title: Transbronchial needle aspiration accurately diagnoses subcentimetre mediastinal and hilar lymph nodes detected by integrated positron emission tomography and computed tomography.
abstract: OBJECTIVE
  Integrated PET and CT (PET/CT) is accurate in detecting hilar-mediastinal metastases. However, it has a moderate positive predictive value, necessitating pathological verification, especially in situations in which the result would make a difference to treatment. This study aimed to evaluate the performance of transbronchial needle aspiration (TBNA) for hilar-mediastinal lesions suspicious on PET/CT.
  
  
  METHODS
  A retrospective study was conducted on 19 patients with a total of 25 positive hilar-mediastinal lymph nodes localized on PET/CT. Standard TBNA technique with rapid on-site cytopathology was performed.
  
  
  RESULTS
  The mean short-axis diameter of the positive lymph nodes identified on PET/CT was 9.9 +/- 3.0 mm. The sensitivity, specificity and diagnostic accuracy of PET/CT-guided TBNA were 81.8%, 100% and 84%, respectively. The number of needle passes to successful lymph node aspiration or a diagnosis of cancer was 2.36 +/- 0.49. Nine of the 25 positive lymph nodes (36%) on PET/CT were smaller than 1.0 cm. The accuracy and sensitivity of TBNA for these subcentimetre nodes was 88.9% and 87.5%, respectively. TBNA replaced surgical sampling in 15 patients (78.9%) with positive lymph nodes on PET/CT. In seven non-small cell lung cancer patients, diagnosis and staging were possible in the one procedure. No complications were encountered.
  
  
  CONCLUSIONS
  PET/CT can identify small malignant lymph nodes that can then be successfully biopsied by TBNA with on-site cytopathology.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan. lhhsu@mail.kfcc.org.tw
authors.forename: Li-Han
authors.initials: LH
authors.lastname: Hsu
authors.forename: Jen-Sheng
authors.initials: JS
authors.lastname: Ko
authors.forename: Dong-Ling
authors.initials: DL
authors.lastname: You
authors.forename: Chia-Chuan
authors.initials: CC
authors.lastname: Liu
authors.forename: Nei-Min
authors.initials: NM
authors.lastname: Chu
mesh_terms: D000368:Aged; D001707:Biopsy, Needle; D001999:Bronchoscopy; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D008479:Mediastinal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*