Chest
Volume 135, Issue 5, May 2009, Pages 1280-1287
Journal home page for Chest

Original Research
Interventional Pulmonology
Application of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration Following Integrated PET/CT in Mediastinal Staging of Potentially Operable Non-small Cell Lung Cancer

https://doi.org/10.1378/chest.08-2019Get rights and content

Background

The role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) following integrated PET/CT scanning in mediastinal staging of non-small cell lung cancer (NSCLC) has not been assessed.

Methods

We prospectively evaluated the diagnostic values of PET/CT scanning and EBUS-TBNA for mediastinal staging in 117 patients with potentially operable NSCLC with accessible mediastinal lymph nodes (diameter range, 5 to 20 mm) by EBUS-TBNA. Subgroup analysis according to histologic type was performed.

Results

Of 30 cases of mediastinal metastasis, 27 were confirmed by EBUS-TBNA and 3 were confirmed by surgery. EBUS-TBNA results confirmed all cases with true-positive PET/CT scan findings and six of nine cases with false-negative PET/CT scan findings. The sensitivity, specificity, positive predictive value, negative predictive value (NPV), and accuracy of EBUS-TBNA in the detection of mediastinal metastasis were 90.0%, 100%, 100%, 96.7%, and 97.4%, respectively. For PET/CT scans, the values were 70.0%, 59.8%, 37.5%, 85.2%, and 62.4%, respectively (p = 0.052; p < 0.001; p < 0.001; p = 0.011; p < 0.001, respectively). In adenocarcinoma (n = 55), EBUS-TBNA detected four of six cases with false-negative PET/CT scan findings, and the NPV was higher for EBUS-TBNA than for PET/CT scans (94.6% vs 77.8%, respectively; p = 0.044). In squamous cell carcinoma (n = 53), the NPV of EBUS-TBNA and PET/CT scans were similarly high (97.9% vs 96.3%, respectively; p = 0.689).

Conclusions

EBUS-TBNA was an effective invasive method following PET/CT scanning in the mediastinal staging of potentially operable NSCLC. In mediastinal PET/CT scan-positive cases, EBUS-TBNA was an excellent tool for detecting mediastinal metastasis. Even in mediastinal PET/CT scan-negative cases, EBUS-TBNA can be useful for confirming mediastinal metastases, especially in adenocarcinoma.

Section snippets

Patients

In this prospective study, consecutive patients with histologically confirmed or strongly suspected potentially operable NSCLC were enrolled from October 2006 to October 2007. Patients were required to have at least one mediastinal lymph node in an accessible location by EBUS-TBNA, with a short diameter of 5 to 20 mm on chest CT scan axial image. Surgical tumor resectability was evaluated after staging workup for NSCLC, including CT scan of the chest and upper abdomen, integrated PET/CT scan,

Patients

We enrolled 129 patients in the study (Fig 1) and safely performed EBUS-TBNA on all without complications. Two patients ultimately were given a diagnosis of small cell lung cancer and one with organizing pneumonia. Of the 126 remaining patients, 9 could not be evaluated (ie, 7 refused surgery, and 2 did not undergo lymph node dissection because of unexpected pleural metastasis found during surgery). Table 1 shows the characteristics of the 117 evaluated patients and the lymph node findings.

EBUS-TBNA and Surgical Lymph Node Dissection

Discussion

In this study, EBUS-TBNA had high diagnostic values that were superior to integrated PET/CT scan in the mediastinal staging of potentially operable NSCLC. We found that EBUS-TBNA was more sensitive than PET/CT scan, although the difference was of borderline statistical significance. EBUS-TBNA had significantly higher specificity, PPV, NPV, and accuracy than PET/CT scan. These results show that EBUS-TBNA is an effective invasive method for mediastinal staging after PET/CT scan is performed. The

Conclusions

EBUS-TBNA, which is more accurate than integrated PET/CT scanning, is an effective invasive method in the mediastinal staging of potentially operable NSCLC after PET/CT scanning is performed. EBUS-TBNA is an excellent tool for detecting mediastinal metastasis in mediastinal PET/CT scan-positive, potentially operable NSCLC and should be considered for patients with this condition. Even in mediastinal PET/CT scan-negative cases, EBUS-TBNA can be helpful in confirming mediastinal metastasis,

References (31)

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This work was supported by National Cancer Center grant 710620.

The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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

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