title: Should endobronchial ultrasonography be part of the thoracic surgeon's armamentarium?
abstract: OBJECTIVE
  The study objective was to determine the clinical usefulness and accuracy of endobronchial ultrasound-guided needle aspiration of mediastinal and hilar lymph nodes.
  
  
  METHODS
  A retrospective analysis of a thoracic surgery unit's experience was performed.
  
  
  RESULTS
  In a period of 19 months, 75 patients underwent the procedure (mean age = 65.5 +/- 1.6 years; male to female = 2:1) most commonly for mediastinal lymphadenopathy in the setting of diagnosed or suspected lung cancer. It was diagnostic in 68.9% after rapid on-site evaluation and 74.3% after final cytologic examination. The rapid on-site evaluation and final cytology results were discordant in 16.2% (P < .001). In 50 cases, the needle aspirate cytology could be compared with pathology results. The sensitivity and specificity for the diagnosis of cancer were 85% and 100%, respectively. The false-negative rate endobronchial ultrasound cytology was 8.1%. Mediastinal lymph node station 7 was most commonly biopsied. The stations with the highest diagnostic yield were: 11R, 3, 10L, and 7. Of the patients with a positive positron emission tomography scan with suspected clinical stage III lung cancer, cancer was downstaged in 40% after endobronchial ultrasound.
  
  
  CONCLUSIONS
  Endobronchial ultrasound-guided needle aspiration is a clinically useful minimally invasive option for lung cancer staging and evaluation of mediastinal lymphadenopathy. The procedure should be considered complementary to mediastinoscopy.
authors.affiliation: University of Pittsburgh, Heart, Lung and Esophageal Institute, Pittsburgh, Pennsylvania, USA.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Gilbert
authors.forename: David O
authors.initials: DO
authors.lastname: Wilson
authors.forename: Neil A
authors.initials: NA
authors.lastname: Christie
authors.forename: James D
authors.initials: JD
authors.lastname: Luketich
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Landreneau
authors.forename: John M
authors.initials: JM
authors.lastname: Close
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Schuchert
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D001980:Bronchi / Q000000981:diagnostic imaging*; D019091:Critical Pathways; D019160:Endosonography / Q000379:methods; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008481:Mediastinoscopy / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult