Relationship between endobronchial ultrasound‐guided (EBUS)‐transbronchial needle aspiration utility and computed tomography staging, node size at EBUS, and positron emission tomography scan node standard uptake values: A retrospective analysis

Abstract

BackgroundEndobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) diagnoses and stages mediastinal lymph node pathology. This retrospective study determined the relationship between EBUS‐TBNA utility and non‐small cell lung cancer (NSCLC) stage, lymph node size, and positron emission tomography (PET) standard uptake values (SUV), and the utility of neck ultrasound in bulky mediastinal disease.MethodsData of 284 consecutive patients who had undergone EBUS‐TBNA was collected. Two hundred patients had suspected NSCLC, with 148 confirmed NSCLC cases. The diagnostic utility of EBUS‐TBNA was determined according to NSCLC stage, EBUS lymph node size, PET SUV, use in distal metastases, and mutation testing. The utility of neck ultrasound for N3 disease was calculated in patients with bulky mediastinal disease.Results EBUS‐TBNA was well tolerated with 97% sensitivity in distant metastatic disease, avoiding the need for distal metastases biopsy in 81% of cases. It had equivalent diagnostic accuracy in all NSCLC stages and in lymph nodes <10 mm, <20 mm or >20 mm (sensitivity >92% in all cases), with no mutation testing failures. EBUS‐TBNA had 33% sensitivity in PET indolent (SUV < 4) nodes and 79% sensitivity in PET active nodes (SUV > 4). EBUS‐TBNA diagnosed 12 cases of lymphoma without flow cytometry.ConclusionsThe use of EBUS‐TBNA meant that distant metastatic biopsy was avoided in 81% of cases, performing well irrespective of cancer stage, node size, and facilitating mutation testing. Neck ultrasound failed to detect N3 disease in patients with bulky mediastinal disease. EBUS‐TBNA had a sensitivity of 33% for metastases in PET negative nodes, highlighting PET limitations.

Cytologic Evaluation of Positron Emission Tomography-Computed Tomography–Positive Lymph Nodes Sampled by Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: Experience at a Large Cancer Center

“…13,14 However, the overlap in SUV/FDG-avidity between benign and malignant conditions, 15,16 as well as high prevalence of inflammation/infection within mediastinal lesions with increased uptake of FDG [17][18][19] in thoracic lesions, has encouraged cytologic sampling by a minimally invasive modality, EBUS-TBNA for PET-CTþ lymph nodes. 20,21 In this study, we retrospectively compared the PET-CTþ/Cytoþ versus PET-CTþ/CytoÀ mediastinal lymph nodes sampled by EBUS-TBNA in patients with primary lung cancer, nonlung cancer, and patients with no known malignancy. We demonstrated that PET-CT positivity of mediastinal lymph nodes is nonspecific, occurring in both benign and malignant conditions with similar frequencies.…”

Novel ProCore 25‐gauge needle for endobronchial ultrasound‐guided transbronchial needle aspiration reduces the puncture time and frequency, with comparable diagnostic rate for mediastinal and hilar lymphadenopathy

“…Although computed tomography (CT) and positron emission tomography (PET) scan can show mediastinal lymphadenopathy, pathological confirmation is still required to complete the staging evaluation. Compared to mediastinoscopy, EBUS‐TBNA is a minimally invasive technique with similar diagnostic rate, less postoperative pain and decreased complication rates …”

“…Compared to mediastinoscopy, EBUS-TBNA is a minimally invasive technique with similar diagnostic rate, less postoperative pain and decreased complication rates. [7][8][9] The quality of the samples punctured by EBUS-TBNA is very crucial for a precise diagnosis. There may be several potential factors that impact the quality of the samples, such as the size and type of the puncture needle.…”

Tissue is the issue to confirm benign disease at pleuroscopy in lung cancer

“…The data are analogous to another clinical difficulty in lung cancer, namely the false positive mediastinal lymph node. It took years before an understanding emerged of the dangers of using node size on computed tomography scan as a means of staging without tissue confirmation, and to some extent this continued in the positron emission tomography era . Now, we have endobronchial ultrasound transbronchial needle aspiration (EBUS‐TBNA) to provide tissue to therefore accurately stage patients opening the way for aggressive therapies for more ‘true negative’ cases …”

“…10 Now, we have endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) to provide tissue to therefore accurately stage patients opening the way for aggressive therapies for more 'true negative' cases. 10 How can we become even more adept at confirming true benign disease at pleuroscopy? First, we can use pleural ultrasound to facilitate access into smaller pleural effusions.…”