Evaluating the role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of mediastinal metastasis from extrapulmonary malignancies

Abstract

Introduction: Mediastinal lymph node enlargement is a common finding in patients with extrathoracic malignancies. Whether these lesions are benign or metastasis is of extreme importance, as it may lead to changes in the management strategy of these patients. Objectives: To evaluate the value of EBUS-TBNA in the diagnosis of intrathoracic metastasis of extrathoracic malignancies. Methods: Retrospective analyses of the patients with extrapulmonary solid organ malignancy in whom EBUS-TBNA was performed for diagnosis of intrathoracic lymph node enlargement. Results: A total of 120 patients – 46 females (38.3%) and 74 males (61.7%) – were evaluated. The mean age was 64.1 (±11.1). Biopsies were performed on 199 lymph nodes, with the subcarinal being the most approached. The majority of the primitive cancers was from the head and neck. EBUS-TBNA diagnosed mediastinal metastases from extrapulmonary malignancy in 41 (34.2%) cases and primary lung cancer in 11 (9.2%) patients. Of those 68 patients in whom malignancy was not detected, 18 underwent further investigation, and 50 had clinical and radiological follow-up. Four (4) patients had malignancy confirmed by a second procedure, and another 4 patients developed clinicoradiological progression and were considered metastases. There were 6 false negatives. The sensitivity, specificity, and negative predictive value were 87.2%, 100%, and 88.2%. Diagnostic yield was 88.3%. Conclusions: EBUS-TBNA is a minimally invasive safe technique, and may be recommended as the first diagnostic approach for the diagnosis of mediastinal metastasis from extrapulmonary malignancies.