title: Application of endobronchial ultrasound-guided transbronchial needle aspiration following integrated PET/CT in mediastinal staging of potentially operable non-small cell lung cancer.
abstract: BACKGROUND
  The role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) following integrated PET/CT scanning in mediastinal staging of non-small cell lung cancer (NSCLC) has not been assessed.
  
  
  METHODS
  We prospectively evaluated the diagnostic values of PET/CT scanning and EBUS-TBNA for mediastinal staging in 117 patients with potentially operable NSCLC with accessible mediastinal lymph nodes (diameter range, 5 to 20 mm) by EBUS-TBNA. Subgroup analysis according to histologic type was performed.
  
  
  RESULTS
  Of 30 cases of mediastinal metastasis, 27 were confirmed by EBUS-TBNA and 3 were confirmed by surgery. EBUS-TBNA results confirmed all cases with true-positive PET/CT scan findings and six of nine cases with false-negative PET/CT scan findings. The sensitivity, specificity, positive predictive value, negative predictive value (NPV), and accuracy of EBUS-TBNA in the detection of mediastinal metastasis were 90.0%, 100%, 100%, 96.7%, and 97.4%, respectively. For PET/CT scans, the values were 70.0%, 59.8%, 37.5%, 85.2%, and 62.4%, respectively (p = 0.052; p < 0.001; p < 0.001; p = 0.011; p < 0.001, respectively). In adenocarcinoma (n = 55), EBUS-TBNA detected four of six cases with false-negative PET/CT scan findings, and the NPV was higher for EBUS-TBNA than for PET/CT scans (94.6% vs 77.8%, respectively; p = 0.044). In squamous cell carcinoma (n = 53), the NPV of EBUS-TBNA and PET/CT scans were similarly high (97.9% vs 96.3%, respectively; p = 0.689).
  
  
  CONCLUSIONS
  EBUS-TBNA was an effective invasive method following PET/CT scanning in the mediastinal staging of potentially operable NSCLC. In mediastinal PET/CT scan-positive cases, EBUS-TBNA was an excellent tool for detecting mediastinal metastasis. Even in mediastinal PET/CT scan-negative cases, EBUS-TBNA can be useful for confirming mediastinal metastases, especially in adenocarcinoma.
authors.affiliation: Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea.
authors.forename: Bin
authors.initials: B
authors.lastname: Hwangbo
authors.affiliation: Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea; Department of Nuclear Medicine, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea.
authors.forename: Seok Ki
authors.initials: SK
authors.lastname: Kim
authors.affiliation: Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea.
authors.forename: Hee-Seok
authors.initials: HS
authors.lastname: Lee
authors.affiliation: Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea.
authors.forename: Hyun Sung
authors.initials: HS
authors.lastname: Lee
authors.affiliation: Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea.
authors.forename: Moon Soo
authors.initials: MS
authors.lastname: Kim
authors.affiliation: Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea.
authors.forename: Jong Mog
authors.initials: JM
authors.lastname: Lee
authors.affiliation: Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea.
authors.forename: Hyae-Young
authors.initials: HY
authors.lastname: Kim
authors.affiliation: Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea.
authors.forename: Geon-Kook
authors.initials: GK
authors.lastname: Lee
authors.affiliation: Cancer Biostatistics Branch, Research Institute for National Cancer Control & Evaluation, National Cancer Center, Goyang, Gyeonggi, Korea.
authors.forename: Byung-Ho
authors.initials: BH
authors.lastname: Nam
authors.affiliation: Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea. Electronic address: jaylzo@ncc.re.kr.
authors.forename: Jae Ill
authors.initials: JI
authors.lastname: Zo
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000379:methods; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary / Q000601:surgery; D019160:Endosonography; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D008479:Mediastinal Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary* / Q000601:surgery; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D013906:Thoracoscopy / Q000379:methods; D014057:Tomography, X-Ray Computed