title: Sensitivity of linear endobronchial ultrasonography and guided transbronchial needle aspiration for the identification of nodal metastasis in lung cancer staging.
abstract: The aim of this study is to determine the sensitivity of real-time endobronchial ultrasonography (EBUS)-guided transbronchial needle aspiration (TBNA) in lung cancer staging. Short- and long-axis node diameters were measured during EBUS in patients referred for lung cancer staging and sensitivities for the identification of nodal malignancy at TBNA determined. Three hundred fifteen real-time EBUS-guided TBNA nodal sampling procedures were performed in 161 patients and in 87 of them, N2/N3 metastasis was confirmed (50.9%), eliminating the need for mediastinoscopy. The median (interquartile range [IQR]) short-axis diameters of the sampled mediastinal and lobar nodes were 11 (8-15) and 8 (7-12) mm, respectively. TBNA provided satisfactory samples from 269 nodes (85.4%) and a sensitivity of 100% for the identification of malignant TBNA samples was reached for a short-axis diameter cut-off of 5 mm and a short- to long-axis ratio of 0.5. The probability of malignancy was over 90% for nodes with a short-axis diameter >20 mm and 55% for round nodes (short- to long-axis ratio of 1). In 18 out of 50 patients with a normal mediastinal computed tomography (CT) scan, the technique identified enlarged nodes in the mediastinum (36%), mainly in the subcarinal region and confirmed mediastinal malignancy in 8 (10%). Real-time EBUS-guided TBNA obtains satisfactory node samples in almost 90% of cases and improves the identification of enlarged nodes in patients with a normal mediastinum at CT. If sampling all nodes with a short-axis diameter of > or =5 mm and a short- to long-axis ratio > or =0.5, a sensitivity of 100% for the cytologic identification of malignant nodes can be expected.
authors.affiliation: Pneumology Department, Hospital Germans Trias i Pujol, Badalona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain. ignasigo@separ.es
authors.forename: Ignasi
authors.initials: I
authors.lastname: Garcia-Olivé
authors.forename: Eduard
authors.initials: E
authors.lastname: Monsó
authors.forename: Felipe
authors.initials: F
authors.lastname: Andreo
authors.forename: José
authors.initials: J
authors.lastname: Sanz
authors.forename: Eva
authors.initials: E
authors.lastname: Castellà
authors.forename: Mariona
authors.initials: M
authors.lastname: Llatjós
authors.forename: Eduardo
authors.initials: E
authors.lastname: de Miguel
authors.forename: Julio
authors.initials: J
authors.lastname: Astudillo
mesh_terms: D044963:Biopsy, Fine-Needle / Q000379:methods; D001980:Bronchi / Q000000981:diagnostic imaging / Q000473:pathology*; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000473:pathology*; D003199:Computer Systems; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D011336:Probability; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D055752:Small Cell Lung Carcinoma / Q000000981:diagnostic imaging / Q000473:pathology*; D018084:Ultrasonography, Interventional / Q000379:methods