RESUMEN

El estudio histológico de los ganglios mediastinales es con frecuencia necesario para un estadiaje preciso del cáncer de pulmón. Las técnicas por imágenes no invasivas (TC, RMN, PET, PET-TC) ayudan, pero no permiten un diagnóstico histológico. La TBNA es un método seguro, realizable durante una broncoscopía de rutina. Desafortunadamente, éste continúa siendo un método subutilizado en la práctica clínica actual, en gran parte debido a la falta de visualización de la aguja en tiempo real. La introducción de ecoendoscopios ha solucionado este problema. La TBNA guiada por ultrasonido endobronquial (EBUS-TBNA) permite tomar muestras de ganglios paratraqueales, mediastinales e hiliares en tiempo real. Los ganglios mediastinales periesofágicos pueden ser evaluados mediante aspiración por aguja fina guiada por el ultrasonido endoesofágico (EUS-FNA). Estudios recientes, utilizando ambos métodos combinados en la evaluación de las diferentes regiones mediastinales, sugieren que es posible lograr un estadiaje completo y preciso. Se espera que la implementación de métodos endoscópicos mínimamente invasivos como EBUS-TBNA y EUS-FNA permitan reducir significativamente la necesidad del estadiaje quirúrgico del cáncer de pulmón. El objetivo de esta revisión es presentar el tema al cuerpo médico latinoamericano, puesto que estos métodos hoy en día se están implementando en nuestra región.

PALABRAS CLAVE

Aspiración transbronquial por aguja, ultrasonido endobroquial, ultrasonido endoesofágico, cáncer de pulmón, estadiaje mediastinal endoscópico.

REFERENCIAS

1. Alberg AJ, Ford JG, Samet JM; American College of Chest Physicians. Epidemiology of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007;132(3 Suppl):29S-55S.

2. Detterbeck FC, Boffa DJ, Tanoue LT. The new lung cancer staging system. Chest 2009;136:260-271.

3. Silvestri GA, Gould MK, Margolis ML, et al; American College of Chest Physicians. Noninvasive staging of non-small cell lung cancer: ACCP evidenced-based clinical practice guidelines (2nd edition). Chest 2007;132(3 Suppl):178S-201S.

4. Detterbeck FC, Jantz MA, Wallace M, Vansteenkiste J, Silvestri GA; American College of Chest Physicians. Invasive mediastinal staging of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007;132(3 Suppl):202S-220S.

5. Erasmus JJ, Sabloff BS. CT, positron emission tomography, and MRI in staging lung cancer. Clin Chest Med 2008;29:39-57, v.

6. 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. Eur Respir J 2006;28:910-914.

7. Medford AR, Bennett JA, Free CM, Agrawal S. Mediastinal staging procedures in lung cancer: EBUS, TBNA and mediastinoscopy. Curr Opin Pulm Med 2009;15:334-342.

8. Wang KP. Staging of bronchogenic carcinoma by bronchoscopy. Chest 1994;106:588-593.

9. Schieppati E. Giant bullous emphysema. Clin Torax 1949;1:303-306.

10. Wang KP, Terry P, Marsh B. Bronchoscopic needle aspiration biopsy of paratracheal tumors. Am Rev Respir Dis 1978;118:17-21.

11. Herth FJF, Rabe KF, Gasparini S, Annema JT. Transbronchial and transoesophageal (ultrasound-guided) needle aspirations for the analysis of mediastinal lesions. Eur Respir J 2006;28:1264-1275.

12. Holty JE, Kuschner WG, Gould MK. Accuracy of transbronchial needle aspiration for mediastinal staging of non-small cell lung cancer: a meta-analysis. Thorax 2005;60:949-955.

13. Baram D, García RB, Richman PS. Impact of rapid on-site cytologic evaluation during transbronchial needle aspiration. Chest 2005;128:869-875.

14. Cameron SE, Andrade RS, Pambuccian SE. Endobronchial ultrasound-guided transbronchial needle aspiration cytology: a state of the art review. Cytopathology 2010;21:6-26.

15. Gasparini S, Silvestri GA. Usefulness of transbronchial needle aspiration in evaluation patients with lung cancer. Thorax 2005;60:890-891.

16. Haponik EF, Shure D. Underutilization of transbronchial needle aspiration: experiences of current pulmonary fellows. Chest 1997;112:251-253.

17. Haponik EF, Russell GB, Beamis JF Jr, et al. Bronchoscopy training: current fellows’ experiences and some concerns for the future. Chest 2000;118:625-630.

18. Annema JT, Rabe KF. State of the art lecture: EUS and EBUS in pulmonary medicine. Endoscopy 2006;38 Suppl 1:S118-S122.

19. 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. Eur Respir J 2005;25:416-421.

20. Yasufuku K, Chiyo M, Sekine Y, et al. Real-time endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal and hilar lymph nodes. Chest 2004;126:122-128.

21. 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;37:833-839.

22. 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;64:757-762.

23. 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;61:795-798.

24. 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. Eur Respir J 2006;28:910-914.

25. Groth SS, Whitson BA, D’Cunha J, Maddaus MA, Alsharif M, Andrade RS. Endobronchial ultrasound-guided fine-needle aspiration of mediastinal lymph nodes: a single institution’s early learning curve. Ann Thorac Surg 2008;86:1104-1109.

26. 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. Eur J Cancer 2009;45:1389-1396.

27. 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;133:887-891.

28. Haas AR. Infectious complications from full extension endobronchial ultrasound transbronchial needle aspiration. Eur Respir J 2009;33:935-938.

29. Herth FJ. Mediastinal staging the role of endobronchial and endo-oesophageal sonographic guided needle aspiration. Lung Cancer 2004; 45 Suppl 2:S63-S67.

30. Vilmann P, Herth F, Krasnik M. State of the art lecture: mediastinal EUS. Endoscopy 2006;38 Suppl 1:S84-S87.

31. von Bartheld MB, Rabe KF, Annema JT. Transaortic EUS-guided FNA in the diagnosis of lung tumors and lymph nodes. Gastrointest Endosc 2009;69:345-49.

32. Eloubeidi MA. Endoscopic ultrasound-guided fine-needle aspiration in the staging and diagnosis of patients with lung cancer. Semin Thorac Cardiovasc Surg 2007;19:206-211.

33. Aloubeidi MA, Cerfolio RJ, Chen VK, Desmond R, Syed S, Ojha B. Endoscopic ultrasound-guided fine needle aspiration of mediastinal lymph node in patients with suspected lung cancer after positron emission tomography and computed tomography scans. Ann Thorac Surg 2005;79:263-268.

34. Micames CG, McCrory DC, Pavey DA, Jowell PS, Gress FG. Endoscopic ultrasound-guided fine-needle aspiration for non-small cell lung cancer staging: A systematic review and meta-analysis. Chest 2007;131:539-548.

35. Annema JT, Versteegh MI, Veseliç M, Voigt P, Rabe KF. Endoscopic ultrasound-guided fine-needle aspiration in the diagnosis and staging of lung cancer and its impact on surgical staging. J Clin Oncol 2005;23:8357-8361.

36. Tournoy KG, Ryck FD, Vanwalleghem L, et al. The yield of endoscopic ultrasound in lung cancer staging: does lymph node size matter? J Thorac Oncol 2008;3:245-249.

37. Herth FJ, Lunn W, Eberhardt R, Becker HD, Ernst A. Transbronchial versus transesophageal ultrasound-guided aspiration of enlarged mediastinal lymph nodes. Am J Respir Crit Care Med 2005;171:1164-1167.

38. Wallace MB, Pascual JM, Raimondo M, et al. Minimally invasive endoscopic staging of suspected lung cancer. JAMA 2008;299:540-546.

39. Vilmann P, Puri R. The complete “medical” mediastinoscopy (EUS-FNA + EBUS-TBNA). Minerva Med 2007;98:331-338.

40. Szlubowski A, Zielin´ ski M, Soja J, et al. 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. Eur J Cardiothorac Surg 2010;37:1175-1179.

41. Hwangbo B, Lee GK, Lee HS, et al. Transbronchial and transesophageal fine needle-aspiration using an ultrasound bronchoscope in mediastinal staging of potentially operable lung cancer. Chest 2010;138:795-802.

42. 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;138:790-794.

43. Vansteenkiste J, Dooms C, De Leyn P. The multidisciplinarity of stage III non-small cell lung cancer. Eur J Cancer 2009;45 Suppl 1:92-105.

44. Betticher DC, Hsu Schmitz SF, Tötsch M, et al. Mediastinal lymph node clearance after docetaxel-cisplatin neoadjuvant chemotherapy is prognostic of survival in patients with stage IIIA pN2 non-small-cell lung cancer: a multicenter phase II trial. J Clin Oncol 2003;21:1752-1759.

45. Annema JT, Veseliç M, Versteegh MI, Willems LN, Rabe KF. Mediastinal restaging: EUS-FNA offers a new perspective. Lung Cancer 2003;42:311-318.

46. Stigt JA, Oostdijk AH, Timmer PR, Shahin GM, Boers JE, Groen HJ. Comparison of EUS-guided fine needle aspiration and integrated PET-CT in restaging after treatment for locally advanced non-small cell lung cancer. Lung Cancer 2009;66:198-204.

47. De Leyn P, Stroobants S, De Wever W, et al. Prospective comparative study of integrated positron emission tomography-computed tomography scan compared with remediastinoscopy in the assessment of residual mediastinal lymph node disease after induction chemotherapy for mediastinoscopy-proven stage IIIA-N2 Non-small-cell lung cancer: a Leuven Lung Cancer Group Study. J Clin Oncol 2006;24:3333-3339.

48. Szlubowski A, Herth FJ, Soja J, et al. Endobronchial ultrasound-guided needle aspiration in non-small cell lung cancer restaging verified by the transcervical bilateral extended mediastinal lymphadenectomy-a prospective study. Eur J Cardiothorac Surg 2010;37:1180-1184.

49. Herth FJ, Annema JT, Eberhardt R, et al. Endobronchial ultrasound with transbronchial needle aspiration for restaging the mediastinum in lung cancer. J Clin Oncol 2008;26:3346-3350.