Endoscopic ultrasound-guided fine needle aspiration and endobronchial ultrasound-guided transbronchial needle aspiration: Are two better than one in mediastinal staging of non-small cell lung cancer?

Abstract

OBJECTIVE:

The role of combined endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) with a single bronchoscope is poorly understood. The purpose of the present study was to elucidate the roles of EBUS-TBNA and EUS-FNA with a single bronchoscope in the preoperative hilar and mediastinal staging of non-small cell lung cancer (NSCLC).

METHODS:

A total of 150 patients with potentially resectable known or suspected NSCLC were enrolled in our prospective study. EBUS-TBNA was performed, followed by EUS-FNA, with an EBUS bronchoscope for N2 and N3 nodes≥5 mm in the shortest diameter on ultrasound images, in a single session.

RESULTS:

EBUS-TBNA was performed for 257 lymph nodes and EUS-FNA for 176 lymph nodes. Of the 150 patients, 146 had a final diagnosis of NSCLC. Of these 146 patients, 33 (23%) had N2 and/or N3 nodal metastases. The sensitivity of EBUS-TBNA, EUS-FNA, and the combined approach per patient was 52%, 45%, and 73%, respectively (EBUS-TBNA vs the combined approach, P=.016, McNemar's test). The corresponding negative predictive value was 88%, 86%, and 93%. Two patients (1%) developed severe cough from EBUS-TBNA.

CONCLUSIONS:

The combined endoscopic approach with EBUS-TBNA and EUS-FNA is a safe and accurate method for preoperative hilar and mediastinal staging of NSCLC, with better results than with each technique by itself.

• Authors: Masahide Oki, Hideo Saka, Masahiko Ando, Chiyoe Kitagawa, Yoshihito Kogure, Yukio Seki
• Journal: The Journal of thoracic and cardiovascular surgery (J Thorac Cardiovasc Surg) Vol. 148 Issue 4 Pg. 1169-77 (Oct 2014) ISSN: 1097-685X [Electronic] United States
• PMID: 24930616 (Publication Type: Journal Article)
• Copyright: Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Aged
• Aged, 80 and over
• Biopsy, Fine-Needle (methods)
• Bronchoscopy
• Carcinoma, Non-Small-Cell Lung (pathology)
• Endoscopic Ultrasound-Guided Fine Needle Aspiration
• Humans
• Lung Neoplasms (pathology)
• Lymphatic Metastasis
• Mediastinum (pathology)
• Middle Aged
• Neoplasm Staging
• Prospective Studies
• Sensitivity and Specificity
• Ultrasonography, Interventional