Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically normal mediastinum

Abstract

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) can sample enlarged mediastinal lymph nodes in patients with nonsmall cell lung cancer (NSCLC). To date, EBUS-TBNA has only been used to sample nodes visible on computed tomography (CT). The aim of the present study was to determine the accuracy of EBUS-TBNA in sampling nodes f1 cm in diameter.NSCLC patients with CT scans showing no enlarged lymph nodes (no node .1 cm) in the mediastinum underwent EBUS-TBNA. Identifiable lymph nodes at locations 2r, 2l, 4r, 4l, 7, 10r, 10l, 11r and 11l were aspirated. All patients underwent subsequent surgical staging. Diagnoses based on aspiration results were compared with those based on surgical results.In 100 patients (mean age 58.9 yrs; 68 males), 119 lymph nodes ranging 5-10 mm in size were detected and sampled. Malignancy was detected in 19 patients but missed in two; all diagnoses were confirmed by surgical findings. The mean diameter of the punctured lymph nodes was 8.1 mm. The sensitivity of EBUS-TBNA for detecting malignancy was 92.3%, specificity was 100%, and the negative predictive value was 96.3%. No complications occurred.In conclusion, endobronchial ultrasound-guided transbronchial needle aspiration can accurately sample even small mediastinal nodes, therefore avoiding unnecessary surgical exploration in one out of six patients who have no computed tomography evidence of mediastinal disease. Potentially operable patients with no signs of mediastinal involvement on computed tomography may benefit from pre-surgical endobronchial ultrasound-guided transbronchial needle aspiration and staging.

Chest CT Findings in EBUS-TBNA-Proven Anthracosis in Enlarged Mediastinal Lymph Nodes

“…Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) was performed with the patient under sedation or under general anesthesia as previously described [10]. A linear array 7.5 MHz ultrasonic bronchoscope (CP EBUS, Olympus Medical Systems, Tokyo, Japan) with a 90°angle of view was introduced orally or through an intubation tube.…”

Effectiveness and safety of endobronchial ultrasound-transbronchial needle aspiration: a systematic review

“…The sensitivity and negative predictive value (NPV) of EBUS-TBNA for detecting malignancy were 94% and 11% respectively. This same group carried out another investigation in the same year to investigate the performance of EBUS-TBNA in the staging of patients with suspected tumours of pulmonary origin (tumour stage T1 to T4) as evidenced by CT, but without enlargement of lymph nodes (nodes measuring ,1 cm) [16]. In this second study, which included 100 consecutive patients, sensitivity and NPV were 92.3% and 96.3% respectively.…”

“…In this second study, which included 100 consecutive patients, sensitivity and NPV were 92.3% and 96.3% respectively. In another study undertaken very recently, HERTH et al [17] determined the results of EBUS-TBNA in sampling mediastinal lymph nodes in 100 patients with NSCLC, radiologically normal mediastinum and no PET activity. Comparing all results with those based on surgical staging, the sensitivity for detecting malignancy was 89% and NPV was 98.9%.…”

“…Sample size ranged 18-502 patients. Seven of the largest-sized prospective studies were conducted by the Japanese group of YASUFUKU and co-workers [9,[12][13][14] and the multicentre group of HERTH and co-workers [15][16][17] with main contributions from Germany, Denmark and the USA. Table 1 summarises the characteristics of all original studies along with the main results.…”

Mediastinal lymph node staging by EBUS-TBNA and CT: Characteristics of lymph node enlargement caused by anthracosis and other benign conditions

“…Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) was performed with the patient under sedation or under general anesthesia as previously described [13] . A linear array 7.5MHz ultrasonic bronchoscope (CP EBUS, Olympus Medical Systems, Tokyo, Japan) with a 90° angle of view was introduced orally or through an intubation tube.…”