Usefulness of transbronchial needle aspiration for initial lung cancer staging.
BACKGROUND
Besides radio logical methods (especially positron emission tomography combined with computed tomography), endoscopic techniques including transbronchial needle aspiration (TBNA) of mediastinal lymph nodes play an important role in lung cancer staging, thus having a significant effect on further patient management.


OBJECTIVE
The aim of the study was to investigate the diagnostic value of blind TBNA in staging of lung cancer, using systematic mediastinal lymph node dissection (SLND) at thoracotomy as a confirmatory test.


METHODS
Patients with lung cancer and enlarged mediastinal lymph nodes on computed tomography scans underwent TBNA. Non-small cell lung cancer (NSCLC) patients with negative TBNA or with single-level N2 disease underwent thoracotomy with appropriate pulmonary resection and with SLND.


RESULTS
In 84 lung cancer patients, 166 TBNA were performed. Metastatic lymph node involvement was identified in 57 patients (67.9%). There were 10 patients (11.9%) with small cell lung cancer. Of the 74 NSCLC patients, TBNA revealed meta stases in 48 (64.9%). Twenty-four TBNA-negative patients (32.4%) and 4 patients (5.4%) with single-level N2 disease underwent pulmonary resection with SLND. In 8 of 28 operated patients (28.6%), N2 meta static nodes were identified. The per-patient analysis showed the sensitivity of TBNA to be 81.5%, specificity - 100%, accuracy - 86.5%, and negative predictive value (NPV) - 66.7%.


CONCLUSIONS
Our results suggest that TBNA may be a useful method for initial NSCLC staging in patients suspected of N2-3 disease. Positive TBNA in 1 station only should not be considered as a true single-level N2 disease, because of a relatively low NPV for TBNA.
Soja
Jerzy
J
2nd Department of Medicine, Jagiellonian University School of Medicine, Kraków, Poland. jerzysoja@op.pl
Szlubowski
Artur
A
Kocoń
Piotr
P
Czajkowski
Wojciech
W
Grzanka
Piotr
P
Tomaszewska
Romana
R
Cmiel
Adam
A
Kuzdzał
Jarosław
J
D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000379:methods*; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012680:Sensitivity and Specificity