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480

R. Rami-Porta and S. Call

 

 

value 0.99 and diagnostic accuracy 0.99 [61]. VAMLA is a safe procedure and requires a short learning curve of 16 to 17 cases to overcome the initial complication rate [62].

Sensitivity and negative predictive value of TEMLA are high: 0.9 and 0.95, respectively, in the frst report including 83 patients, [12], and 0.94 and 0.97, respectively, in an updated reports with 256 patients [63]. With the increasing number of procedures (698 TEMLAs), sensitivity and negative predictive values are still maintained at 0.96 and 0.98 respectively [64]. TEMLA has proved to be highly reliable as a restaging method in those patients with lung cancer initially staged by endoscopic techniques and fne-needle ­aspiration. In these cases, sensitivity, negative predictive value and accuracy were 0.95, 0.97 and 0.98, respectively [65]. In addition, TEMLA can be combined with uniportal transcervical lobectomy, if imprint cytology examination proves all the removed lymph nodes are negative. This was attempted in nine patients, and the procedure had to be converted to uniportal videothoracoscopic approach in only one case because of extensive adhesions [66].

Summary and Recommendations

Mediastinoscopy explores the upper mediastinum and is useful in the assessment of nodal disease, direct tumour invasion and diagnosis of mediastinal diseases. To expand the range of the exploration, procedures such as parasternal mediastinotomy, extended cervical mediastinoscopy, mediastino-thoracoscopy and inferior mediastinoscopy have been devised during the past decades. VAMLA and TEMLA have the objective to perform a mediastinal lymphadenectomy as thorough as that performed at the time of lung cancer resection. They are indicated when the mediastinum is normal on CT and PET, and their sensitivity and negative predictive values are higher than those for mediastinoscopy. Therefore, they should be incorporated in future staging algorithms. At the present time, the ESTS guidelines are valuable, have been validated in two studies, with sensitivity and negative predictive

values of 0.84 and 0.94, respectively, [67] and of 0.95 and 0.94, respectively [68]. Therefore, they should be applied in the management of patients with lung cancer.

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Lung Cancer Staging Methods:

28

A Practical Approach

Travis L. Ferguson, Tejaswi R. Nadig,

and Gerard A. Silvestri

Abbreviations

LDCT\

Low dose computed

 

 

 

 

 

tomography

 

ACCP\

American College of Chest

MET\

Mesenchymal epithelial

 

 

Physicians

 

transition

 

ALK\

Anaplastic lymphoma kinase

MPE\

Malignant pleural effusion

 

BRAF\

B-Raf proto-oncogene serine/

MRI\

Magnetic resonance imaging

 

threonine kinase

NTRK\

Neurotrophic tyrosine receptor

CP-EBUS\

curvilinear probe endobron-

 

kinase

 

 

chial ultrasound

NCCN\

National comprehensive cancer

CT\

Computed tomography

 

network

 

CXR\

Chest x-ray

NLST\

National lung cancer screening

EBUS-FNA\

Endobronchial ultrasound ne

 

trial

 

 

needle aspiration

NPV\

Negative predictive value

 

EBUS-TBNA\

Endobronchial ultrasound with

NSCLC\

Non-small cell lung cancer

 

 

transbronchial needle aspiration

PD-L1\

Programmed death ligand 1

 

ECM\

Extended cervical

PE\

Pulmonary embolism

 

 

mediastinoscopy

PET-CT\

Positron emission tomography-­

EGFR\

Epidermal growth factor

 

computed tomography

 

 

receptor

PPL\

Peripheral pulmonary lesions

ENB\

Electromagnetic navigation

PPV\

Positive predictive value

 

 

bronchoscopy

RB\

Robotic bronchoscopy

 

EUS-FNA\

Endoscopic ultrasound ne

RCT\

Randomized controlled trials

 

needle aspiration

RET\

Rearranged during transfection

FDG\

18F-Fluorodeoxyglucose

ROS1\

c-Ros oncogene 1

 

HHM\

Humoral hypercalcemia of

ROSE\

Rapid onsite evaluation

 

 

malignancy

RP-EBUS\

Radial probe endobronchial

 

 

 

 

 

ultrasound

 

 

 

 

SCC\

Squamous cell carcinoma

 

T. L. Ferguson · T. R. Nadig · G. A. Silvestri (*)

 

SCM\

Standard cervical

 

Department of Medicine, Division of Pulmonary and

 

 

mediastinoscopy

 

Critical Care, Allergy and Sleep Medicine, Medical

 

 

University of South Carolina, Charleston, SC, USA

SIADH\

Syndrome of inappropriate

 

e-mail: fergustr@musc.edu; nadigt@musc.edu;

 

antidiuretic hormone secretion

silvestri@musc.edu

 

 

 

 

 

 

 

 

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023

483

J. P. Díaz-Jiménez, A. N. Rodríguez (eds.), Interventions in Pulmonary Medicine,

 

https://doi.org/10.1007/978-3-031-22610-6_28