Clinical application of endobronchial ultrasound-guided transbronchial needle aspiration in preoperative staging of non-small cell lung cancer

Abstract

Objective To determine the value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in staging of mediastinal lymph nodes of lung cancer. Methods From September 2010 to September 2012, mediastinal lymph node staging was conducted by EBUS-TBNA among patients in People′s Hospital, Peking University with confirmed or suspicious non-small cell lung cancer and detected enlarged mediastinal lymph nodes (short diameter of lymph node at N2≥1.0cm, or short diameter of lymph node at N1≥1.0cm with short diameter of lymph node at N2≥0.5cm) who had the chance of surgical resection and no history of radiotherapy and chemotherapy before operation. A total of 82 patients with non-small cell lung cancer were involved. Results Of the 82 patients, mediastinal lymph node metastasis (positive finding) was confirmed by EBUS-TBNA in 54 patients, and no mediastinal lymph node metastasis (negative finding) was detected in the other 28 patients. The diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value of EBUS-TBNA for the preoperative staging of mediastinal lymph nodes of lung cancer were 94.7%(54/57), 100.0%(25/25), 96.3%(79/82), 100.0%(54/54) and 89.3%(25/28), respectively. The diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CT scans for the preoperative staging of mediastinal lymph nodes of lung cancer were 98.2%(55/56), 38.5% (10/26), 79.3%(65/82), 77.5%(55/71) and 90.9%(10/11), respectively. The false positive rate of CT scans for the preoperative staging of mediastinal lymph nodes was 22.5%(16/71). EBUS-TBNA resulted in the alteration of individual treatment strategies in 16 patients (19.5%). Conclusion EBUS-TBNA has the high diagnostic sensitivity, specificity and accuracy for the staging of mediastinal lymph nodes of non-small cell lung cancer, which may serve as an effective technique for preoperative staging and treatment guiding. Key words: Endobronchial ultrasound; Transbronchial needle aspiration; Lung cancer, Staging