title: Endobronchial ultrasound and value of PET for prediction of pathological results of mediastinal hot spots in lung cancer patients.
abstract: In the staging of lung cancer with positron emission tomography (PET) positive mediastinal lymph nodes, tissue sampling is required. The performance of transbronchial needle aspiration (TBNA) using linear endobronchial ultrasound (real-time EBUS-TBNA) under local anaesthesia and the value of PET for prediction of pathological results were assessed in that setting. The number of eluded surgical procedures was evaluated. All consecutive patients with suspected/proven lung cancers and FDG-PET positive mediastinal adenopathy were included. If no diagnosis was reached, further surgical sampling was required. Lymph node SUVmax (maximum standardized uptake value) was assessed in patients whose PET was performed in the leading centre. One hundred and six patients were included. The average number of TBNA samples per patient was 4.9+/-1.1. The prevalence of lymph node metastasis was 58%. Sensitivity, accuracy and negative predictive value of EBUS-TBNA in the staging of mediastinal hot spots were 95, 97 and 91%. Patients without malignant lymph node involvement showed lower SUVmax (respective median values of 3.7 and 10.0; p<0.0001). Surgical procedures were eluded in 56% of the patients. Real-time EBUS-TBNA should be preferred over mediastinoscopy as the first step procedure in the staging of PET mediastinal hot spots in lung cancer patients. In case of negative EBUS, surgical staging procedure should be undertaken. The addition of SUVmax cut-off may allow further refinement but needs validation.
authors.affiliation: Chest Service, Saint-Pierre Hospital, Rue Haute 322, 1000 Brussels, Belgium.
authors.forename: Olivier
authors.initials: O
authors.lastname: Bauwens
authors.forename: Michelle
authors.initials: M
authors.lastname: Dusart
authors.forename: Philippe
authors.initials: P
authors.lastname: Pierard
authors.forename: Jean
authors.initials: J
authors.lastname: Faber
authors.forename: Thierry
authors.initials: T
authors.lastname: Prigogine
authors.forename: Bernard
authors.initials: B
authors.lastname: Duysinx
authors.forename: Bich
authors.initials: B
authors.lastname: Nguyen
authors.forename: Marianne
authors.initials: M
authors.lastname: Paesmans
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Sculier
authors.forename: Vincent
authors.initials: V
authors.lastname: Ninane
mesh_terms: D000368:Aged; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D008297:Male; D008482:Mediastinum / Q000000981:diagnostic imaging / Q000473:pathology*; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric