Elsevier

The Annals of Thoracic Surgery

Volume 96, Issue 5, November 2013, Pages 1756-1760
The Annals of Thoracic Surgery

Original article
General thoracic
Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Differentiating N0 Versus N1 Lung Cancer

Presented at the Poster Session of the Forty-ninth Annual Meeting of The Society of Thoracic Surgeons, Los Angeles, CA, Jan 26–30, 2013.
https://doi.org/10.1016/j.athoracsur.2013.05.090Get rights and content

Background

The aim of this study was to assess the value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for differentiating cN0 versus cN1 non-small cell lung cancer.

Methods

A retrospective review of EBUS-TBNA results in patients with potentially resectable clinical N0 or N1 non-small cell lung cancer based on computed tomography and positron emission tomography was performed. Systematic mediastinal and hilar lymph node sampling was performed by EBUS-TBNA. Lymph nodes larger than 5 mm in short axis or suspicious nodes were targeted. In the absence of N2 or N3 disease, patients underwent resection with lymph node dissection.

Results

A total of 981 patients underwent EBUS-TBNA during the study period, of which 163 patients met the study criteria. There were 94 cN0 and 69 cN1 patients. A total of 453 lymph nodes (338 mediastinal and 115 N1 lymph nodes, average 2.8 nodes/patient) were sampled. Endobronchial ultrasound upstaged 9 (5.5%) patients to N2 disease, but was falsely negative in the mediastinum in 7 (4.3%) patients. In cN0 patients, EBUS confirmed N0 in 87 (53.4%) and upstaged in 7 (4.3%, N1 in 1, N2 in 6). In cN1 patients, EBUS confirmed N1 in 19 (11.7%), downstaged in 47 (28.8%), and upstaged in 3 (1.8%). The sensitivity, specificity, diagnostic accuracy, and negative predictive value of EBUS-TBNA to accurately differentiate between N0 and N1 disease was 76.2%, 100%, 96.6%, and 96.2%, respectively. The accuracy of mediastinal staging was 95.7%.

Conclusions

Endobronchial ultrasound-guided transbronchial needle aspiration can accurately access the hilar and interlobar lymph nodes in patients with potentially resectable lung cancer. Accurate assessment of cN0 versus cN1 by EBUS-TBNA may be used to guide induction therapy before surgery.

Section snippets

Patients and Methods

The EBUS-TBNA database of the Department of Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan, from April 2003 to June 2008 was reviewed, and the results of EBUS-TBNA in patients with potentially resectable clinical N0 or N1 NSCLC based on noninvasive staging modalities (computed tomography [CT] scan, positron emission tomography [PET] scan) were analyzed. The primary tumor and lymph node status was classified according to the international TNM staging system

Results

From April 2003 to June 2008, a total of 981 patients underwent EBUS-TBNA, of which 163 patients (mean age, 68 years; 120 male) met the study criteria and were included in the analysis. The final pathologic diagnosis of the primary tumor consisted of adenocarcinoma in 104, squamous cell carcinoma in 49, large cell neuroendocrine carcinoma in 8, and small cell carcinoma in 2. The clinical N staging based on imaging before EBUS-TBNA was cN0 in 94 patients and cN1 in 69 patients (Table 1). Of the

Comment

In the current study, we were able to demonstrate that EBUS-TBNA can accurately stage the hilar and interlobar lymph nodes to differentiate between N0 and N1 patients in potentially resectable lung cancer patients. Among the 163 patients who underwent EBUS-TBNA for lymph node staging, the majority of the patients (126 patients, 77.3%) had pathologic N0 disease without any evidence of lymph node metastases, and of note, all 163 patients had normal mediastinum based on CT and PET scans. Even

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