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Minimally Invasive Techniques for the Diagnosis and Staging of Lung Cancer

Medford, Andrew R. L. MBChB, BSc, MD, MRCP; Bennett, Jonathan A. MBChB, BSc, MD, FRCP; Free, Catherine M. MBChB, MD, MRCP; Agrawal, Sanjay MBChB, FCCP

doi: 10.1097/CPM.0b013e3181be1104
Topics in Pulmonary Medicine

Interventional pulmonology, lung cancer staging, and diagnostic algorithms are evolving. Endoscopic needle aspiration techniques (endobronchial ultrasound-guided transbronchial needle aspiration and endoscopic ultrasound-guided fine-needle aspiration [EUS]) have a key role to play in staging the mediastinum and offer potential advantages over surgical staging. They are less invasive, avoid hospital admission, and save costs. However, a negative endobronchial ultrasound-guided transbronchial needle aspiration or EUS result should still be clarified by surgical staging. EUS also offers the ability to diagnose M1 disease.

Neck ultrasound-guided fine needle aspiration offers a minimally invasive method of diagnosing N3 or M1 disease, potentially avoiding endoscopic needle aspiration techniques as well as surgical staging in patients with suspected N2 or N3 disease or extrapulmonary inaccessible metastases.

Local anesthetic video-assisted thoracoscopy offers a minimally invasive method to diagnose malignant pleural metastases more effectively than by traditional closed pleural biopsy techniques. It also allows drainage of the effusion and pleurodesis in one combined procedure while avoiding more invasive surgical thoracoscopy.

Interventional pulmonology will continue to expand in the future and offer further benefits to patients with suspected lung cancer as well as potential cost savings to health care systems.

This review considers following 4 minimally invasive techniques in the field of the interventional pulmonology: endobronchial ultrasound-guided transbronchial needle aspiration, endoscopic ultrasound-guided fine needle aspiration, neck ultrasound-guided fine needle aspiration, and local anesthetic video-assisted thoracoscopy. It explores their contribution to lung cancer diagnosis and staging algorithms, which continue to evolve.

From the Department of Respiratory Medicine, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, Leicestershire, United Kingdom.

Address correspondence to: Andrew R. L. Medford, MBChB, BSc, MD, MRCP, Department of Respiratory Medicine, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester LE3 9QP, Leicestershire, United Kingdom. E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.