Abstract
Objective: Mediastinoscopy is the golden standard for mediastinal staging of lung cancer.The aim of the present study was to examine whether mediastinoscopy may be avoided if a standardized EBUS-TBNA procedure using the same criterias as required during mediastinoscopy with representative biopsies without malignant cells from lymph nodes in station 4R, 7 and 4L, is performed.
Methods: Patients with known or suspected lung cancer underwent a standardized EBUS-TBNA procedure. All patients with EBUS-TBNA from station 4 R, 4L and 7 without cancer cells og a specific diagnose were further referred for a VATS/thoracotomy.
Results: A total of 76 out of 95 consecutive patients, 48 males, 28 females were enrolled. Mean age 65 years (range 40-85). The mean sizes of the lymph nodes in all 3 stations were 9mm (range 2 - 35mm). The final primary diagnosis was cancer in 67 patients and benign diagnoses in 8 patients. In 4 patients mediastinal metastases were found by surgery (5%). One patient had a metastasis in station 4 R and 2 patients in station 5 and one patient in station 6. The NPV was 0.95 and with a specificity of 1
In total the false negative rate of EBUS-TBNA in mediastinal staging of lung cancer was 4 out of 67 (6%).
Conclusions: The results of the present study seem to challenge mediastinoscopy as the gold standard. When EBUS-TBNA is performed under the same standardised conditions as described by the ESTS guidelines for mediastinoscopy with demonstration of lymphatic tissue from relevant lymph node stations, our study shows that very little, if anything, is gained by an additional mediastinoscopy and can be avoided.
- © 2011 ERS
