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A camera with an ultrasound probe on its tip is passed down the windpipe; the ultrasound finds the lymph nodes sitting just outside the airway wall and a needle is passed through the wall to sample them. It is how lung cancer is staged without an operation.
Getting the nodal stage right decides whether a lung cancer is operable, and imaging cannot do it alone: CT only shows that a node is enlarged and PET only that it is metabolically active, and both are wrong often enough to matter. Endobronchial ultrasound-guided transbronchial needle aspiration samples the paratracheal, hilar and subcarinal stations through the airway wall; endoscopic ultrasound-guided fine-needle aspiration reaches the inferior mediastinal and left-sided stations through the oesophagus; together they cover most of the mediastinum. NICE NG122 asks for EBUS-TBNA for paratracheal and peri-bronchial lesions, and for EBUS-TBNA or EUS-FNA or both wherever the nodal stage would change treatment, with surgical mediastinal staging held back for a negative result with continuing high suspicion. It also asks every cancer alliance to have at least one centre offering them and to audit local test performance, and it dropped transthoracic needle biopsy, plain bronchoscopy and non-ultrasound-guided needle aspiration from nodal staging because they do not reach the required sensitivity. The ninth edition of TNM raised the stakes: N2 is now split into N2a and N2b by how many mediastinal stations are involved, so a systematic sampling of each suspicious station, rather than a single positive node, is what the stage now needs.
Showing the technology this term belongs to: CT (computed tomography).
Shares Mediastinum, Mediastinal lymph node stations, Lung cancer (all types), Small-cell lung cancer and the tag lung.
Shares Resectability in lung cancer, TNM 9: what changed in lung cancer staging, CT (computed tomography), Lung cancer (all types) and the tag lung.
Shares TTF-1 and p40 (how lung histology is decided), Resectability in lung cancer, TNM 9: what changed in lung cancer staging, Lung cancer (all types) and the tag lung.
Shares Mediastinal lymph node stations, Resectability in lung cancer, TNM 9: what changed in lung cancer staging, Lung cancer (all types) and the tag lung.
Shares Bronchoscopy (EBUS, robotic navigation), Lung cancer (all types), Small-cell lung cancer, Non-small-cell lung cancer and the tag lung.
Shares TNM 9: what changed in lung cancer staging, Lung cancer (all types), Small-cell lung cancer, Non-small-cell lung cancer and the tag lung.
Shares CT (computed tomography), Lung cancer (all types), Small-cell lung cancer, Non-small-cell lung cancer and the tag lung.
Shares CT (computed tomography), Lung cancer (all types), Small-cell lung cancer, Non-small-cell lung cancer and the tag lung.