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This Article Full Text (PDF) All Versions of this Article: chest.07-2535v1 133/4/887    most recent Submit a response View responses Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Herth, F. J. F. Articles by Ernst, A. Search for Related Content PubMed PubMed Citation Articles by Herth, F. J. F. Articles by Ernst, A.

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration of Lymph Nodes in the Radiologically and PET Normal Mediastinum in Patients with Lung Cancer

(1) Dept of Pneumology and Critical Care Medicine, Thoraxklinik am Universitätsklinikum Heidelberg, Germany. (2) Cardiothoracic Surgery, Gentofte University Hospital, Copenhagen, Denmark. (3) Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

aernst{at}bidmc.harvard.edu

Abstract

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) can reliably sample enlarged mediastinal lymph nodes in patients with non-small cell lung cancer (NSCLC) and in practice is mostly used to biopsy nodes visible on computed tomography (CT) or Positron Emission Tomography (PET). Little data is available on the use of endoscopic procedures to stage the mediastinum in clinical stage 1 lung cancer.

The aim of the present study was to determine the results of EBUS-TBNA in sampling mediastinal lymph nodes in patients with lung cancer and a radiographically normal mediastinum and no PET activity.

From January 2004 to May 2007 patients highly suspicious for NSCLC with CT scans showing no enlarged lymph nodes (no node >1 cm) and a negative PET of the mediastinum underwent EBUS-TBNA. Identifiable lymph nodes at locations 2r, 2l, 4r, 4l, 7, 10r, 10l, 11r and 11l were aspirated. All patients underwent subsequent surgical staging. Diagnoses based on aspiration results were compared with those based on surgical results.

100 patients (mean age 52.4 yrs; 59 males), were included. After surgery 97 (mean age 52.9 yrs; 57 males) had NSCLC confirmed and were included in the analysis. In this group 156 lymph nodes ranging 5–10 mm in size were detected and sampled. Malignancy was detected in 9 patients but missed in one. The mean diameter of the punctured lymph nodes was 7.9 mm. The sensitivity of EBUS-TBNA for detecting malignancy was 89%, specificity was 100%, and the negative predictive value was 98.9 %. No complications occurred.

In conclusion, EBUS-TBNA can be used to accurately sample and stage patients with clinical stage 1 lung cancer and no evidence of mediastinal involvement on CT and PET. Potentially operable patients with no signs of mediastinal involvement may benefit from pre-surgical staging with EBUS-TBNA .

Key Words: Endobronchial ultrasound • lung cancer • mediastinal lymphadenopathy • PET • transbronchial needle aspiration • EBUS-TBNA

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