Minimally Invasive Lymph Node Staging May Prevent Unnecessary Mesothelioma Surgery

A minimally invasive procedure for lymph node staging may help some pleural mesothelioma patients avoid the pain and risk of surgery.

That is the conclusion of a recent study on endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). 

EBUS-TBNA is a minimally invasive method for testing the lymph nodes deep in the chest (mediastinal lymph nodes). If lymph node staging shows evidence of pleural mesothelioma, surgery is less likely to be effective. 

Mediastinal Lymph Node Staging and Mesothelioma

Pleural mesothelioma is a rare cancer that starts on the membrane around the lungs. It can spread to the lungs and other organs and is usually fatal. 

The mediastinal lymph nodes are located in the area between the lungs. When the body is fighting a lung disease like malignant mesothelioma, these lymph nodes often become enlarged. 

Lymph node staging involves removing and examining some tissue from these nodes. This can help doctors determine how advanced the cancer is. 

Some cases of pleural mesothelioma may be too advanced for surgery. Experts recommend that patients have the staging procedure before considering mesothelioma surgery. 

The conventional way to perform mediastinal lymph node staging is to make an incision in the neck above or next to the breast bone. The surgeon inserts a narrow scope to cut a small tissue sample. 

EBUS-TBNA for Minimally-Invasive Staging

EBUS-TBNA is a minimally invasive approach to mediastinal lymph node staging in people with pleural mesothelioma. With EBUS-TBNA, the surgeon inserts a bronchoscope through the windpipe and uses a fine gauge needle to take a tissue sample. There is no need for an incision.

EBUS-TBNA is the subject of a recent Canadian study of 48 pleural mesothelioma patients. Researchers reviewed the charts of patients who had the procedure between 2012 and 2014. 

The average age of the study subjects was 70 and most (70%) had the epithelioid mesothelioma subtype. 

They found that the test had a positive predictive value of 100 percent for advanced pleural mesothelioma. PPV is the probability that people with a positive screening test actually have the disease. EBUS-TBNA lymph node staging showed that some patients were not good candidates for surgery. 

“EBUS-TBNA mediastinal LN staging prevented unnecessary surgery in 18.8% [of patients] by detection of N2/N3 disease and metastatic secondary malignancy,” write the researchers.

EBUS-TBNA was also 100 percent accurate at ruling out patients who did not have advanced pleural mesothelioma.

The research team concludes that the new lymph node staging procedure may “impact significantly” the management of pleural mesothelioma. They say it can help prevent deaths and complications from ill-advised surgeries.

Sources:

Czarnecka-Kujawa, K, et al, “Endobronchial ultrasound-guided transbronchial needle aspiration mediastinal lymph node staging in malignant pleural mesothelioma”, February 2019, Journal of Thoracic DIsease, pp. 602-612, http://jtd.amegroups.com/article/view/26697

“Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS TBNA)”, Seattle Cancer Care Alliance, https://www.seattlecca.org/diseases/lung-cancer/endobronchial-ultrasound