[Endobronchial ultrasound for local tumour and lymph node staging in patients with centrally growing lung cancer].
OBJECTIVE
Lung cancer is a common disease and exact staging is of extreme importance in order to plan therapy. A frequent problem in assessing the extent of tumour spread is the question of infiltration versus compression of central airways by central tumours and a correct lymph node staging. Chest CT as the general imaging procedure of choice is often not helpful with these questions. Endobronchial ultrasound (EBUS) has been available for several years, and we were interested to find out if the addition of EBUS to regular bronchoscopy can help to differentiate between airway infiltration and external compression and improves the yield of transbronchial needle aspiration (TBNA).


METHODS
Patients with central tumour growth and enlarged lymph nodes were examined with EBUS and CT, classified according to local tumour invasion, and a needle biopsy of the lymph nodes was performed after EBUS detection.


RESULTS
50 patients were examined and subsequently operated. Relative to the local T-staging EBUS resulted in a sensitivity of 89 % and a specificity of 100 %. The results were highly improved statistically compared to the CT results (sensitivity 25 %, specificity 80 %). With EBUS-guided TBNA the results of correct N-staging could be improved to 86 %.


CONCLUSIONS
Our study suggests that EBUS, if performed by experienced endoscopists for the detection of airway wall infiltration or compression is highly accurate and superior to chest CT in assessing potential airway infiltration by a malignant tumour. Furthermore, the results of the lymph node staging could be improved through the additional use of EBUS. It is easily performed within the context of a standard bronchoscopy and may spare many patients unnecessary surgical biopsies.
Herth
F
F
Sektion interdisziplinäre Endoskopie, Thoraxklinik Heidelberg, Heidelberg, Germany. f@herth.net
Hecker
E
E
Hoffmann
H
H
Becker
H D
HD
D001707:Biopsy, Needle; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging / Q000473:pathology; D009367:Neoplasm Staging; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D018615:Ultrasonography, Doppler, Color / Q000379:methods*