Real-time endobronchial ultrasound-guided transbronchial lymph node aspiration

Background. Accurate staging of lung cancer requires noninvasive and pathologic examination of intrathoracic lymphadenopathy, which determines both the treatment options and prognosis. The gold standard for mediastinal staging has been mediastinoscopy. Other options include video-assisted thoracoscopic surgery, blind transbronchial needle aspiration, and endoscopic ultrasound-guided fine-needle aspiration. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has recently been introduced. Here we report the use of EBUS-TBNA as a diagnostic modality for mediastinal adenopathy and staging modality for lung cancer. Methods. This was a retrospective analysis of 152 consecutive patients who underwent EBUS-TBNA with undiagnosed intrathoracic adenopathy or cancer staging as the primary indications. The procedures occurred between January 2005 and June 2006 at a single academic medical center. Of the 152 patients, 117 were included in the final statistical analysis after excluding those with benign disease diagnosed by EBUS-TBNA. Rapid on-site cytopathologic examination was used in all cases. Results. Malignancy was identified in 113 patients, of which 67 (59.3%) had non-small cell lung carcinoma, and 20 (17.7%) underwent surgical resection. Four patients had benign diagnoses at surgical pathology. Only 1 surgical patient was found to have nodal metastasis at a lymph node station previously biopsied by EBUS-TBNA ( negative predictive value, 97%). Compared with radiologic staging, EBUS-TBNA down-staged 18 of 113 (15.9%) and up-staged 11 (9.7%). Sensitivity was 98.7%, with 100% specificity. No major complications were associated with the procedure. Conclusions. EBUS-TBNA is useful in accessing mediastinal and hilar lymph nodes for the diagnosis and staging of non-small cell lung cancer and other disorders of the mediastinum. Thoracic surgeons and pulmonologists are well positioned to use this tool in everyday practice.