Application of endobronchial ultrasound-guided transbronchial needle aspiration following integrated PET/CT in mediastinal staging of potentially operable non-small cell lung cancer

Chest. 2009 May;135(5):1280-1287. doi: 10.1378/chest.08-2019. Epub 2008 Dec 31.

Abstract

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenocarcinoma / diagnostic imaging
  • Adenocarcinoma / pathology
  • Adenocarcinoma / secondary
  • Adenocarcinoma / surgery
  • Adult
  • Aged
  • Aged, 80 and over
  • Biopsy, Needle / methods
  • Carcinoma, Non-Small-Cell Lung / diagnostic imaging*
  • Carcinoma, Non-Small-Cell Lung / pathology
  • Carcinoma, Non-Small-Cell Lung / secondary*
  • Carcinoma, Non-Small-Cell Lung / surgery
  • Carcinoma, Squamous Cell / diagnostic imaging
  • Carcinoma, Squamous Cell / pathology
  • Carcinoma, Squamous Cell / secondary
  • Carcinoma, Squamous Cell / surgery
  • Endosonography
  • Female
  • Humans
  • Lung Neoplasms / pathology*
  • Male
  • Mediastinal Neoplasms / diagnostic imaging*
  • Mediastinal Neoplasms / secondary*
  • Mediastinal Neoplasms / surgery
  • Middle Aged
  • Neoplasm Staging
  • Positron-Emission Tomography
  • Prospective Studies
  • Thoracoscopy / methods
  • Tomography, X-Ray Computed