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

¹ Dept of Pneumology and Critical Care Medicine, Thoraxklinik at the University of Heidelberg, Germany
² Dept of Pneumology and Critical Care Medicine, Thoraxklinik at the University of Heidelberg, Germany; and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
³ Dept of Surgical Gastroenterology
⁴ Dept of Thoracic Surgery, Thoraxklinik at the University of Heidelberg, Germany
⁵ Dept of Cardiothoracic Surgery, Gentofte University Hospital, Copenhagen, Denmark

^* To whom correspondence should be addressed. E-mail: Felix.Herth{at}thoraxklinik-heidelberg.de.

	Abstract

Endobronchial ultrasound-guided, transbronchial-needle aspiration (EBUS-TBNA) can sample enlarged mediastinal lymph nodes in patients with non-smaIl cell lung cancer (NSCLC). To date, EBUS-TBNA has been used to sample only nodes visible on computed tomography (CT).

To determine the accuracy of EBUS-TBNA in sampling nodes less or equal to 1 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 to those based on surgical results.

Among 100 patients (mean age 58.9 y; 68 men), 119 lymph nodes with a size between 5 up to 10 mm were detected and sampled. Malignancy was detected in 19 patients but missed in 2 others; all diagnoses were confirmed by surgical findings. The mean (SD) diameter of the punctured lymph nodes was 8.1 mm. The sensitivity of EBUS-TBNA for detecting malignancy was 92.3%; the specificity was 100%; and the negative predictive value was 96.3%. No complications occurred.

EBUS-TBNA can accurately sample even small mediastinal nodes, therefore avoiding unnecessary surgical exploration in 1 of 6 patients who have no CT evidence of mediastinal disease. Potentially operable patients with no signs of mediastinal involvement on CT may benefit from presurgical EBUS-TBNA aspiration and staging.

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