Chest
Volume 130, Issue 3, September 2006, Pages 710-718
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Original Research: Interventional Pulmonology
Comparison of Endobronchial Ultrasound, Positron Emission Tomography, and CT for Lymph Node Staging of Lung Cancer

https://doi.org/10.1378/chest.130.3.710Get rights and content

Study objectives

To perform a prospective comparison of direct real-time endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA), positron emission tomography (PET), and thoracic CT for detection of mediastinal and hilar lymph node metastasis in patients with lung cancer considered for surgical resection.

Design

Prospective patient enrollment.

Setting

University teaching hospital.

Patients

One hundred two potentially operable patients with proven (n = 96) or radiologically suspected (n = 6) lung cancer were included in the study.

Interventions

CT, PET, and EBUS-TBNA were performed prior to surgery for the evaluation of mediastinal and hilar lymph node metastasis. The convex probe EBUS, which is integrated with a convex scanning probe on its tip, was used for EBUS-TBNA. Surgical histology was used as the “gold standard” to confirm lymph node metastasis unless patients were found inoperable for N3 or extensive N2 disease proven by EBUS-TBNA.

Main results

EBUS-TBNA was successfully performed in all 102 patients (mean age, 67.8 years) from 147 mediastinal and 53 hilar lymph nodes. EBUS-TBNA proved malignancy in 37 lymph node stations in 24 patients. CT identified 92 positive lymph nodes, and PET identified 89 positive lymph nodes (4 supraclavicular, 63 mediastinal, 22 hilar). The sensitivities of CT, PET, and EBUS-TBNA for the correct diagnosis of mediastinal and hilar lymph node staging were 76.9%, 80.0%, and 92.3%, respectively; specificities were 55.3%, 70.1%, and 100%, and diagnostic accuracies were 60.8%, 72.5%, and 98.0%. EBUS-TBNA was uneventful, and there were no complications.

Conclusion

Compared to CT and PET, EBUS-TBNA has a high sensitivity as well as specificity for mediastinal and hilar lymph node staging in patients with lung cancer. EBUS-TBNA should be considered for evaluation of the mediastinum early in the staging process of lung cancer.

Section snippets

Patients

From December 2003 to March 2005, patients with suspected or pathologically established lung cancer referred to the Department of Thoracic Surgery, Chiba University Hospital were enrolled in this study. All patients were evaluated by history; physical examination; CBC count; renal, liver, and pulmonary function tests; chest radiography; CT scan of the chest and upper abdomen; brain MRI; bone scan; and FDG-PET. All tests were presented in a multidisciplinary session, and the staging of the

Patients

From December 2003 to March 2005, a total of 280 patients with suspected or pathologically established lung cancer were evaluated by the multidisciplinary group. Of these 280 patients, 178 patients were not further evaluated for presence of distant metastasis, tumor resectability, or medical operability. The remaining 102 patients with proven (n = 96) or suspected (n = 6) lung cancer fulfilled the criteria and underwent CT, PET, and EBUS-TBNA for mediastinal staging prior to surgery. The

DISCUSSION

Our report is the first study to compare CT, PET, and EBUS-TBNA for mediastinal staging of potentially operable lung cancer patients. EBUS-TBNA was performed in 102 potentially resectable patients with lung cancer or suspected lung cancer. The sensitivity, specificity, and accuracy of EBUS-TBNA for the prediction of mediastinal lymph node staging were 92.3%, 100%, and 98.0%, respectively. EBUS-TBNA was highly sensitive and specific compared to CT and PET. As a single procedure for mediastinal

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    All authors have no conflicts of interest to disclose.

    Supported by a grant from The Japanese Foundation for Research and Promotion of Endoscopy to Dr. Yasufuku.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

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