Endobronchial Ultrasound: An Atlas and Practical Guide

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Visit My Account to manage your email alerts. MM is known to disseminate virtually to all the organs. However, initial spread occurs to regional lymph nodes with subsequent extension to deep nodes including mediastinal nodes. Therefore, intrathoracic lymph node metastases are frequent. The most important factor for successful management of MM is early diagnosis. Patients with metastatic melanoma have limited treatment opportunities. In cases of localized metastasis, surgical resection can enable in some patients a prolonged interval of recurrence-free survival.

Precise pathological diagnosis of mediastinal lymphadenopathy in cases of MM is crucial for effective treatment. Open thoracic surgery and mediastinoscopy are standard methods for hilar and mediastinal lymph node staging.


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However, they are costly, invasive, require general anesthesia, and can lead to complications. Endobronchial ultrasound-guided transbronchial needle aspiration EBUS-TBNA cytology is a minimally invasive, safe and suitable procedure that can be used for diagnosing hilar and mediastinal lymphadenopathy. However, there is limited experience with this procedure.

Endobronchial Ultrasound : An Atlas and Practical Guide [Hardcover]

Thus, there is a case report 5 and a series of nine cases seven metastatic 6 in the literature using this technique to detect metastatic MM to the mediastinal lymph nodes. All the cases were identified inhouse. Specimens were obtained with a gauge needle. The average number of needle passes from each location was 3 range An on-site evaluation was performed in all the cases and the specimen was assumed adequate. Each case had aspirate smears that were stained with Diff-Quick and Papanicolaou method.

In all the cases we had cell block preparations. Sections of the cytoblocks were stained with hematoxylin and eosin. Considering the tissue limitation, we did not use the Fontana-Masson silver method for melanin. This pigment was evaluated in the sections stained with hematoxylin and eosin.


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  8. Antibodies used in the immunohistochemical study are detailed in Table I. The immunohistochemical reactions were performed using appropriate tissue controls. In the remaining cases, there was not enough material in the cytoblock. Formalin-fixed, paraffin-embedded agar cell pellets prepared from the PD-L1-positive and PD-L1-negative cell line and tonsil tissues were used as controls. Assessment of PD-L1 staining was performed by a pathologist previously trained on the and 22C3 Dako pharmDx assays.

    The percentage of tumor cells with linear membranous staining at any intensity was reported following and 22C3 Dako pharmDx assays interpretation guides.

    Endobronchial Ultrasound

    Because of limited material and variation of the staining panel over the years, not all tumors were stained with the same series of antibodies. The patients underwent this procedure because of suspected hilar or mediastinal metastasis according to CT. Eight patients had been diagnosed with MM in the past mean There were 6 male and 5 female patients M:F, and the mean age was Click Here to Zoom Table II: Clinical details of patients with mediastinal metastases caused by melanoma CT scans with contrast enhancement in the eight patients showed well-defined, large, heterogeneously-enhancing solid masses in the hilar zone or anterior mediastinum Figure 1A-C.

    The mean hilar or mediastinal lymph node size detected with CT was 3. Endobronchial ultrasound study of the lymph nodes included increased size, irregularity, non-homogeneity, hypervascularization and increased eco-quality Figure 1D. A CT scan Case 1. The red arrow shows a rounded pathological lymph node with low attenuation values located in the subcarinal region level 7.

    B CT scan case 5. The arrow indicates a rounded, homogeneous hypodense nodular image at level 10R, corresponding to a pathological lymph node by size and location.

    Endobronchial Ultrasound (EBUS) Biopsy of Mediastinal Lymph Nodes 2

    C CT scan case 8 The arrows indicate a large, hypodense heterogeneous lymphadenopathic conglomerate. It has been located in the left paratracheal region 4L that extends to the aortopulmonary window and the ipsilateral hilum.

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    D Endobronchial ultrasound case 8. A needle is observed within a large, heterogeneous lymph node conglomerate in the left paratracheal region. Cytological smears revealed a lymphoid and hematic background on which there were atypical cells arranged in small clusters Cellularity was moderate The cytological type varied between epithelioid Epithelioid or round cells formed groups of large, disaggregated, atypical cells or isolated elements occasionally binucleated, or multinucleated.

    The nuclei were frequently in an eccentric position Figure 2.