Original Article
EBUS-TBNA for the Clarification of PET Positive Intra-Thoracic Lymph Nodes—an International Multi-Centre Experience

https://doi.org/10.1097/JTO.0b013e3181914357Get rights and content
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Introduction:

To determine the sensitivity and accuracy of endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) for clarification of the nature of fluorodeoxyglucose-positron emission tomography (18FDG) positive hilar and/or mediastinal lymph nodes in patients with (suspected) lung cancer.

Methods:

All consecutive patients who had undergone EBUS-TBNA alone for assessment of abnormal 18FDG-uptake in hilar and/or mediastinal lymph nodes between January 2005 and August 2007 were reviewed.

Results:

One-hundred-nine patients underwent EBUS-TBNA of 127 positron emission tomography positive lymph nodes. Hilar (station 10 or 11) nodes (N1 or N3) were aspirated in 26 patients and mediastinal (stations 2, 4, 7) nodes (N2 or N3) in 90 patients. In 7 patients both hilar and mediastinal nodes were sampled. There were no procedure-related complications. Malignancy was detected in 77 (71%) cases. Thirty-two patients were tumor negative by EBUS-TBNA; subsequent surgical biopsy in 19 showed malignancy in 7. In four cases the false negative result was due to sampling error and in three cases due to detection error. In 13 cases surgical staging was not performed although long term follow-up in 3 showed no evidence of malignancy. The sensitivity and accuracy of EBUS-TBNA for malignancy in patients with reference pathology was 91% and 92%, respectively. The negative predictive value was 60%. If the 10 cases for which confirmatory surgical staging was not performed are assumed to be false negative results, overall sensitivity and accuracy were 82% and 84%, respectively.

Conclusions:

EBUS-TBNA offers an effective accurate, minimally invasive strategy for evaluating FDG avid hilar and mediastinal lymph nodes. However, negative findings should be confirmed by surgical staging.

Key Words:

Lung cancer
Endobronchial ultrasound
Positron emission tomography
Mediastinum
Staging

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Disclosure: Dr Rintoul has advised Olympus and Olympus KeyMed during the development of the EBUS-TBNA bronchoscope. His institution (Papworth Hospital) is in receipt of loan equipment from Olympus KeyMed and has received unrestricted educational grants to run courses on the use of EBUS. He has never received any payment for this work nor does he have a personal pecuniary interest in Olympus or Olympus KeyMed. The other authors declare no conflicts of interest.