Evaluation of mediastinal lymph nodes with endobronchial ultrasound: The thoracic surgeon's perspective

Objective: The objectives of our study are to ( 1) describe our experience with endobronchial ultrasound-guided fine-needle aspiration of mediastinal lymph nodes and ( 2) illustrate how thoracic surgeons facile with ultrasound-guided fine-needle aspiration have the potential to streamline patient care. Methods: We performed a retrospective review of all patients within our prospectively maintained database who underwent endobronchial ultrasound-guided fine-needle aspiration of mediastinal lymph nodes by thoracic surgeons at the University of Minnesota from September 1, 2006, to April 15, 2009. We included patients in our analysis if ( 1) their malignancy diagnosis was based on immediate endobronchial ultrasound-guided fine-needle aspiration cytology or ( 2) they underwent a confirmatory procedure (ie, mediastinoscopy or thoracoscopy) that sampled the same mediastinal lymph node stations biopsied by endobronchial ultrasound-guided fine-needle aspiration to verify normal, benign, or nondiagnostic endobronchial ultrasound-guided fine-needle aspiration findings. We also collected data on additional diagnostic or therapeutic procedures performed in the same anesthesia setting as endobronchial ultrasound-guided fine-needle aspiration. Results: Over the study period, 192 patients underwent endobronchial ultrasound-guided fine-needle aspiration; 98 patients met our inclusion criteria. We achieved a sensitivity of 87.9%, specificity of 97.4%, and diagnostic accuracy of 91.7%. For patients undergoing lung cancer staging, we sampled a mean of 3.0 +/- 0.9 mediastinal lymph node stations. Half of our patients underwent an additional diagnostic or therapeutic procedure at the time of endobronchial ultrasound-guided fine-needle aspiration. Conclusion: Thoracic surgeons who perform endobronchial ultrasound-guided fine-needle aspiration can achieve excellent sensitivity, specificity, and diagnostic accuracy while adhering to sound oncologic principles. Endobronchial ultrasound-guided fine-needle aspiration adds to the thoracic surgeon's unique capacity to expedite a diagnostic workup and treatment, thereby streamlining patient care. (J Thorac Cardiovasc Surg 2010; 139: 578-83)