased the complexity of tissue-based diagnostics. Endobronchial ultrasound-guided transbronchial needle aspirations (EBUS-TBNA) are commonly performed for diagnostic biopsies and lymph node staging. EBUS-TBNA has increasi...
Citations
... There are several IASLC regions suitable for TBNA procedure, including upper paratracheal (station 2R & 2L), lower paratracheal nodes (station 4R & 4L), subcarinal nodes (station 7), hilar and interlobar nodes (station 10 and 11). Among them, the lower paratracheal LNs are most frequently involved [10], and may easily be confounded with mediastinal (4R & 4L) and hilar LNs (10R & 10L). P r e p r i n t 3 Distinguishing lower paratracheal (IASLC-4R and 4L) from hilar (IASLC-10R and 10L) lymph nodes is important because an error may result in misclassification of a stage N1 tumor as stage N2 or vice versa. ...
... In clinical practice, the region anterior to the tracheal bifurcation is in the mediastinum regardless of vessels' locations, they should be typically grouped with station IASLC-4 at CT. Furthermore, surgical management of LNs anterior to the tracheal bifurcation mirrors that of mediastinal LNs [12]. However, such findings had been simply documented in a small part of both articles, and there were no solid data P r e p r i n t 10 to support these observations. In contrast, our study used clinical data to analyze the effects of vascular variants on the lymph node staging. ...
Introduction
The lower rim of the azygous arch and the upper rim of the left main pulmonary artery are used as the lower borders of the lower paratracheal lymph nodes (LNs) in the IASLC map. However, there is some confusion about it. Our aim was to investigate the best landmarks as the boundaries to stage N more accurately for lung cancer.
Material and methods
One hundred patients with benign lung diseases, fifty with lung cancer diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), and thirteen with right metastatic LNs confirmed by surgery were included. The lymph nodes (including W1, W3, W5, 10R below W5, W4, W6) were classified with Wang's and IASLC map concurrently, and the different outcomes of N stage were compared.
Results
The azygous arch and the left main pulmonary artery varied in relation to the airway, causing the following changes of classification, 9.4% benign LNs of W1 and 38.6% of W5 were down-regulated as IASLC-10R, 9.5% of 10R below W5 were up-regulated as IASLC-4R, 51.4% of W4 and 94% of W6 were down-regulated as IASLC-10L. In 50 patients diagnosed by EBUS-TBNA, the concordance between the two maps was 0.768 for the right 92 LNs, while it was 0.374 for the left 46 nodes. If based on the location of azygous arches, postoperative stages might be changed in 2 surgery patients.
Conclusions
The locations of the lower vascular boundaries of IASCL-4 were varied. The bronchial landmarks of the proximal right and left main bronchus might be used as such borders.
