The evaluation of lymph node metastasis by endobronchial ultrasound-guided transbronchial needle aspiration: crucial for selection of surgical candidates with metastatic lung tumors.
OBJECTIVE
Pulmonary metastasectomy is accepted as an effective treatment for properly selected patients with metastatic lung tumors. In such patients, the presence of mediastinal and/or hilar lymph node metastasis is a significant negative prognostic factor. The purpose of this study was to evaluate the usefulness of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for the detection of mediastinal and hilar lymph node metastasis in patients with potentially resectable metastatic lung tumors.


METHODS
Patients with metastatic lung tumors with radiologically defined mediastinal and/or hilar lymph nodes on chest computed tomographic scans referred to our department for pulmonary resection were retrospectively analyzed. Successful lymph node aspiration was evidenced by the presence of malignant cells or normal lymphocytes. Cytologic and histologic analysis was used to confirm metastasis in surgically resected specimens unless metastasis was proven by EBUS-TBNA.


RESULTS
A total of 106 patients were referred for metastasectomy during the study period. EBUS-TBNA was performed in 60 lymph nodes (37 mediastinal and 23 hilar nodes) from 43 patients. Cytologic and/or histologic samples were diagnostic in 41 (95.3%) patients. EBUS-TBNA detected lymph node metastasis in 23 patients. The sensitivity, specificity, and diagnostic accuracy rate of EBUS-TBNA for diagnosis of mediastinal and hilar lymph node metastasis were 92.0%, 100%, and 95.3%, respectively.


CONCLUSIONS
EBUS-TBNA is a highly sensitive modality for the evaluation of mediastinal and hilar lymph node metastasis in patients with metastatic lung tumors. EBUS-TBNA allows preoperative histologic as well as cytologic evaluation of mediastinal and hilar lymph nodes.
Nakajima
Takahiro
T
Department of Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Yasufuku
Kazuhiro
K
Iyoda
Akira
A
Yoshida
Shigetoshi
S
Suzuki
Makoto
M
Sekine
Yasuo
Y
Shibuya
Kiyoshi
K
Hiroshima
Kenzo
K
Nakatani
Yukio
Y
Fujisawa
Takehiko
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D001999:Bronchoscopy; D019160:Endosonography; D005260:Female; D006801:Humans; D008168:Lung; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000556:secondary / Q000601:surgery*; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D009367:Neoplasm Staging; D018579:Patient Selection; D011013:Pneumonectomy; D011300:Preoperative Care; D012189:Retrospective Studies