Bronchoscopic Needle Aspiration in Mediastinal Staging of Patients with Bronchogenic Carcinoma

Abstract

Seventy-six patients (mean age. 64 years) with chest radiographs suggestive of lung cancer and with evidence of mediastinal adenopathy on computed tomography (CT) underwent bronchoscopy with bronchoscopic needle aspiration (BNA) of the affected mediastinal nodes. Patients with meta-static disease or other findings suggesting nonresectability were excluded from the study. Cytologic examination of BNA was positive for malignancy in 72% of patients (55/76). BNA of subcarinal nodes was positive in 74% of patients (41/55), and BNA of paratracheal nodes was positive in 67% of patients (14/21). BNA was positive in 82% of patients (49/56) whose main carina or trachea appeared abnormal on bronchoscopy, and was positive in 45% of patients (9/20) who, under bronchoscopic examination, had a normal main carina and trachea. Of 21 patients with negative BNA cytology, 10 patients had nonsmall-cell carcinoma. Those individuals underwent further surgical staging, establishing that eight aspirates were false negative and two aspirates were true negative. The sensitivity of BNA in patients with nonsmall-cell carcinoma was 78%, considering all positive aspirates as true positive. No serious complications were observed. In conclusion, BNA of the mediastinal nodes is a safe and valuable staging procedure in patients with lung cancer and evidence of mediastinal adenopathy on chest CT.