Are Ebus and Mediastinoscopy redundant ? - 1274108

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stevea
Are Ebus and Mediastinoscopy redundant ? - 1274108

My wife just had a Ebus and Mediastinoscopy . After the Surgeon explained it to us I got to thinking and it seemed to me that the two procedures were accomplishing the same thing. Are the Ebus and Mediastinoscopy sampling the same lymph nodes and tissue? Is there a reason that they do both procedures? Thanks

Steve

JimC
Hi Steve,

Hi Steve,

It's possible that your wife's doctors felt that both procedures were necessary because of the location of the lymph nodes that they wanted to assess. As Dr. West has written:

"In truth, EUS and EBUS are better at evaluating the lymph nodes in the lower part and the back of the mediastinum, while mediastinoscopy is best at finding involved lymph nodes in the upper and front parts of the mediastinum. So depending on the CT imaging, it may be possible to target the best approach for a particular case, and sometimes these endoscopic approaches will be the best or only way to reach difficult mediastinal nodes."
- http://cancergrace.org/lung/2008/03/30/ebus-intro/

Perhaps you can ask her doctor if there was a particular reason in her case to perform both procedures.

JimC
Forum moderator

<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>

stevea
Jim

Jim

Thanks for the reply, the Dr. West article you highlighted is from 2008,from what I've read at that time Ebus was still not widely used whereas now I think it is more of a standard practice. This is why I was posing the question of whether the two procedures were redundant. You do bring up a good point that perhaps one procedure is better then the other at reaching certain areas of the Mediastinum but I've done some google searching and I haven't read that anywhere. Thanks

Steve

JimC
Hi Steve,

Hi Steve,

The procedures can be redundant; if they're aimed at the same nodes and the EBUS finds positive nodes, there may not be a reason to perform the mediastinoscopy. But as Dr. Harpole suggested in his podcast from 2013:

"[I]f the PET scan suggests that there are lymph nodes in the mediastinum or the center part of the chest that are positive, we want tissue confirmation and that can either be done with EUS or EBUS. Right now, if they’re negative, I am still doing mediastinoscopy on them because this is the gold standard. If this is positive you can go right to therapy but if it’s negative we tend to still go ahead and do mediastinoscopy because we want to make sure we only operate on patients that are truly negative over here." - http://cancergrace.org/lung/2013/03/16/harpole-on-lc-staging-advances/

If your wife's EBUS was performed first and results were negative, that would probably explain why both were done.

It's also possible to perform an EBUS to try to biopsy a tumor if it can be reached through the airway, which could also provide the answer to your question.

JimC
Forum moderator

<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>

stevea
Jim,

Jim,

This makes sense, My wife had the procedures on Thursday and after they were done the Surgeon had a five minute conversation with me and he did say that the Ebus was negative and that they took tissue samples during the Mediastinoscopy for biopsy, still waiting for those results. I should have looked into it more before the procedures because going into it I was under the impression that they were one in the same , Thanks for helping us sort that out and for all the support and information you guys provide on cancer grace its all been helpful and very much appreciated.

Steve

JimC
Hi Steve,

Hi Steve,

Hope the mediastinoscopy results confirm those from the EBUS!

JimC
Forum moderator

<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>

carrigallen
We will usually try for EBUS

We will usually try for EBUS or EUS to sample a lymph node site first, since it is less invasive than mediastinoscopy. If the EBUS is non-diagnostic or technically unsuccessful, we can do a mediastinoscopy. Mediastinoscopy has more risks and a longer recovery period than EUS or EBUS. As mentioned also, mediastinoscopy is better for lymph nodes which are closer to the breastbone (anterior).

Both are sampling procedures, intended to diagnose and stage a cancer; not to definitively treat a cancer.