Endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis and staging of lung cancer

Abstract

The endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) bronchoscope has a built-in miniaturized ultrasound probe that facilitates real-time TBNA biopsies. The sensitivity of EBUS-TBNA in lung cancer is 88% to 90% and specificity is 100%. The test performance is excellent with an area under the summary receiver operating characteristics curve of 0.99. This diagnostic yield clearly exceeds that of conventional blind TBNA. However, the false negative rate remains high, about 20%. Therefore, negative aspirates need to be confirmed with mediastinoscopy, surgical sampling or clinical follow up. Restaging the mediastinum after neoadjuvant chemotherapy has had less success with a reported EBUS-TBNA sensitivity of only 76% and a negative predictive value of 20%. The procedure has also been used to successfully obtain biopsy specimens in primary tumors located in the paratracheal and peribronchial region with a sensitivity of 82 to 94%. The benefit of EBUS-TBNA is that it can be performed under moderate sedation in an outpatient setting without ionizing radiation. Although the current practice in most institutions remains targeted sampling of enlarged lymph nodes, complete staging of a radiologically normal mediastinum is also possible. Therefore, EBUS-TBNA can be considered one of the first-line modalities for the diagnosis and invasive staging of lung cancer if the equipment and expertise are available.