Abstract
BackgroundIn tuberculosis (TB)-endemic areas, contrast-enhanced computed tomography (CT) and positron emission tomography (PET) findings of lung cancer patients with non-enlarged lymph nodes are frequently discrepant. Endobronchial ultrasound-guided transbronchial aspiration (EBUS-TBNA) enables real-time nodal sampling, and thereby improves nodal diagnosis accuracy. This study aimed to compare the accuracy of nodal diagnosis by using EBUS-TBNA, and PET.MethodsWe studied 43 lung cancer patients with CT-defined non-enlarged mediastinal and hilar lymph nodes and examined 78 lymph nodes using EBUS-TBNA.ResultsThe sensitivity, specificity, positive predictive value, and negative predictive value of EBUS-TBNA were 80.6%, 100%, 100%, and 85.7%, respectively. PET had low specificity (18.9%) and a low positive predictive value (44.4%). The diagnostic accuracy of EBUS-TBNA was higher than that of PET (91% vs. 47.4%; p<0.001). Compared to CT-based nodal assessment, PET yielded a positive diagnostic impact in 36.9% nodes, a negative diagnostic impact in 46.2% nodes, and no diagnostic impact in 16.9% nodes. Patients with lymph nodes showing negative PET diagnostic impact had a high incidence of previous pulmonary TB. Multivariate analysis indicated that detection of hilar nodes on PET was an independent predictor of negative diagnostic impact of PET.ConclusionIn a TB-endemic area with a condition of CT-defined non-enlarged lymph node, the negative diagnostic impact of PET limits its clinical usefulness for nodal staging; therefore, EBUS-TBNA, which facilitates direct diagnosis, is preferred.
Highlights
Lung cancer remains a fatal disease worldwide, and surgical treatment may offer long-term survival
FDG-positron emission tomography (PET) is increasingly being used for lymph node staging in non-small cell lung cancer (NSCLC) when lymph node enlargement is not detected by computed tomography (CT)
CT images were obtained from the thoracic inlet to the adrenal gland, and the images were assessed by an experienced radiologist who was blinded to the FDG-PET and pathology reports
Summary
Lung cancer remains a fatal disease worldwide, and surgical treatment may offer long-term survival. Conventional contrast-enhanced computed tomography (CT) has been used to identify enlarged lymph nodes; lymph nodes .1 cm are defined as nodal metastatic lesions. In tuberculosis (TB)-endemic areas such as Eastern Asia, FDG-PET has been reported to have low specificity and a positive predictive value in nodal staging in NSCLC [10,11,12] In such areas, the PET scan does not appear to replace mediastinoscopy for nodal staging of NSCLC [11], especially in the case of potentially operable patients without enlarged mediastinal lymph nodes. In tuberculosis (TB)-endemic areas, contrast-enhanced computed tomography (CT) and positron emission tomography (PET) findings of lung cancer patients with non-enlarged lymph nodes are frequently discrepant. This study aimed to compare the accuracy of nodal diagnosis by using EBUS-TBNA, and PET
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