Diagnosis of mediastinal adenopathy - Real-time endobronchial ultrasound guided needle aspiration versus mediastinoscopy

Background: Real-time endobronchial ultrasound has increased the accuracy of conventional transbronchial needle aspiration biopsy in sampling mediastinal lymph nodes. Nevertheless, direct comparisons with rnediastinoscopy are not available to determine the role of endobronchial ultrasound in pathologic staging. Objectives: To compare the diagnostic yield of endobronchial ultrasound against cervical mediastinoscopy in the diagnosis and staging of radiologically enlarged mediastinal lymph nodes stations accessible by both modalities in patients with suspected nonsmall cell lung cancer. Methods: Prospective, crossover trial with surgical lymph node dissection used as the accepted standard. Biopsy results of paratra-cheal and subcarinal lymph nodes were compared. Results: Sixty-six patients with a mean age 60 +/- 10 years were studied. The prevalence of malignancy was 89% (59/66 cases). Endobronchial ultrasound had a higher overall diagnostic yield (91%) compared with mediastinoscopy (78%; p = 0.007) in the per lymph node analysis. There was disagreement in the yield between the two procedures in the subcarinal lymph nodes (24%; p = 0.011). There were no significant differences in the yield at other lymph node stations. The sensitivity, specificity, and negative predictive value of endobronchial ultrasound were 87, 100, and 78%, respectively. The sensitivity, specificity, and negative predictive value of mediastinoscopy were 68, 100, and 59%, respectively. No significant differences were found between endobronchial ultrasound (93%) and mediastinoscopy (82%; p = 0.083) in determining true pathologic N stage (per patient analysis). Conclusions: In suspected nonsmall cell lung cancer, endobronchial ultrasound may be preferred in the histologic sampling of paratra-cheal and subcarinal mediastinal adenopathy because the diagnostic yield can surpass mediastinoscopy.