Transbronchial needle aspiration in lung cancer patients suitable for operation with positive mediastinal positron emission tomography.
BACKGROUND
The objectives of this study were to analyze our experience with transbronchial needle aspiration as a minimally invasive procedure alternative to mediastinoscopy in the preoperative staging of non-small cell lung cancer patients with positive mediastinal positron emission tomography and to propose a staging algorithm that combines performance characteristics of these three methods.


METHODS
Fifty-one patients staged N2 or N3 after positron emission tomography imaging underwent transbronchial needle aspiration.


RESULTS
A malignant adenopathy was identified in 26 patients (51%) that were excluded from operation and referred for neoadjuvant chemotherapy or chemoradiotherapy according to the mediastinal status (N2 or N3), as determined on the positron emission tomography image. In the remaining 25 patients (49%), samples were considered adequate negative in 12 patients, inadequate in 11, or inconclusive in 2. These patients underwent mediastinoscopy. Mediastinoscopy showed N2 disease in 19 cases, and the patients received neoadjuvant chemotherapy. In the remaining 6 cases no mediastinal involvement was identified and patients underwent operation. Postoperatively, 5 patients were staged N0 and 1 was staged N2. For transbronchial needle aspiration, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 76%, 100%, 100%, 33%, and 79%, respectively.


CONCLUSIONS
Transbronchial needle aspiration avoided a mediastinoscopy in approximately half of lung cancer patients referred for operation with positive mediastinal positron emission tomography, sparing the associated costs and risks of more invasive surgical procedures. The minimally invasive mediastinal staging algorithm that we proposed seems to be efficacious and easily applicable in clinical practice.
Melloni
Giulio
G
Department of Thoracic Surgery, Scientific Institute H San Raffaele, Milan, Italy. giulio.melloni@hsr.it
Casiraghi
Monica
M
Bandiera
Alessandro
A
Ciriaco
Paola
P
Carretta
Angelo
A
Libretti
Lidia
L
Zannini
Piero
P
D000368:Aged; D044963:Biopsy, Fine-Needle / Q000379:methods*; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008481:Mediastinoscopy / Q000379:methods; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods; D049268:Positron-Emission Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
D019788:Fluorodeoxyglucose F18