Tuberc Respir Dis.  2011 Sep;71(3):180-187.

The Efficacy of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in Mediastinal Staging of Non-Small Cell Lung Cancer in a University Hospital

• Joo H
• Kim HR
• Oh YM
• Kim YH
• Shim TS
• Kim DK
• Park SI
• Kim WS
• Kim DS
• Choi CM

Abstract

BACKGROUND
In mediastinal lymph node sampling in non-small cell lung cancer (NSCLC) it is important to determine the appropriate treatment as well as to predict an outcome. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a recently developed, accurate, safe technique in patients with NSCLC for sampling mediastinal lymph nodes. We sought to determine the usefulness of EBUS-TBNA in mediastinal staging with NSCLC considered to be operable.
METHODS
We retrospectively reviewed the records of 142 patients who underwent EBUS-TBNA for mediastinal staging in the Asan Medical Center, Korea from July 2008 to July 2010. If patients were in an operable state, they underwent subsequent surgical staging. Diagnoses based on biopsy results were compared with those based on surgical results.
RESULTS
We performed EBUS-TBNA in 184 mediastinal lymph nodes in 142 NSCLC patients. Almost all of the EBUS-TBNA samples were from the lower paratracheal (112, 60.9%) and subcarinal (57, 31.0%) lymph nodes. In 142 patients, 51 patients (35.9%) were confirmed with malignant invasion of the mediastinal lymph node by EBUS-TBNA and 91 (64.1%) patients were not confirmed. Among the 91 patients, 64 patients (70.3%) underwent surgical staging. 3 patients (4.7%) who were misdiagnosed by the EBUS-TBNA were confirmed by surgery. After Diagnostic sensitivity of EBUS-TBNA, the prediction of mediastinal metastatsis was 94.4% and specificity was 100%. The procedures were performed safely and no serious complications were observed.
CONCLUSION
We demonstrated the high diagnostic value of EBUS-TBNA for mediastinal staging.

Keyword

Bronchi; Ultrasonography, Interventional; Biopsy, Fine-Needle; Mediastinum; Lymphatic Metastasis; Carcinoma, Non-Small-Cell Lung

MeSH Terms

Biopsy
Biopsy, Fine-Needle
Bronchi
Carcinoma, Non-Small-Cell Lung
Humans
Korea
Lymph Nodes
Lymphatic Metastasis
Mediastinum
Needles
Retrospective Studies
Ultrasonography, Interventional

Figure

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  Figure 1 Clinical course of 142 patients enrolled in the study. CTx: chemotherapy; EBUS-TBNA: endobronchial ultrasound-guided transbronchial needle aspiration; F/U: follow up; LN: lymph node; RTx: radiation therapy; mLN (+): tumor invade the mediastinal lymph node.

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  Figure 2 In a patient with right lower lobe (RLL) sarcomatoid carcinoma, nodal station 7 was assessed by EBUS-TBNA. (A) Axial CT image of stations 7. (B) EBUS image of station 7. EBUS-TBNA: endobronchial ultrasound-guided transbronchial needle aspiration; CT: computed tomography.

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  Figure 3 In a patient with left lower lobe (LLL) squamous cell carcinoma, nodal station 4L was assessed by EBUS-TBNA. (A) Axial CT image of stations 4L. (B) EBUS image of station 4L. EBUS-TBNA: endobronchial ultrasound-guided transbronchial needle aspiration; CT: computed tomography.

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  Figure 4 In a patient with Left lower lobe adenocarcinoma, nodal station 7 was assessed by EBUS-TBNA. (A) Axial CT image of stations 7. (B) EBUS image of station 7. EBUS-TBNA: endobronchial ultrasound-guided transbronchial needle aspiration; CT: computed tomography.

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