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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Estudio preliminar que tiene por objetivo conocer la sensibilidad &#40;S&#41; y especificidad &#40;E&#41; de la punci&#243;n transbronquial &#40;PTB&#41; en comparaci&#243;n con la mediastinoscopia&#47;me- diastinotom&#237;a anterior &#40;MED&#47;MEDA&#41;&#44; y&#47;o toracotom&#237;a en la estadificaci&#243;n ganglionar mediast&#237;nica del carcinoma no microc&#237;tico &#40;CNM&#41;&#46; Se analiz&#243; la S y E de la TAC como t&#233;cnica utilizada para la selecci&#243;n de pacientes&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Fueron evaluados 33 pacientes con CNM sin met&#225;stasis a distancia y con buena funci&#243;n pulmonar&#46; Se realiz&#243; una TAC tor&#225;cica previa a la broncoscopia en 27 enfermos y antes de la cirug&#237;a en el resto&#46; La estadif&#237;caci&#243;n por PTB se realiz&#243; en las regiones ganglionares consideradas patol&#243;gicas en la TAC y en la regi&#243;n subcarinal cuando no se pudo disponer de la informaci&#243;n de la TAC antes de realizar la broncoscopia&#46; Los resultados de la PTB se compararon con la MED&#47;MEDA y&#47;o toracotom&#237;a&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La prevalencia de enfermedad ganglionar metast&#225;sica fue del 47&#37;&#46; En 24 pacientes la TAC detect&#243; ganglios mediast&#237;nicos agrandados y en 9 casos el estudio ganglionar mediast&#237;nico por imagen fue considerado normal&#46; La S y E de la TAC fue del 93 y 54&#37;&#44; con un valor predictivo positivo &#40;VPP&#41; del 68&#37; y un valor predictivo negativo &#40;VPN&#41; del 87&#44;5&#37;&#46; Para la MED&#47;MEDA la S fue del 73&#37; y la E del 100&#37;&#44; siendo los VPP y VPN del 100 y 75&#37;&#44; respectivamente&#46; La S y E de la PTB fueron&#44; respectivamente&#44; del 36 y del 92&#37;&#44; con un VPP del 83&#37; y un VPN del 57&#37;&#46; Un paciente sufri&#243; un neumotorax con empiema pleural tras la MED que pudo ser evitado al ser previamente positiva la PTB&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La PTB es una t&#233;cnica &#250;til y segura en la estadificaci&#243;n ganglionar del CNM&#46; Aunque la sensibilidad de la PTB es menor que la de la MED&#44; la PTB permite analizar regiones de dif&#237;cil acceso para la MED y puede hacer innecesaria la realizaci&#243;n de esta &#250;ltima si se ha obtenido una punci&#243;n positiva para malignidad&#46; La TAC tor&#225;cica es una t&#233;cnica sensible pero poco espec&#237;fica para determinar la presencia de afectaci&#243;n ganglionar metast&#225;sica&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Preliminary study to compare the sensitivity and specificity of transbronchial needle aspiration &#40;TBNA&#41; and mediastinoscopy&#47;anterior mediastinotomy &#40;MED&#47;AMED&#41; and&#47;or thoracotomy for staging of mediastinal nodes in non-small cell carcinoma&#46; To determine the sensitivity and specificity of computerized tomography &#40;CT&#41; as a screening technique&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Thirty-three patients with non-small cell carcinoma but no remote metastasis and good lung function were evaluated&#46; A chest CT scan was performed before bronchoscopy in 27 patients and before surgery in the others&#46; Nodular areas considered diseased based on CT images were staged by TBNA&#46; When CT images were not available before bronchoscopy&#44; TBNA for staging was performed in the subcarinal region&#46; Results by TBNA were compared with those obtained by MED&#47;AMED and&#47;or thoracotomy&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The prevalence of metastatic nodular disease was 47&#37;&#46; CT detected enlarged mediastinal nodes in 24 patients&#59; the images were considered normal in 9 patients&#46; Sensitivity and specificity of CT was 93&#37; and 54&#37;&#44; respectively&#44; with a positive predictive value &#40;PPV&#41; of 68&#37; and negative predictive value &#40;NPV&#41; of 87&#46;5&#37;&#46; The sensitivity and specificity of MED&#47;AMED were 73&#37; and 100&#37;&#44; respectively&#59; PPV was 100&#37; and NPV was 75&#37;&#46; The sensitivity and specificity of TBNA were 36&#37; and 92&#37;&#44; respectively&#59; PPV was 83&#37; and NPV was 57&#37;&#46; The pneumothorax with pleural empyema suffered by one patient after MED could have been avoided&#44; given that the earlier TBNA was positive&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">TBNA is a safe&#44; useful technique for staging nodes in non-small cell carcinoma&#46; Although the sensitivity of TBNA is lower than that of MED&#44; regions that are difficult to reach with the latter technique can be sampled by TBNA&#46; Furthermore&#44; MED can be rendered unnecessary by positive TBNA results&#46; CT imaging of the chest is sensitive but its specificity is low for detecting ganglial metastasis&#46;</p></span>"
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                        "link" => array:1 [
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                        "paginaFinal" => "499"
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                          "autores" => array:2 [
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                        "link" => array:1 [
                          0 => array:2 [
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                        "paginaInicial" => "149"
                        "paginaFinal" => "154"
                        "link" => array:1 [
                          0 => array:2 [
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                        "paginaFinal" => "696"
                        "link" => array:1 [
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                        "link" => array:1 [
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                          0 => array:2 [
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                        "link" => array:1 [
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              ]
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            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bronchoscopy in North America&#58; The ACCP survey"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "U&#46;B&#46;S&#46; Prakash"
                            1 => "K&#46;P&#46; Oxfford"
                            2 => "S&#46;E&#46; Strubbs"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1991"
                        "volumen" => "100"
                        "paginaInicial" => "1&#46;668"
                        "paginaFinal" => "1&#46;675"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1835689"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
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                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Education and experience improve transbronchial needle aspiration performance"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46;F&#46; Haponik"
                            1 => "J&#46;O&#46; Cappellari"
                            2 => "R&#46; Chin"
                            3 => "N&#46;E&#46; Adair"
                            4 => "M&#46; Lykens"
                            5 => "P&#46;T&#46; Alford"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.151.6.7767560"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1995"
                        "volumen" => "151"
                        "paginaInicial" => "1&#46;998"
                        "paginaFinal" => "2&#46;002"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7767560"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Relevance of training in transbronchial fine-needle aspiration technique"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "F&#46; Rodr&#237;guez de Castro"
                            1 => "F&#46; D&#237;az L&#243;pez"
                            2 => "G&#46; Julia Serd&#225;"
                            3 => "A&#46; Rey L&#243;pez"
                            4 => "J&#46; Freixenet Gilart"
                            5 => "P&#46; Cabrera Navarro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1997"
                        "volumen" => "111"
                        "paginaInicial" => "103"
                        "paginaFinal" => "105"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8996001"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Trans&#46;bronchial fine needle aspiration of the mediastinum"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;J&#46; Baker"
                            1 => "P&#46;H&#46; Solani"
                            2 => "D&#46;A&#46; Schenk"
                            3 => "C&#46; Van Pelt"
                            4 => "I&#46; Ramzy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Importance of lymphocytes as an indicador of specimen adequacy&#46; Acta Cytologica"
                        "fecha" => "1990"
                        "volumen" => "34"
                        "paginaInicial" => "517"
                        "paginaFinal" => "523"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The bronchoscopic survey&#58; some reflections"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "U&#46;B&#46;S&#46; Prakash"
                            1 => "S&#46;E&#46; Stubbs"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1991"
                        "volumen" => "100"
                        "paginaInicial" => "1&#46;660"
                        "paginaFinal" => "1&#46;667"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1835689"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "31&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The hige price of bronchoscopy&#58; maintenance and repair of the flexible fiberoptic bronchoscope"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46;C&#46; Mehta"
                            1 => "P&#46;S&#46; Curtis"
                            2 => "M&#46;L&#46; Scalzitti"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1990"
                        "volumen" => "98"
                        "paginaInicial" => "448"
                        "paginaFinal" => "454"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2376176"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "32&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "False positive transbron chial needle aspiration in bronchogenic carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46;J&#46; Cropp"
                            1 => "A&#46;F&#46; DiMarco"
                            2 => "M&#46; Lankerani"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1984"
                        "volumen" => "85"
                        "paginaInicial" => "696"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6713981"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "33&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "False positive transcarinal needle aspirate in the evaluation of bronchogenic carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "B&#46;W&#46; Carlin"
                            1 => "J&#46;H&#46; Harrell"
                            2 => "P&#46;F&#46; Fedullo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm/140.6.1727"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am Rev Respir Dis"
                        "fecha" => "1989"
                        "volumen" => "140"
                        "paginaInicial" => "1&#46;800"
                        "paginaFinal" => "1&#46;802"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2690707"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "34&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Potential false positive mediastinal transbronchial needle aspiration in bronchogenic carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46;A&#46; Schenk"
                            1 => "M&#46;H&#46; Chasen"
                            2 => "M&#46;J&#46; McCarthy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1984"
                        "volumen" => "86"
                        "paginaInicial" => "649"
                        "paginaFinal" => "650"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6478914"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "35&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Flexible transbronchial fine needle aspiration for staging of bronchogenic carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "K&#46;P&#46; Wang"
                            1 => "R&#46; Brower"
                            2 => "E&#46;F&#46; Haponik"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1983"
                        "volumen" => "84"
                        "paginaInicial" => "571"
                        "paginaFinal" => "576"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6313305"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "36&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transbronchial needle aspiration in clinical practice&#46; A five-year experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46;M&#46; Harrow"
                            1 => "F&#46;A&#46; Oldenburg Jr&#46;"
                            2 => "M&#46;S&#46; Ligenfelter"
                            3 => "A&#46;M&#46; Smith Jr&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1989"
                        "volumen" => "96"
                        "paginaInicial" => "1&#46;268"
                        "paginaFinal" => "1&#46;272"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2582851"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "37&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The role of transcarinal needle aspiration in the staging of bronchogenic carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;P&#46; Utz"
                            1 => "M&#46; Ashok"
                            2 => "M&#46;D&#46; Patel"
                            3 => "E&#46;S&#46; Edell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1993"
                        "volumen" => "104"
                        "paginaInicial" => "1&#46;012"
                        "paginaFinal" => "1&#46;016"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8252992"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "38&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Probabilidad y estad&#237;stica en medicina"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "P&#46; Juez"
                            1 => "F&#46;J&#46; D&#237;ez"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Madrid&#58; D&#237;az de Santos"
                        "fecha" => "1997"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "39&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "How reliable is the diagnosis of lung cancer using small biopsy specimens&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;S&#46;J&#46; Thomas"
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                            2 => "T&#46; Ashcroft"
                            3 => "B&#46; Corrin"
                            4 => "C&#46;W&#46; Edwars"
                            5 => "A&#46;R&#46; Gibbs"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Report of a UKCCCR Lung Cancer Working Party&#46; Thorax"
                        "fecha" => "1993"
                        "volumen" => "48"
                        "paginaInicial" => "1&#46;135"
                        "paginaFinal" => "1&#46;139"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cell type accuracy of bronchial biopsy specimens in primary lung cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;J&#46; Soler Catalu&#241;a"
                            1 => "M&#46; Perpi&#241;a"
                            2 => "V&#46; Calvo"
                            3 => "J&#46;D&#46; Padilla"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
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                        "volumen" => "109"
                        "paginaInicial" => "1&#46;199"
                        "paginaFinal" => "1&#46;203"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8769523"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "41&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bronchoscopic and roentgeno-graphic correlates of a positive transbronchial needle aspiration in the staging of lung cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "E&#46; Harrow"
                            1 => "M&#46; Halber"
                            2 => "S&#46; Hardy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1991"
                        "volumen" => "100"
                        "paginaInicial" => "1&#46;592"
                        "paginaFinal" => "1&#46;596"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1835689"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib0210"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A randomized trial comparing preoperative chemotherapy plus surgery with surgery alone in patients with non-small cell lung cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46; Rosell"
                            1 => "J&#46;G&#46; Codina"
                            2 => "C&#46; Camps"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1994"
                        "volumen" => "330"
                        "paginaInicial" => "23"
                        "paginaFinal" => "32"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib0215"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A randomized trial comparing preoperative chemotherapy and surgery with surgery alone in resectable stage III non-small cell lung cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;A&#46; Roth"
                            1 => "F&#46; Fossella"
                            2 => "Komaki"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Natl Cancer Inst"
                        "fecha" => "1994"
                        "volumen" => "86"
                        "paginaInicial" => "673"
                        "paginaFinal" => "680"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8158698"
                            "web" => "Medline"
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                    ]
                  ]
                ]
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            ]
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Vol. 34. Issue 5.
Pages 237-244 (May 1998)
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Vol. 34. Issue 5.
Pages 237-244 (May 1998)
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Utilidad de la punción transbronquial y la mediastinoscopia en la estadificación ganglionar mediastínica del carcinoma broncogénico no microcítico. Estudio preliminar
The usefulness of transbronchial needle aspiration and mediastinoscopy for staging mediastinal nodes in non small cell bronchogenic carcinoma. A preliminar study
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C. Disdier*, J. Sánchez de Cos, J.F. Masa
Unidad de Neumología. Hospital San Pedro de Alcántara. Cáceres
G. Varelaa, O. Bengoecheab, M. Jiméneza, J. Garínc, J.J. Cruzd
a Secciones de Cirugía Torácica, Hospital Universitario de Salamanca
b Servicios de Anatomía Patológica, Hospital San Pedro de Alcántara. Cáceres
c Servicios de Radiodiagnóstico. Hospital San Pedro de Alcántara. Cáceres
d Secciones de Oncología Médica. Hospital Universitario de Salamanca
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Estudio preliminar que tiene por objetivo conocer la sensibilidad (S) y especificidad (E) de la punción transbronquial (PTB) en comparación con la mediastinoscopia/me- diastinotomía anterior (MED/MEDA), y/o toracotomía en la estadificación ganglionar mediastínica del carcinoma no microcítico (CNM). Se analizó la S y E de la TAC como técnica utilizada para la selección de pacientes.

Fueron evaluados 33 pacientes con CNM sin metástasis a distancia y con buena función pulmonar. Se realizó una TAC torácica previa a la broncoscopia en 27 enfermos y antes de la cirugía en el resto. La estadifícación por PTB se realizó en las regiones ganglionares consideradas patológicas en la TAC y en la región subcarinal cuando no se pudo disponer de la información de la TAC antes de realizar la broncoscopia. Los resultados de la PTB se compararon con la MED/MEDA y/o toracotomía.

La prevalencia de enfermedad ganglionar metastásica fue del 47%. En 24 pacientes la TAC detectó ganglios mediastínicos agrandados y en 9 casos el estudio ganglionar mediastínico por imagen fue considerado normal. La S y E de la TAC fue del 93 y 54%, con un valor predictivo positivo (VPP) del 68% y un valor predictivo negativo (VPN) del 87,5%. Para la MED/MEDA la S fue del 73% y la E del 100%, siendo los VPP y VPN del 100 y 75%, respectivamente. La S y E de la PTB fueron, respectivamente, del 36 y del 92%, con un VPP del 83% y un VPN del 57%. Un paciente sufrió un neumotorax con empiema pleural tras la MED que pudo ser evitado al ser previamente positiva la PTB.

La PTB es una técnica útil y segura en la estadificación ganglionar del CNM. Aunque la sensibilidad de la PTB es menor que la de la MED, la PTB permite analizar regiones de difícil acceso para la MED y puede hacer innecesaria la realización de esta última si se ha obtenido una punción positiva para malignidad. La TAC torácica es una técnica sensible pero poco específica para determinar la presencia de afectación ganglionar metastásica.

Palabras clave:
Cáncer de pulmón
Punción transbronquial
Es- tadificación
Mediastinoscopia
Tomografía axial computarizada

Preliminary study to compare the sensitivity and specificity of transbronchial needle aspiration (TBNA) and mediastinoscopy/anterior mediastinotomy (MED/AMED) and/or thoracotomy for staging of mediastinal nodes in non-small cell carcinoma. To determine the sensitivity and specificity of computerized tomography (CT) as a screening technique.

Thirty-three patients with non-small cell carcinoma but no remote metastasis and good lung function were evaluated. A chest CT scan was performed before bronchoscopy in 27 patients and before surgery in the others. Nodular areas considered diseased based on CT images were staged by TBNA. When CT images were not available before bronchoscopy, TBNA for staging was performed in the subcarinal region. Results by TBNA were compared with those obtained by MED/AMED and/or thoracotomy.

The prevalence of metastatic nodular disease was 47%. CT detected enlarged mediastinal nodes in 24 patients; the images were considered normal in 9 patients. Sensitivity and specificity of CT was 93% and 54%, respectively, with a positive predictive value (PPV) of 68% and negative predictive value (NPV) of 87.5%. The sensitivity and specificity of MED/AMED were 73% and 100%, respectively; PPV was 100% and NPV was 75%. The sensitivity and specificity of TBNA were 36% and 92%, respectively; PPV was 83% and NPV was 57%. The pneumothorax with pleural empyema suffered by one patient after MED could have been avoided, given that the earlier TBNA was positive.

TBNA is a safe, useful technique for staging nodes in non-small cell carcinoma. Although the sensitivity of TBNA is lower than that of MED, regions that are difficult to reach with the latter technique can be sampled by TBNA. Furthermore, MED can be rendered unnecessary by positive TBNA results. CT imaging of the chest is sensitive but its specificity is low for detecting ganglial metastasis.

Key words:
Lung cancer
Transbronchial needle aspiration
Staging
Mediastinoscopy
Computed axial tomography
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Bibliografía
[1.]
T.W. Shields.
Surgical therapy for carcinoma of the lung.
Clin Chest Med, 14 (1993), pp. 121-147
[2.]
F.G. Pearson, N.C. DeLarue, R. Ilves, et al.
Significance of positive superior mediastinal nodes identified at mediatinoscopy in patients with resectable cancer of the lung.
J Thorac Cardiovasc Surg, 83 (1982), pp. 1-11
[3.]
M. Coughlin, J. Deslauriers, M. Beaulieu.
Role of mediastinoscopy in pretreatment staging of patients with primary lung cancer.
Ann Thorac Surg, 40 (1985), pp. 556-560
[4.]
T.C. McLoud, P.M. Bourgouin, R.W. Greenberg, J.P. Kosiuk, P.A. Templeton, J.O. Shepard, et al.
Bronchogenic carcinoma: analysis of staging in the mediastinum with CT by correlative lymph node mapping and sampling.
Radiology, 182 (1992), pp. 319-323
[5.]
R.S. Fontana.
Meta-analysis of computed tomography for staging non-small cell lung cancer.
Am Rev Respir Dis, 141 (1990), pp. 1.093-1.094
[6.]
J.W. Lewis, J.L. Pearlberg, G.H. Beute, et al.
Can computed tomography of the chest stage lung cancer?. Yes and no.
Ann Thorac Surg, 49 (1990), pp. 591-596
[7.]
E. Schieppati.
La punción mediastinal a través de la carina traqueal.
Rev As Med Argent, 663 (1949), pp. 497-499
[8.]
K.P. Wang, P.B. Terry.
Transbronchial needle aspiration in the diagnosis and staging of bronchogenic carcinoma.
Am Rev Respir Dis, 127 (1983), pp. 344-347
[9.]
A.D. Blainey, M. Curling, M. Green.
Transbronchial aspiration of subcarinal lymph nodes.
Br J Dis Chest, 82 (1988), pp. 149-154
[10.]
D. Shure, P.F. Fedullo.
The role of transcarinal needle aspiration in the staging of bronchogenic carcinoma.
Chest, 86 (1984), pp. 693-696
[11.]
D.A. Schenk, J.H. Bower, C. Bryan, et al.
Transbronchial needle aspiration staging of bronchogenic carcinoma.
Am Rev Respir Dis, 134 (1986), pp. 146-148
[12.]
G.B. Ratto, C. Mereu, G. Motta.
The prognostic significance of preoperative assessment of mediastinal lymph nodes in patients with lung cancer.
Chest, 93 (1988), pp. 807-813
[13.]
C.F. Mountain.
A new international staging system for lung cancer.
Chest, 89 (1986), pp. 225-233
[14.]
R. Ramí Porta, J.L. Duque Medina, J.R. Hernández Hernández, A. López Encuentra, J. Sánchez de Cos.
Grupo de Trabajo de la SEPAR. Normativa sobre diagnóstico y estadificación del carcinoma broncogénico.
Ediciones Doyma, S.A, (1996),
[15.]
G.M. Tisi, P.J. Friedman, R.M. Peters, G. Pearson, C. Carr, R.E. Lee, et al.
American Thoracic Society.
Clinical staging of primary lung cancer. Am Rev Respir Dis, 127 (1983), pp. 659-664
[16.]
K.P. Wang.
Staging of bronchogenic carcinoma by bronchoscopy.
Chest, 106 (1994), pp. 588-593
[17.]
K.P. Wang, P.K. Gupta, E.F. Haponik, et al.
Flexible transbronchial needle aspiration.
Technical considerations. Ann Otol Rhinol Laryngol, 93 (1984), pp. 233-236
[18.]
J.D. Olsen, D.A. Thomas, M.B. Young, M.E. Perry.
Cough and transbronchial needle aspiration.
Chest, 89 (1986), pp. 315
[19.]
K.P. Wang.
Transbronchial needle aspiration.
J Bronchol, 1 (1994), pp. 63-68
[20.]
D. Shure, P.F. Pedidlo.
Transbronchial needle aspiration in the diagnosis of submucosal and peribronchial bronchogenic carcinoma.
Chest, 88 (1985), pp. 49-51
[21.]
D. Shure, P.F. Fedullo.
Transbronchial needle aspiration of peripheral masses.
Am Rev Respir Dis, 128 (1983), pp. 1.090-1.092
[22.]
K.P. Wang, E.F. Haponick, E.J.B. Britt, et al.
Transbronchial needle aspiration of peripheral pulmonary nodules.
Chest, 86 (1984), pp. 819-823
[23.]
K. Katis, E. Inglesos, E. Zachariadis, P. Palamidas, I. Paraskevopoulos, G. Sideris, et al.
The role transbronchial needle aspiration in the diagnosis of peripheral lung masses or nodules.
Eur Respir J, 8 (1995), pp. 963-966
[24.]
P.C. Gay, W.M. Brutinel.
Transbronchial needle aspiration in the practice of bronchoscopy.
Mayo Clin Proc, 64 (1989), pp. 158-162
[25.]
D.J. Malenka, G.L. Colice, C. Jacobs, J.R. Beck.
Mediastinal staging in non-small-cell lung cancer.
Med Decis Making, 9 (1989), pp. 231-242
[26.]
U.B.S. Prakash, K.P. Oxfford, S.E. Strubbs.
Bronchoscopy in North America: The ACCP survey.
Chest, 100 (1991), pp. 1.668-1.675
[27.]
E.F. Haponik, J.O. Cappellari, R. Chin, N.E. Adair, M. Lykens, P.T. Alford, et al.
Education and experience improve transbronchial needle aspiration performance.
Am J Respir Crit Care Med, 151 (1995), pp. 1.998-2.002
[28.]
F. Rodríguez de Castro, F. Díaz López, G. Julia Serdá, A. Rey López, J. Freixenet Gilart, P. Cabrera Navarro.
Relevance of training in transbronchial fine-needle aspiration technique.
Chest, 111 (1997), pp. 103-105
[29.]
J.J. Baker, P.H. Solani, D.A. Schenk, C. Van Pelt, I. Ramzy.
Trans.bronchial fine needle aspiration of the mediastinum.
Importance of lymphocytes as an indicador of specimen adequacy. Acta Cytologica, 34 (1990), pp. 517-523
[30.]
U.B.S. Prakash, S.E. Stubbs.
The bronchoscopic survey: some reflections.
Chest, 100 (1991), pp. 1.660-1.667
[31.]
A.C. Mehta, P.S. Curtis, M.L. Scalzitti, et al.
The hige price of bronchoscopy: maintenance and repair of the flexible fiberoptic bronchoscope.
Chest, 98 (1990), pp. 448-454
[32.]
A.J. Cropp, A.F. DiMarco, M. Lankerani.
False positive transbron chial needle aspiration in bronchogenic carcinoma.
Chest, 85 (1984), pp. 696
[33.]
B.W. Carlin, J.H. Harrell, P.F. Fedullo.
False positive transcarinal needle aspirate in the evaluation of bronchogenic carcinoma.
Am Rev Respir Dis, 140 (1989), pp. 1.800-1.802
[34.]
D.A. Schenk, M.H. Chasen, M.J. McCarthy, et al.
Potential false positive mediastinal transbronchial needle aspiration in bronchogenic carcinoma.
Chest, 86 (1984), pp. 649-650
[35.]
K.P. Wang, R. Brower, E.F. Haponik, et al.
Flexible transbronchial fine needle aspiration for staging of bronchogenic carcinoma.
Chest, 84 (1983), pp. 571-576
[36.]
E.M. Harrow, F.A. Oldenburg Jr., M.S. Ligenfelter, A.M. Smith Jr..
Transbronchial needle aspiration in clinical practice. A five-year experience.
Chest, 96 (1989), pp. 1.268-1.272
[37.]
J.P. Utz, M. Ashok, M.D. Patel, E.S. Edell.
The role of transcarinal needle aspiration in the staging of bronchogenic carcinoma.
Chest, 104 (1993), pp. 1.012-1.016
[38.]
P. Juez, F.J. Díez.
Probabilidad y estadística en medicina.
Madrid: Díaz de Santos, (1997),
[39.]
J.S.J. Thomas, D. Lamb, T. Ashcroft, B. Corrin, C.W. Edwars, A.R. Gibbs, et al.
How reliable is the diagnosis of lung cancer using small biopsy specimens?.
Report of a UKCCCR Lung Cancer Working Party. Thorax, 48 (1993), pp. 1.135-1.139
[40.]
J.J. Soler Cataluña, M. Perpiña, V. Calvo, J.D. Padilla.
Cell type accuracy of bronchial biopsy specimens in primary lung cancer.
Chest, 109 (1996), pp. 1.199-1.203
[41.]
E. Harrow, M. Halber, S. Hardy, et al.
Bronchoscopic and roentgeno-graphic correlates of a positive transbronchial needle aspiration in the staging of lung cancer.
Chest, 100 (1991), pp. 1.592-1.596
[42.]
R. Rosell, J.G. Codina, C. Camps, et al.
A randomized trial comparing preoperative chemotherapy plus surgery with surgery alone in patients with non-small cell lung cancer.
N Engl J Med, 330 (1994), pp. 23-32
[43.]
J.A. Roth, F. Fossella, Komaki, et al.
A randomized trial comparing preoperative chemotherapy and surgery with surgery alone in resectable stage III non-small cell lung cancer.
J Natl Cancer Inst, 86 (1994), pp. 673-680
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