Background Lung cancer(LC) is the leading cause of worldwide cancer-related deaths and its accurate diagnosis and staging is crucial to guide appropriate treatment and prognosis.¹ EBUS-TBNA is a minimally invasive standard procedure for staging that has proven to be useful in diagnosis too, allowing a complete characterisation of the disease in a single procedure and, thus, decreasing time-to-treatment.²

Aim To evaluate the role of EBUS-TBNA as initial technique for simultaneous diagnosis and staging in patients with suspected LC and calculate its sensitivity, specificity, positive and negative predictive values.

Methods Retrospective study of all patients with suspected LC in computed tomography(CT) or positron-emission tomography(PET)/CT submitted to EBUS-TBNA for simultaneous diagnosis and staging, from September/2011 to February/2017.Results of EBUS-TBNA were compared to surgical ones, when patients were subsequently submitted to surgery, or to clinical and radiological follow-up.

Results Patients included(n=62) had mean age of 68 years(SD=10) and 66.1% were male. Smoking history was present in 53.2% and history of extrathoracic malignant disease in 17.7%. Mean diameter of pulmonary lesions in CT or PET/CT was 37.2 mm(SD=21 mm) and in 64.5% of cases were associated to lymphadenopathy. 59.7%(n=48) of patients were diagnosed with LC, 77.1%(n=37) of them by EBUS-TBNA, 8.3(n=4) by other bronchoscopic methods at same time of EBUS and 14.6%(n=7) needed surgical biopsy. LC diagnosed by EBUS-TBNA were 59.5% adenocarcinoma, 16.2% squamous, 21.6% small cell and 2.7% carcinoid. In all of LC diagnosed by EBUS-TBNA, staging was achieved in the same procedure(8.1% N0, 5.4% N1, 67.6% N2 and 18.9% N3).EBUS-TBNA showed a sensitivity of 86%, specificity of 88.9%, PPV of 97.4% and PNV of 57.1% for simultaneous diagnosis and staging in our setting.

Conclusions In our study EBUS-TBNA was useful to simplify the diagnosis and staging of LC, allowing both simultaneously in 77.1% of the patients and may be the preferred method for the initial approach after CT or PET/CT scan in this group of patients, in order to achieve faster diagnosis.

References

1. Navani N, et al. Lung-BOOST trial investigators. Lung cancer diagnosis and staging with endobronchial ultrasound-guided transbronchial needle aspiration compared with conventional approaches: An open-label, pragmatic, randomised controlled trial. Lancet RespirMed2015, April;3(4):282–9.

2. Steinhauser Motta JP, et al. Endobronchial ultrasound in real life: Primary diagnosis and mediastinal staging of lung cancer in patients submitted to thoracic surgery. BMC Pulm Med 2016, July 19;16(1):101.