Editorial
Access to the mediastinum—The standard has changed
Abordagem do Mediastino—A norma foi alterada
F.J.F. Herth
Department of Pneumology and Critical Care Medicine, Thoraxklinik Heidelberg, German Center for Lung Research, University of Heidelberg, Heidelberg, Germany
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"apellidos" => "Morais" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215913000949?idApp=UINPBA00004E" "url" => "/08732159/0000001900000005/v3_201509041357/S0873215913000949/v3_201509041357/en/main.assets" ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Access to the mediastinum—The standard has changed" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "190" "paginaFinal" => "191" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "F.J.F. Herth" "autores" => array:1 [ 0 => array:3 [ "nombre" => "F.J.F." "apellidos" => "Herth" "email" => array:1 [ 0 => "felix.herth@thoraxklinik-heidelberg.de" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Pneumology and Critical Care Medicine, Thoraxklinik Heidelberg, German Center for Lung Research, University of Heidelberg, Heidelberg, Germany" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Abordagem do Mediastino—A norma foi alterada" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">100 years ago, lung cancer was a rare disease.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Over time it has become one of the leading causes of cancer death worldwide.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Along with this the diagnostic and also the therapeutic implications have changed several times over the last few decades. In 1968 the first TNM description was published, trying to standardize the tumor staging and thereby the specific therapeutic recommendations. Today the 7th edition of the TNM system is still in use and the fact that the staging of the mediastinum is one of the most important topics has still not been challenged.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In 1964 Werner Maaßen published his first full report about mediastinoscopy as a staging technique and in the following years the technique was established as the gold standard for the mediastinum.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Even after the implementation of improved imaging techniques like computer tomography (CT) and Positron emissions tomography (PET), the surgical option was not discussed.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Watching and learning from gastroenterologists, Olympus Medical introduced the world's first curved linear array ultrasonic bronchoscope in 2004. The development of the endoscope had started more than 5 years earlier based on a request to minimise existing EUS-FNA technology so that can be used for diagnosis from within the bronchial system.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The success story of EBUS-TBNA starts in 2003 with the publication in the journal <span class="elsevierStyleItalic">Thorax</span> by Krasnik and Vilmann,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> followed by an article by Yasufuku in <span class="elsevierStyleItalic">Chest</span>.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Both articles gave an initial description of the principle of EBUS-TBNA. In 2006, the biggest case series on 502 patients showed that EBUS-TBNA resulted in 93% diagnostic yield, a sensitivity of 94%, specificity of 100% and accuracy of 94%.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Over the last ten years the evidence about EBUS-TBNA has grown rapidly and after several meta-analyses<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8–10</span></a> the endoscopic technique is quoted now as the first test for evaluation of the mediastinum, replacing mediastinoscopy.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In this issue Dr. Bugalho<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> writes about his experience with this method in Portugal. The paper nicely demonstrates that there has been a rapid learning curve; the results achieved are consistent with previous published results and, especially in relation to the initial results, the negative predicted value has increased dramatically. Particularly in line with the most recent publications on this topic,<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13–16</span></a> it is clear that nowadays not only have the tissue samplers been adapted to the new technique, but also the tissue readers, mainly cytopathologist, primed to read cells instead of tissue.</p><p id="par0040" class="elsevierStylePara elsevierViewall">And today? As mentioned, EBUS-TBNA has become the Gold standard for diagnosing and staging the mediastinum. But we still need to get better. Due to modern oncological options, cell analysis is no longer enough. Molecular staging will become the future standard and therefore we have to work on our techniques, to provide sufficient material for such questions.But for the moment, endobronchial ultrasound has replaced mediastinoscopy.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Smoking and health" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.M. Fletcher" 1 => "D. 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Kahn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.09-2149" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2010" "volumen" => "138" "paginaInicial" => "790" "paginaFinal" => "794" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20154073" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transbronchial and transesophageal fine needle aspiration using an ultrasound bronchoscope in mediastinal staging of potentially operable lung cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "B. Hwangbo" 1 => "G.K. Lee" 2 => "H.S. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 10 | 18 |
| 2024 October | 28 | 38 | 66 |
| 2024 September | 47 | 29 | 76 |
| 2024 August | 59 | 34 | 93 |
| 2024 July | 46 | 36 | 82 |
| 2024 June | 31 | 24 | 55 |
| 2024 May | 35 | 41 | 76 |
| 2024 April | 54 | 33 | 87 |
| 2024 March | 49 | 33 | 82 |
| 2024 February | 43 | 19 | 62 |
| 2024 January | 32 | 29 | 61 |
| 2023 December | 24 | 22 | 46 |
| 2023 November | 34 | 45 | 79 |
| 2023 October | 23 | 38 | 61 |
| 2023 September | 23 | 34 | 57 |
| 2023 August | 25 | 22 | 47 |
| 2023 July | 22 | 29 | 51 |
| 2023 June | 18 | 17 | 35 |
| 2023 May | 35 | 30 | 65 |
| 2023 April | 23 | 22 | 45 |
| 2023 March | 40 | 23 | 63 |
| 2023 February | 41 | 21 | 62 |
| 2023 January | 21 | 22 | 43 |
| 2022 December | 35 | 12 | 47 |
| 2022 November | 52 | 32 | 84 |
| 2022 October | 53 | 42 | 95 |
| 2022 September | 24 | 26 | 50 |
| 2022 August | 36 | 42 | 78 |
| 2022 July | 39 | 41 | 80 |
| 2022 June | 31 | 32 | 63 |
| 2022 May | 28 | 28 | 56 |
| 2022 April | 33 | 31 | 64 |
| 2022 March | 40 | 59 | 99 |
| 2022 February | 34 | 23 | 57 |
| 2022 January | 60 | 34 | 94 |
| 2021 December | 60 | 49 | 109 |
| 2021 November | 64 | 32 | 96 |
| 2021 October | 103 | 40 | 143 |
| 2021 September | 34 | 31 | 65 |
| 2021 August | 32 | 19 | 51 |
| 2021 July | 15 | 21 | 36 |
| 2021 June | 29 | 22 | 51 |
| 2021 May | 41 | 39 | 80 |
| 2021 April | 81 | 89 | 170 |
| 2021 March | 62 | 31 | 93 |
| 2021 February | 44 | 18 | 62 |
| 2021 January | 40 | 31 | 71 |
| 2020 December | 43 | 22 | 65 |
| 2020 November | 36 | 22 | 58 |
| 2020 October | 38 | 25 | 63 |
| 2020 September | 53 | 25 | 78 |
| 2020 August | 56 | 35 | 91 |
| 2020 July | 70 | 30 | 100 |
| 2020 June | 62 | 28 | 90 |
| 2020 May | 72 | 32 | 104 |
| 2020 April | 75 | 20 | 95 |
| 2020 March | 59 | 19 | 78 |
| 2020 February | 68 | 33 | 101 |
| 2020 January | 74 | 32 | 106 |
| 2019 December | 55 | 24 | 79 |
| 2019 November | 72 | 29 | 101 |
| 2019 October | 60 | 31 | 91 |
| 2019 September | 64 | 21 | 85 |
| 2019 August | 79 | 31 | 110 |
| 2019 July | 77 | 27 | 104 |
| 2019 June | 72 | 18 | 90 |
| 2019 May | 131 | 33 | 164 |
| 2019 April | 88 | 28 | 116 |
| 2019 March | 124 | 12 | 136 |
| 2019 February | 106 | 16 | 122 |
| 2019 January | 74 | 18 | 92 |
| 2018 December | 69 | 9 | 78 |
| 2018 November | 20 | 0 | 20 |
| 2018 October | 23 | 8 | 31 |
| 2018 September | 20 | 9 | 29 |
| 2018 August | 26 | 29 | 55 |
| 2018 July | 33 | 22 | 55 |
| 2018 June | 45 | 15 | 60 |
| 2018 May | 52 | 18 | 70 |
| 2018 April | 61 | 18 | 79 |
| 2018 March | 89 | 16 | 105 |
| 2018 February | 44 | 8 | 52 |
| 2018 January | 83 | 18 | 101 |
| 2017 December | 98 | 18 | 116 |
| 2017 November | 21 | 20 | 41 |
| 2017 October | 21 | 14 | 35 |
| 2017 September | 19 | 20 | 39 |
| 2017 August | 25 | 10 | 35 |
| 2017 July | 21 | 15 | 36 |
| 2017 June | 24 | 24 | 48 |
| 2017 May | 29 | 13 | 42 |
| 2017 April | 17 | 5 | 22 |
| 2017 March | 15 | 13 | 28 |
| 2017 February | 10 | 6 | 16 |
| 2017 January | 15 | 3 | 18 |
| 2016 December | 16 | 13 | 29 |
| 2016 November | 10 | 5 | 15 |
| 2016 October | 14 | 13 | 27 |
| 2016 September | 9 | 6 | 15 |
| 2016 August | 5 | 4 | 9 |
| 2016 July | 5 | 6 | 11 |
| 2016 May | 0 | 8 | 8 |
| 2016 April | 16 | 3 | 19 |
| 2016 March | 27 | 5 | 32 |
| 2016 February | 35 | 16 | 51 |
| 2016 January | 35 | 10 | 45 |
| 2015 December | 38 | 9 | 47 |
| 2015 November | 28 | 15 | 43 |
| 2015 October | 11 | 15 | 26 |
| 2015 September | 31 | 15 | 46 |
| 2015 August | 26 | 8 | 34 |
| 2015 July | 23 | 7 | 30 |
| 2015 June | 15 | 3 | 18 |
| 2015 May | 39 | 17 | 56 |
| 2015 April | 42 | 11 | 53 |
| 2015 March | 25 | 11 | 36 |
| 2015 February | 24 | 15 | 39 |
| 2015 January | 32 | 11 | 43 |
| 2014 December | 34 | 8 | 42 |
| 2014 November | 28 | 9 | 37 |
| 2014 October | 23 | 13 | 36 |
| 2014 September | 30 | 12 | 42 |
| 2014 August | 22 | 6 | 28 |
| 2014 July | 30 | 9 | 39 |
| 2014 June | 34 | 9 | 43 |
| 2014 May | 54 | 14 | 68 |
| 2014 April | 55 | 13 | 68 |
| 2014 March | 58 | 10 | 68 |
| 2014 February | 48 | 16 | 64 |
| 2014 January | 71 | 9 | 80 |
| 2013 December | 47 | 22 | 69 |
| 2013 November | 73 | 23 | 96 |
| 2013 October | 82 | 36 | 118 |
| 2013 September | 67 | 30 | 97 |
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