title: The true false negative rates of esophageal and endobronchial ultrasound in the staging of mediastinal lymph nodes in patients with non-small cell lung cancer.
abstract: BACKGROUND
  Accurate false negative rates for endobronchial ultrasound (EBUS) and esophageal ultrasound (EUS) for mediastinal (N2) lymph nodes are unknown.
  
  
  METHODS
  A retrospective review of patients with non-small cell lung cancer (NSCLC) underwent integrated positron emission tomography and computed tomography (PET/CT) and CT scan. All suspicious N2 lymph nodes were biopsied before thoracotomy. The EBUS was performed for suspicious nodes in stations 2R, 4R, 4L, 5, and 7; the EUS was performed for 4L, 4R, 5, 7, 8, and 9. Mediastinoscopy was performed in selected patients if they were negative by EUS/EBUS; if N2 negative, all patients underwent thoracotomy with complete thoracic lymphadenectomy.
  
  
  RESULTS
  There were 425 patients over a 2-year period, and 234 had suspected N2 disease. Of these patients, 72 had an EBUS; 16 were positive for N2 disease and 12 were false negative (7 patients at station 4R/4L, 4 patients at station 7; patient sensitivity 57%, negative predictive value 79%, accuracy 83%). Seventy-nine patients had EUS; 20 patients were positive for N2 disease and 12 were false negative (4 patients at station 4R/4L, 4 patients at station 7; patient sensitivity 63%, negative predictive value 80%, accuracy 85%). One hundred and forty-six patients had mediastinoscopy, which revealed N2 or N3 disease in 42 patients, and 7 were false negative (patient sensitivity 88%, negative predictive value 93%, accuracy 95%).
  
  
  CONCLUSIONS
  Both EBUS and EUS are useful initial tests to biopsy suspicious N2 mediastinal lymph nodes; however, as EBUS and EUS have high false negative rates, especially at stations 4R and 7, mediastinoscopy is still required for patients with suspicious nodal disease in these stations.
authors.affiliation: JH Estes Endowed Chair for Lung Cancer Research, University of Alabama at Birmingham, Birmingham, AL 35294, USA. robert.cerfolio@ccc.uab.edu
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Cerfolio
authors.forename: Ayesha S
authors.initials: AS
authors.lastname: Bryant
authors.forename: Mohamad A
authors.initials: MA
authors.lastname: Eloubeidi
authors.forename: Paul A
authors.initials: PA
authors.lastname: Frederick
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Minnich
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Harbour
authors.forename: Mark T
authors.initials: MT
authors.lastname: Dransfield
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001980:Bronchi / Q000000981:diagnostic imaging*; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000473:pathology / Q000556:secondary*; D015331:Cohort Studies; D004947:Esophagus / Q000000981:diagnostic imaging*; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D014463:Ultrasonography; D055815:Young Adult