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Endobronchial ultrasound-guided needle aspiration in the non-small cell lung cancer staging

Artur Szlubowski^a, Jarosaw Kuda^a,_*, Marcin Koodziej^a, Jerzy Soja^b, Juliusz Pankowski^c, Anna Obrochta^a, Piotr Kopiski^d, Marcin Zieliski^a

^a Department of Thoracic Surgery, Sokoowski Pulmonary Hospital, Zakopane, Poland
^b Department of Medicine, Jagiellonian University, Kraków, Poland
^c Department of Pathology, Sokoowski Pulmonary Hospital, Zakopane, Poland
^d Department of Gene Therapy, Nicolaus Copernicus University of Toru, Collegium Medium of Bydgoszcz, Poland

Received 5 June 2008; received in revised form 8 September 2008; accepted 17 September 2008.

^_* Corresponding author. Address: Department of Thoracic Surgery, Pulmonary Hospital Zakopane, ul. Gadkie 1, 34-500 Zakopane, Poland. Tel.: +48 663 430242; fax: +48 18 20 14632. (Email: j.kuzdzal{at}mp.pl).

Objective: The aim of the study was to assess the diagnostic yield of the endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-NA) in the mediastinal staging in non-small cell lung cancer (NSCLC) patients. Methods: Consecutive NSCLC patients with enlarged or normal mediastinal nodes on CT scans underwent EBUS-NA. All patients with negative EBUS-NA subsequently underwent the transcervical extended bilateral mediastinal lymphadenectomy (TEMLA) as a confirmatory test. Results: Two hundred and twenty-six patients underwent EBUS-NA between 1.02.07 and 30.04.08. There were 320 mediastinal lymph nodes biopsied (stations: 2R – 8, 4R – 83, 2L – 1, 4L – 61, 7 – 167). EBUS-NA revealed metastatic lymph node involvement in 129/226 patients (57.1%) and in 171/320 biopsies (53.4%). In 97 patients with negative EBUS-NA, who underwent subsequent TEMLA, metastatic nodes were diagnosed in 16 patients (7.1%) – in 12 (5.3%) in stations accessible for EBUS-NA (stations: 4R – 3, 4L – 2, 7 – 8) and in 4 (1.8%) in stations not accessible for EBUS-NA (stations: 5 – 4, 6 – 1). All positive N2 nodes diagnosed by the TEMLA contained only small metastatic deposits. A diagnostic sensitivity, specificity, accuracy, PPV and NPV of EBUS-NA were 89.0%, 100%, 92.9%, 100% and 83.5%, respectively. No complications of EBUS-NA were observed. Conclusions: (1) EBUS-NA is an effective and safe technique for mediastinal staging in NSCLC patients. (2) In patients with negative results of EBUS-NA, surgical exploration of the mediastinum should be performed.

Key Words: Mediastinum • Non-small cell lung cancer • Staging • EBUS-NA