Diagnostic Accuracy Of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration Research Articles

Accuracy of convex probe EBUS-TBNA versus FDG-PET/CT imaging in diagnosis and mediastinal staging of lung cancer patients; an Egyptian Experience

BackgroundAppropriate staging of lung cancer is of paramount importance, as it customizes treatment and predicts prognosis. Both Fludeoxyglucose-18 (FDG) positron emission tomography (PET) combined with contrast computed tomography (CT) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) are two widely used diagnostic modalities in the field of staging & diagnosis of lung malignancies, the former depends on image analysis while the later enables real-time sampling of lymph nodes under sonographic guidance.ObjectiveTo compare the diagnostic and staging accuracy of convex probe EBUS-TBNA versus FDG – PET/CT as two modalities in diagnosis & mediastinal staging of lung cancer patients.MethodsThis prospective, observational (daignostic accuracy) research was performed on 40 cases with lung malignancies. All cases were examined via FDG-PET/CT followed by convex probe EBUS-TBNA for diagnosis & staging of concurrent mediastinal lymphadenopathy (MLN).ResultsThe diagnostic yield of EBUS-TBNA reached 92.5% (37/40) compared to 70% (28/40) for FDG-PET/CT. There was poor agreement between EBUS-TBNA & FDG-PET/CT regarding (MLN) staging (k = 0.043), in 16/40 patients (40%), EBUS MLN staging matched that of FDG-PET/CT, while in 24/40(60%) there were discrepancies between the two diagnostic modalities; 18/40(45%) were up-staged after EBUS while 6/40(15%) were down staged after EBUS. In addition, EBUS-TBNA confirmed occult mediastinal nodal involvement in 9/10 FDG-PET/CT negative scans (N0). The overall diagnostic accuracy of EBUS-TBNA was significantly greater than FDG-PET/CT in staging of lung cancer (97.37% & 70% respectively, p < 0.001).ConclusionEBUS-TBNA is a minimally invasive procedure that we currently recommend as a first choice for MLN staging.Trial registrationClinicalTrials.gov, NCT06479798. Registered 26 June 2024—Retrospectively registered, https://clinicaltrials.gov/study/NCT06479798.

Ekstra-torasik maligniteli hastalarda EBUS-TBİA tanı değeri ve PET-BT ile ilişkisi

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a well-established diagnostic tool for lung cancer, sarcoidosis, and suspected metastatic extra-thoracic malignancy (ETM). Patients with primary ETM often have hypermetabolic mediastinal/hilar lymph node enlargement in the PET-scan done for initial staging or post treatment followup. We aimed to determine the diagnostic performance of EBUS-TBNA and the relationship between PET-SUV values and diagnosis of malignancy metastasis in patients with ETM.Results of EBUS-TBNA in ETM patients with suspected MLN metastasis were retrospectively analysed (May 2016 to July 2019). Non-malign results were confirmed for surgery or clinical/radiological followup. Lymph nodes with a high FDG-uptake (SUV > 2.5, MLN) were reported as suspicious for metastasis.Of the 588 EBUS procedures, 109 were included in the analysis. Patient' mean age was 62.5 ± 10.1 years; there were 35 men and 74 women. Primary malignancies were breast cancer in 33, gastrointestinal in 23, female genital tract in 17, head and neck in 14, genitourinary cancer in 13, malignant melanoma in 6, sarcoma in 2 and kaposi sarcoma in 1. According to EBUS-TBNA smear and cell block histopathologic evaluations, 16 patients' results (14.7%) were malignant compatible with metastasis of ETM. Among the 93 patients with non-malignant diagnosis, EBUS-TBNA revealed a granulomatous lympadenitis compatible with sarcoid reaction in 7 and tuberculosis in 2. A total of 9 patients underwent surgical procedures after EBUSTBNA, with a definitive histological diagnosis of granulomatous lymphadenitis in 2, malignancy in 5 and, reactive lymph node in 2. Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of EBUS-TBNA were 76.19% (95% CI 52.83-91.78), 100% (95% CI 95.89-100.00), 100%, 94.62% (95% CI 89.12-97.12) and 95.4%, respectively.EBUS-TBNA sampling has high diagnostic performance. Histopathological confirmation requirement for MLN should be kept in mind in patients with ETM, even they have negative EBUS results.

Diagnosis of mediastinal tuberculous lymphadenitis using endobronchial ultrasound-guided transbronchial needle aspiration with rinse fluid polymerase chain reaction

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been gradually introduced in the diagnosis of mediastinal tuberculous (TB) lymphadenitis. The purposes of this study were to evaluate the utility of polymerase chain reaction for Mycobacterium tuberculosis (TB-PCR) using EBUS-TBNA rinse fluid and to explore the factors that influence the accuracy of EBUS-TBNA. A retrospective study with prospective data collection was carried out with patients with unselected mediastinal lymphadenopathy who underwent EBUS-TBNA and a TB-PCR study from April 2010 to July 2017. Patients without TB were excluded. The diagnostic accuracy rate for each diagnostic modality (pathology, smear, culture, and TB-PCR) was calculated respectively. The characteristics of the lymph node (LN) and the pathologic findings were analyzed as possible impact factors. 240 consecutive patients who received EBUS-TBNA were enrolled, and in the end, 21 patients with a diagnosis of TB lymphadenitis were included. When combined with histologic results and traditional microbiologic studies, the diagnostic accuracy of EBUS-TBNA was 57.1%. If TB-PCR was also utilized, the diagnostic accuracy would significantly increase to 71.4% (p<0.001). Univariate and multivariate regression analysis revealed that pathology showing necrosis had a higher positive microbiologic result when using EBUS-TBNA rinse fluid. EBUS-TBNA is a valuable tool for diagnosis of mediastinal TB lymphadenitis. Using TB-PCR assay and targeting LNs with a necrotic component would improve the diagnostic performance of EBUS-TBNA.

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Re-biopsy in Previously Treated Lung Cancer.

PurposeEndobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is widely used for the diagnosis and staging of lung cancer. However, evidence of its usefulness for re-biopsy in treated lung cancer, especially according to the previous treatment, is limited. We evaluated the role of EBUS-TBNA for re-biopsy and its diagnostic values in patients with different treatment histories.Materials and MethodsWe reviewed the medical records of patients who underwent EBUS-TBNA for re-biopsy of suspicious recurrent or progressive lesions between January 2006 and December 2016 at the National Cancer Center in South Korea. Patients were categorized into three groups based on the previous treatment modalities: surgery, radiation, and palliation.ResultsAmong the 367 patients (surgery, n=192; radiation, n=40; palliation, n=135) who underwent EBUS-TBNA for re-biopsy, the overall sensitivity, negative predictive value (NPV), and diagnostic accuracy of EBUS-TBNA in detecting malignancy were 95.6%, 82.7%, and 96.3%, respectively. The sensitivity was lower in the radiation group (83.3%) when compared with the surgery (95.7%, p=0.042) and palliation (97.7%, p=0.012) groups. The NPV was lower in the palliation group (50.0%) than in the surgery group (88.5%, p=0.042). The sample adequacy of EBUS-TBNA specimens was lower in the radiation group (80.3%) than in the surgery (95.4%, p < 0.001) or palliation (97.8%, p < 0.001) groups. EGFR mutation analysis was feasible in 94.6% of the 92 cases, in which mutation analysis was requested. There were no major complications. Minor complications were reported in 12 patients (3.3%).ConclusionEBUS-TBNA showed high diagnostic values and high suitability for EGFR mutation analysis with regard to re-biopsy in patients with previously treated lung cancer. The sensitivity was lower in the radiation group and NPV was lower in the palliation group. The complication rate was low.

Excellence in non-small cell lung cancer staging by endobronchial-TBNA: Comparison with PET-CT and surgery

Objective: To determine the correlation and/or discrepancies between positron emission tomography (PET-CT) findings, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and surgery in the staging of non-small cell lung carcinoma.Material and methods: Data were evaluated retrospectively from a prospective interventional endoscopy database. Positive results with EBUS-TBNA was the first end point and all cytology negatives were confirmed with mediastinoscopy/surgery.Results: Four hundred and eighty three patients were included and 1017 lymph nodes (LNs) were sampled in the study. One hundred and twenty eight LNs were excluded (positive with EBUS-TBNA). Four hundred and sixty five LN (52.3%) were found benign with EBUS-TBNA; however, only 15 of these were confirmed to be malignant by surgery (1.7%). The sensitivity, specificity, PPV, NPV and diagnostic accuracy of EBUS-TBNA were 96.5, 100, 100, 96.7 and 98.3%, respectively. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of PET-CT for maximum standardized uptake value (SUVmax) 2.5 were 90.1, 29.2, 55.3, 75.4, 59.2%, respectively. A cut-off SUVmax of 5.2 was detected with 74.8% sensitivity, 84% specificity, 82.0% PPV, 77.5% NPV and 79.5% accuracy (area under the curve (AUC) of 0.818, 95% CI 0.791–0.843, p<.001).Conclusion: EBUS is a reliable, repeatable and safe technique with a high diagnostic accuracy and should be performed quickly to avoid superfluous time loss in the staging of lung cancer.AbbreviationsPET-CTF-18 fluorodeoxyglucose positron emission computed tomographyNSCLCNon-small cell lung cancerEBUS-TBNAEndobronchial ultrasound-guided transbronchial needle aspirationSUVmaxMaximum standardized uptake valueLNsLymph nodesTTF-1Thyroid transcription factor-1H&EHematoxylin and eosin; Med: MediastinoscopyVATSVideo associated thoracic surgeryAUCArea under curveOROdds ratioCIConfidence intervals

Yaşlı hastalarda endobronşiyal ultrason eşliğinde alınan transbronşiyal iğne aspirasyonunun tanı değeri

In the elderly population, diagnosis and initial treatment should be considered as soon as possible because of co-morbidities and complications. We aimed to evaluate the Þndings of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) to determine the diagnostic utility of EBUS-TBNA in patients 65 years of age and older. We retrospectively evaluated records of patients who underwent EBUS-TBNA from February 2014 to August 2017 for diagnosis and/or staging. The demographic data, clinical and EBUS Þndings, diagnostic procedures during EBUS-TBNA and the incidence of accurate diagnosis with EBUS-TBNA in patients 65 years of age and older and in younger patients were determined. A total of 496 patients [younger patients (< 65 years, n= 293, M/F: 198/95) and older patients (≥ 65 years, n= 203, M/F: 155/48)] who underwent EBUS-TBNA at our clinic were included. The mean age of the older patients was 69.7 ± 5.1 years, while the mean age of the younger patients was 51.4 ± 10.4 years. Overall, the diagnostic accuracy of EBUS-TBNA was 96.5% in the older patients and 98% in the younger patients. The diagnostic utility of EBUS-TBNA in the two study groups was similar (p= 0.191). While 196 (96.6%) of the older patients had no complications during EBUS-TBNA, 285 (97.3%) of the younger patients had no complications. Complication rates were not statistically different between the two groups (p= 0.389). In general, EBUS-TBNA is a safe method. The results of this study demonstrated the high diagnostic value of EBUS-TBNA and its low complication rates in patients 65 years of age and older.

Diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration in various lung diseases.

Objective: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a new method for the diagnosis and staging of lung disease, and its use is increasing worldwide. It has been used as a means of diagnosing lung cancer in its initial stages, and there are data supporting its use for the diagnosis of benign lung disease. The aim of this study was to share our experience with EBUS-TBNA and discuss its diagnostic value. Methods: We retrospectively analyzed the results related to 159 patients who underwent EBUS-TBNA at our pulmonary medicine clinic between 2010 and 2013. We recorded the location and size of lymph nodes seen during EBUS. Lymph nodes that appeared to be affected on EBUS were sampled at least twice. We recorded the diagnostic results of EBUS-TBNA and (for cases in which EBUS-TBNA yielded an inconclusive diagnosis) the final diagnoses after further investigation and follow-up. Results: We evaluated 159 patients, of whom 89 (56%) were male and 70 (44%) were female. The mean age was 54.6 ± 14.2 years among the male patients and 51.9 ± 11.3 years among the female patients. Of the 159 patients evaluated, 115 (84%) were correctly diagnosed by EBUS. The diagnostic accuracy of EBUS-TBNA was 83% for benign granulomatous diseases and 77% for malignant diseases. Conclusions: The diagnostic value of EBUS-TBNA is also high for benign pathologies, such as sarcoidosis and tuberculosis. In patients with mediastinal disorders, the use of EBUS-TBNA should be encouraged, primarily because it markedly reduces the need for mediastinoscopy.

The value of rapid on-site evaluation during EBUS-TBNA

BackgroundRapid on-site evaluation (ROSE) has the potential to increase endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) accuracy in the diagnosis of mediastinal lesions and lung cancer staging. However, studies have reported controversial results.The purpose of our study was to evaluate the influence of ROSE on sample adequacy and diagnostic accuracy of EBUS-TBNA. MethodsProspective observational study that enrolled 81 patients who underwent EBUS-TBNA for investigation of hilo-mediastinal lesions or lung cancer staging. The first 41 patients underwent EBUS-TBNA with ROSE (ROSE group) and the last 40 patients without ROSE (non-ROSE group). Sample adequacy and diagnostic accuracy of EBUS-TBNA in both groups were compared. ResultsAdequate samples were obtained in 93% of the patients in the ROSE group and 80% in non-ROSE group (p=0.10). The diagnostic accuracy of EBUS-TBNA was 91% in ROSE group and 83% in non-ROSE group (p=0.08). Analyzing the EBUS-TBNA purpose, in the subgroup of patients who underwent EBUS-TBNA for investigation of hilo-mediastinal lesions, these differences between ROSE and non-ROSE group were higher compared to lung cancer staging, 93% of patients with adequate samples in the ROSE group vs. 75% in the non-ROSE group (p=0.06) and 87% of diagnostic accuracy in ROSE group vs. 77% in non-ROSE group (p=0.10). ConclusionsDespite the lack of statistical significance, ROSE appears to be particularly useful in the diagnostic work-up of hilo-mediastinal lesions, increasing the diagnostic yield of EBUS-TBNA.

Comparison between endobronchial ultrasound-guided transbronchial needle aspiration and 18F-fluorodeoxyglucose positron emission tomography in the diagnosis of postoperative nodal recurrence in patients with lung cancer

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has a high diagnostic value for preoperative mediastinal staging in patients with lung cancer. In this study, the utility of EBUS-TBNA for the pathological diagnosis of postoperative lymph node recurrence was investigated and compared with that of (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET). Patients who received both EBUS-TBNA and FDG-PET for the diagnosis of postoperative lymph node recurrence were retrospectively investigated. They underwent routine chest computed tomography (CT) follow-up after thoracotomy, and when hilar or mediastinal lymph nodes showed enlargement on CT compared with the previous chest CT, they were referred for FDG-PET and EBUS-TBNA. We compared the diagnostic performance of these two modalities. In addition, pathological findings of the biopsied sample were evaluated precisely and compared with the results of FDG-PET. Positivity for hypermetabolism on FDG-PET was defined as a standardized uptake value (SUV) greater than 2.5. A total of 40 patients were retrospectively reviewed. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of EBUS-TBNA were 100% for each parameter, whereas those of FDG-PET were 95.8, 12.5, 62.2, 66.7 and 62.5%, respectively. The SUV of true-positive nodes was significantly higher than that of false-positive nodes (P = 0.001). Twenty-two of 24 patients who were confirmed for recurrence by EBUS-TBNA underwent anticancer treatment. The pathological diagnoses of 14 false-positive cases by FDG-PET were chronic inflammation in 12 and non-specific granuloma in 2. The diagnostic yield of EBUS-TBNA is higher than that of FDG-PET when postoperative lymph node recurrence is suspected.

A study of patients with isolated mediastinal and hilar lymphadenopathy undergoing EBUS-TBNA

BackgroundIsolated mediastinal and/or hilar lymphadenopathy (IMHL) may be caused by benign and malignant disorders or be ‘reactive’. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has a reported low negative predictive value...

Is there enough support for endobronchial ultrasound-guided transbronchial needle aspiration as an initial diagnostic tool?

See Article on Page 660-667 The main purpose of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is in the staging workup of patients with lung cancer. However, the indications for EBUS-TBNA have widened to include the diagnosis of mediastinal lymphadenopathy. A biopsy via mediastinoscopy has been the standard diagnostic procedure for mediastinal lymphadenopathy of unknown etiology. However, mediastinoscopy is invasive and has associated morbidity. For isolated mediastinal lymphadenopathy, EBUS-TBNA has shown promising diagnostic results. EBUS-TBNA prevented the need for 87% of mediastinoscopies, and its sensitivity is 92% [1]. In a previous study on 101 patients with mediastinal and hilar lymphadenopathy or suspected lung cancer seen prospectively, EBUS-TBNA had a sensitivity of 95.1% for the correct diagnosis [2]. Choi et al. [3] studied 56 patients who underwent EBUS-TBNA as an initial diagnostic tool for enlarged lymph nodes. All diagnostic accuracy of EBUS-TBNA regardless of procedure purpose was calculated to be 83.9%. Overall, that study's diagnostic yield was comparable to other previous studies, although the diagnostic yield of benign disease was much lower than in previous studies. Recent studies have suggested that EBUS-TBNA is useful for the diagnosis not only malignant lymphadenopathy but also benign lesions, such as sarcoidosis or tuberculosis lymphadenopathy. Of 65 patients with suspected sarcoidosis, Wong et al. [4] diagnosed sarcoidosis in 61 (93.8%) using EBUS-TBNA. Garwood et al. [5] found that EBUS-TBNA had a sensitivity of 85% for the primary diagnosis of sarcoidosis. Navani et al. [6] found that EBUS-TBNA was diagnostic in 94% of 156 patients with tuberculous intrathoracic lymphadenopathy. Moreover, EBUS-TBNA provided a positive culture in 47% and identified eight cases of drug-resistant tuberculosis. In contrast, in Choi et al. [3], the diagnostic yield of EBUS-TBNA was 50% for tuberculosis and 60% for sarcoidosis; the reason for the low diagnostic yield remains obscure, and needs further study. We should be cautious when using EBUS-TBNA as the initial diagnostic tool in patients with lymphoma because of the relatively low diagnostic yield. Steinfort et al. [7] reviewed a prospectively recorded database of consecutive patients with suspected lymphoma who underwent EBUS-TBNA. The sensitivity of EBUS-TBNA for detecting lymphoma was 76%, and that for a definitive diagnosis of lymphoma was 57%. One possible explanation for this low diagnostic yield for lymphoma was the relatively small volume of the EBUS-TBNA samples [6]. Some subtypes of lymphoma, such as marginal zone and follicular lymphomas, are difficult to diagnose definitively from small secimens. In conclusion, EBUS-TBNA can be an initial diagnostic tool for mediastinal lymphadenopathy. If does not provide a diagnosis, mediastinoscopy can be considered the next step.

Suitability of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration Specimens for Subtyping and Genotyping of Non–Small Cell Lung Cancer

Rationale: The current management of advanced non–small cell lung cancer (NSCLC) requires differentiation between squamous and nonsquamous subtypes as well as epidermal growth factor receptor (EGFR) mutation status. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is increasingly used for the diagnosis and staging of lung cancer. However, it is unclear whether cytology specimens obtained with EBUS-TBNA are suitable for the subclassification and genotyping of NSCLC.Objectives: To determine whether cytology specimens obtained from EBUS-TBNA in routine practice are suitable for phenotyping and genotyping of NSCLC.Methods: Cytological diagnoses from EBUS-TBNA were recorded from 774 patients with known or suspected lung cancer across five centers in the United Kingdom between 2009 and 2011.Measurements and Main Results: The proportion of patients with a final diagnosis by EBUS-TBNA in whom subtype was classified was 77% (95% confidence interval [CI], 73–80). The rate of NSCLC not otherwise specified (NSCLC-NOS) was significantly reduced in patients who underwent immunohistochemistry (adjusted odds ratio, 0.50; 95% CI, 0.28–0.82; P = 0.016). EGFR mutation analysis was possible in 107 (90%) of the 119 patients in whom mutation analysis was requested. The sensitivity, negative predictive value, and diagnostic accuracy of EBUS-TBNA in patients with NSCLC were 88% (95% CI, 86–91), 72% (95% CI, 66–77), and 91% (95% CI, 89–93), respectively.Conclusions: This large, multicenter, pragmatic study demonstrates that cytology samples obtained from EBUS-TBNA in routine practice are suitable for subtyping of NSCLC and EGFR mutation analysis and that the use of immunohistochemistry reduces the rate of NSCLC-NOS.

The utility of endobronchial ultrasound-guided transbronchial needle aspiration in mediastinal or hilar lymph node evaluation in extrathoracic malignancy: Benign or malignant?

OBJECTIVE:Newly arising enlarged or hypermetabolic mediastinal/hilar lymph nodes (LNs) in patients with previously diagnosed extrathoracic malignancies raise suspicion of metastasis. Relatively high proportion of these LNs is due to a benign condition. We aimed to determine frequency of malignant LNs and role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for clarification of the origin of suspicious LNs in these patients.METHODS:Consecutive patients with a known extrathoracic malignancy and suspected hilar/mediastinal LN were included in this prospective study. Computed tomography (CT) of thorax and positron emission tomography-CT of all patients were taken. LNs with short axis >1 cm at CT of thorax and SUV ≥ 2.5 were accepted suspicious for malignancy. All patients underwent EBUS-TBNA for pathological verification of LNs. Patients with benign diagnosis either underwent invasive procedures or were followed up. The results were evaluated for frequency of malignant hilar/mediastinal LNs and sensitivity, specificity, and diagnostic values of EBUS-TBNA.RESULTS:A total of 48 cases with a mean age of 57.4±11.6 were included. All cases had the diagnosis of an extrathoracic malignancy. 78 LNs were aspirated with EBUS-TBNA in 48 cases (1.62 LNs/patient). The mean short axis of aspirated LNs was 1.51±0.63. Results of EBUS-TBNA revealed malignancy in 15 cases (31.2%), tuberculosis in six cases (12.5%), sarcoidosis in four cases (8.3%), and reactive adenitis in 23 cases (48%). The sensitivity, specificity, and negative predictive value of EBUS-TBNA for malignancy were 83.3%, 100%, and 90.9%, respectively. When both benign and malignant diseases were considered, sensitivity, specificity, negative predictive value, and diagnostic accuracy of EBUS-TBNA were 89.2%, 100%, 86.9%, and 93.7%, respectively.CONCLUSIONS:The ratio of benign LNs in patients with extrathoracic malignancies is relatively high. EBUS-TBNA is a safe, minimally invasive, and effective method for clarification of intrathoracic LNs.

Transbronchial and Transesophageal Fine-Needle Aspiration Using an Ultrasound Bronchoscope in Mediastinal Staging of Potentially Operable Lung Cancer

We performed this study to evaluate the role of transesophageal endoscopic ultrasound with bronchoscope-guided fine-needle aspiration (EUS-B-FNA) following endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the mediastinal staging of lung cancer. In this prospective study, we applied transbronchial and transesophageal ultrasonography using an ultrasound bronchoscope on patients with confirmed or strongly suspected potentially operable non-small cell lung cancer. Following EBUS-TBNA, EUS-B-FNA was used for mediastinal nodes that were inaccessible or difficult to access by EBUS-TBNA. The accessibility by EBUS-TBNA and EUS-B-FNA to mediastinal nodal stations having at least one node ≥ 5 mm was also checked. In 150 patients, we performed EBUS-TBNA and EUS-B-FNA on 299 and 64 mediastinal nodal stations, respectively. Among 143 evaluable patients, EBUS-TBNA diagnosed mediastinal metastasis in 38 patients. EUS-B-FNA identified mediastinal metastasis in three additional patients. Surgery diagnosed mediastinal metastasis in four more patients. The sensitivity, negative predictive value, and diagnostic accuracy of EBUS-TBNA in the detection of mediastinal metastasis were 84.4%, 93.3%, and 95.1%, respectively. These values for the combined approach of EBUS-TBNA and EUS-B-FNA increased to 91.1%, 96.1%, and 97.2%, respectively, although the differences were not statistically significant (P = .332, P = .379, and P = .360, respectively). Among 473 mediastinal nodal stations having at least one node ≥ 5 mm that were evaluated, the proportion of accessible mediastinal nodal stations by EBUS-TBNA was 78.6%, and the proportion increased to 84.8% by combining EUS-B-FNA with EBUS-TBNA (P = .015). Following EBUS-TBNA in the mediastinal staging of potentially operable lung cancer, the accessibility to mediastinal nodal stations increased by adding EUS-B-FNA and an additional diagnostic gain might be obtained by EUS-B-FNA. clinicaltrials.gov, NCT00741247.

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

Purpose We performed this study to evaluate the role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the pathologic diagnosis of lung cancer including lung masses as well as lymph nodes as targets. Methods We retrospectively reviewed 126 patients who underwent EBUS-TBNA to diagnose radiologically suspected lung cancer. The patients had masses or lymph nodes that were highly suspicious for malignancy and accessible by EBUS-TBNA. Results EBUS-TBNA was performed on 195 lesions (lymph nodes, n = 151; lung masses, n = 44). In 61 cases, other diagnostic methods had failed previous to EBUS-TBNA. In 118 patients, no definite endobronchial mucosal tumor invasion was observed. In eight patients with endobronchial tumor invasion, EBUS-TBNA was chosen due to tumor bleeding, necrosis, or difficult location for endobronchial biopsy. EBUS-TBNA confirmed 105 lung cancers, five other malignancies and six specific benign cases, demonstrating a diagnostic yield of 92.1% (116/126). Nine cases were diagnosed by other methods (lung cancer, n = 2; other malignancies, n = 2; benign cases, n = 5). One case that was not confirmed by any diagnostic method was considered false negative. The sensitivity and diagnostic accuracy of EBUS-TBNA in the diagnosis of lung cancer were 97.2% (105/108) and 97.6% (123/126), respectively. Conclusions EBUS-TBNA targeting lymph nodes or masses highly suspicious for malignancy demonstrated high diagnostic value in the diagnosis of lung cancer. EBUS-TBNA is recommended for these cases, especially when other diagnostic methods have failed or are difficult.