Clinical utility of EBUS‐TBNA of hilar, interlobar, and lobar lymph nodes in patients with primary lung cancer

Abstract

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is used to evaluate hilar/interlobar/lobar lymph nodes. This study aimed to assess the clinical utility of EBUS-TBNA for station 10/11/12 lymph nodes (LNs) in patients with primary lung cancer. Methods: This was a retrospective analysis of a prospectively collected database of patients with primary lung cancer who underwent EBUS-TBNA for station 10/11/12 LNs from January 2015 to December 2019. Patients with benign results from EBUS-TBNA who did not undergo surgical sampling/clinical follow-up or who received radiotherapy/chemotherapy were excluded. Results: The analyses were conducted on 889 LNs from 797 patients. The overall diagnostic sensitivity, specificity, accuracy, negative predictive value (NPV), and positive predictive value of EBUS-TBNA were 95.7, 100, 97.3, 93.2, and 100%, respectively. Diagnostic sensitivity was significantly lower for LNs <10 mm than ≥10 mm in size (90.1% vs. 97.8%; p < 0.001). There was no significant difference in diagnostic performance according to the nodal station (10 vs. 11/12) and left-versus right-sided LNs. The diagnostic sensitivity (100 vs. 95.5%; p = 0.221) and specificity (100 vs. 100%) of N3 LNs was not significantly different from those of N1 LNs. In this study, eight (8/91, 8.8%) patients with cN1 NSCLC received neoadjuvant treatment based on the results of EBUS-TBNA. Conclusion: EBUS-TBNA accurately evaluates station 10/11/12 LNs of both N1 and N3 disease. The diagnostic performances of EBUS-TBNA for station 10/11/12 LNs seem to be comparable to those of EBUS-TBNA for mediastinal LNs.

Portrayal of video-assisted mediastinoscopic lymphadenectomy’s range subsequent to its simultaneous use with uniportal VAT-lobectomy for left-sided NSCLC: a case-based perspective

“…To further clarify, notwithstanding these aspects mentioned above, EBUS-TBNA is a highly valuable mediastinal staging tool [ 16 – 19 ]. For example, in one study, the overall diagnostic sensitivity, specificity, accuracy, negative predictive value, and positive predictive value of EBUS-TBNA were 95.7, 100, 97.3, 93.2, and 100%, respectively [ 16 ]. Moreover, its staging accuracy was significantly improved when EBUS-TBNA was combined with EUS-FNA [ 20 , 21 ].…”

Diagnostic Performance of Endosonography to Detect Mediastinal Lymph Node Metastasis in Patients with Radiological N1 Non–Small Cell Lung Cancer

“…Endosonography procedures were performed by trained physicians using a convex probe-EBUS bronchoscope (BF-UC260F-OL8, Olympus, Tokyo, Japan) and a dedicated 22-gauge needle (NA-201SX-4022, Olympus) [ 15 ]. The patients were placed under moderate sedation with intravenous midazolam and fentanyl [ 6 ].…”

“…When core tissue was obtained, at least two passes were conducted whenever possible. However, when we obtained enough core tissue at the first pass and the patient’s condition was unstable, we completed the procedure after the first pass [ 15 ]. During the study period, rapid on-site cytology and elastography were not available.…”

“…Benignancy was reported based on the absence of tumor cells on a background of lymphoid tissue. Samples showing only blood, mucus, benign bronchial epithelial cells, or lacking lymphoid tissue were classified as inadequate and non-diagnostic [ 15 ]. The gold standard definition of OMM is the detection of MLNs metastases in either MLND or endosonographic biopsy in patients with no radiologic evidence of MLN metastases [ 14 ].…”