NCCN Guidelines for Patients® | Non-Small Cell Lung Cancer - page 24

24
NCCN Guidelines for Patients
®
: Non-Small Cell Lung Cancer
Version 1.2014
Part 3: Testing for lung cancer
Open surgical biopsy
You may have an open surgical biopsy when other
biopsies won’t work or a larger piece of tissue is needed.
Larger pieces of tissue are often needed for molecular
testing. Read Part 5.4 for more information on molecular
testing.
An open surgical biopsy requires staying overnight in the
hospital. General anesthesia is used. To obtain tissue, a
large cut is made between the ribs. The surgeon removes
tissue with a surgical knife. The cut is then closed with
stitches and a chest tube may be left in place for a few
days.
3.2 Biopsies of lymph nodes
Type of biopsy
Mediastinoscopy
EBUS-TBNA (
e
ndo
b
ronchial
u
ltra
s
ound-guided
t
rans
b
ronchial
n
eedle
a
spiration)
EUS-FNA (
e
ndoscopic
u
ltra
s
ound-guided
f
ine
n
eedle
a
spiration)
Mediastinoscopy
This biopsy accesses lymph nodes in the middle of
the chest with a mediastinoscope. A mediastinoscope
is very much like a bronchoscope. A cut right above
or alongside the breastbone is made to insert the
mediastinoscope into the body. When a cut alongside the
breastbone is made, the biopsy is called a Chamberlain
mediastinoscopy. It allows access to lymph nodes on the
left side of the chest. General anesthesia is used during
mediastinoscopy. These biopsies may cause some
pain and swelling and will leave a small scar.
EBUS-TBNA
Like a radial EBUS, a flexible bronchoscope fitted with an
ultrasound device is guided down the trachea. However,
for this biopsy, the device doesn’t need to be removed in
order to insert the sampling tool. Once the bronchoscope
is in place, a needle is inserted through the bronchus
and into a lymph node to obtain a sample. EBUS-TBNA
requires local anesthesia.
EUS-FNA
Food passes from the mouth into the stomach through
the esophagus. The esophagus extends further down
into the body than the trachea and bronchi. Thus, lymph
nodes below the bronchi can be accessed through the
esophagus. EUS-FNA is performed just like EBUS-
TBNA except that the bronchoscope is guided down the
esophagus.
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