Prospective Study of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in Non-Small Cell Lung Cancer Stadification: How Many Passes Are Adequate for PET Positive and Negative Lymph Nodes?

Abstract

SESSION TITLE: Rapid Session: Interventional Procedures SESSION TYPE: Original Investigation Slide PRESENTED ON: Sunday, October 29, 2017 at 03:15 PM - 04:15 PM PURPOSE: It is recommended in the absence of rapid on-site evaluation (ROSE) in patients suspected of having lung cancer and undergoing endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for diagnosis, that a minimum of 3 separate needle passes be performed per sampling site (Ungraded Consensus-Based Statement).1 However it is still unclear if there is a difference between PET-positive lymph nodes (LN) and those PET negative. The purpose of the present study was to elucidate the number of passes needed for PET positive or negative LN. METHODS: A prospective study was performed from 2012 to 2017 at the Bellvitge University Hospital, 103 patients with diagnosed NSCLC were recruited. The patients underwent 3 passes of EBUS-TBNA in 150 lymph nodes found during the procedure that were bigger than 5 mm. The 3 passes were studied by ROSE and by cell block, each pass separately. LN were divided by PET results. The results of the passes and the final diagnosis were analyzed. RESULTS: A total of 103 patients were selected, 85,7% of them were male with an average age of 66.9 years. All of them have been diagnosed of non-small cell lung cancer (NSCLC) prior to the test performance, 34,3% were adenocarcinoma and 65,7% squamous cell carcinoma. ROC analysis and Sensitivity has been assessed for each of the two groups of LN (PET + and PET-) and the results were compared for each pass. We observed that in PET positive LN there is a significant improvement in the sensitivity if 3 passes were performed, while in PET negative LN there is no significant difference in the diagnostic yield between one or three passes. There is no significant difference if the LN were <10 mm or >10 mm. There is neither significant difference if the tumor was an Adenocarcinoma. CONCLUSIONS: In NSCLC stadification by EBUS-TBNA, we recommend three passes in those PET-positive LN and only one in those PET-negative even if ROSE is available. CLINICAL IMPLICATIONS: This study suggest that three passes per PET-positive LN and one for PET-negative LN are necessary to obtain satisfactory results for NSCLC stratification with ROSE available. DISCLOSURE: The following authors have nothing to disclose: Noelia Cubero, Melisa Masis, Rosa Lopez Lisbona, Marta Diez-Ferrer, Antoni Rosell No Product/Research Disclosure Information