title: Mediastinoscopy in patients with lung cancer and negative endobronchial ultrasound guided needle aspiration.
abstract: BACKGROUND
  Endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) has been proposed as a safe, less-invasive alternative to mediastinoscopy to stage mediastinal lymph nodes in patients with lung cancer. We evaluated the negative predictive value of EBUS-TBNA in lung cancer patients suspected of having N2 nodal metastases.
  
  
  METHODS
  This study is a single-institution retrospective review of cases with suspected or confirmed lung cancer undergoing mediastinoscopy after a negative EBUS-TBNA between June 2006 and February 2008.
  
  
  RESULTS
  A total of 494 patients underwent EBUS-TBNA during the study period. Twenty-nine patients with suspected or confirmed lung cancer had a negative EBUS-TBNA and underwent subsequent mediastinoscopy. Mediastinoscopy was performed for findings suspicious of N2 disease based on noninvasive imaging. Mediastinoscopy found metastatic nodes in eight of 29 patients (28%) for a patient-specific negative predictive value of EBUS-TBNA of 72% (95% CI, 56% to 89%). Mediastinal lymph node dissection found four further patients with positive N2 nodes (19%). The EBUS-TBNA and mediastinoscopy sampled the same lymph node station on 36 occasions in the 29 patients. The average lymph node size was 10 mm. Mediastinoscopy was positive in 5 of 36 stations, for a nodal-specific negative predictive value of EBUS-TBNA of 86% (95% CI, 75% to 97%).
  
  
  CONCLUSIONS
  Endobronchial ultrasound with transbronchial needle aspiration can effectively sample mediastinal lymph node stations in patients with lung cancer. However, in this early experience, 28% of patients with high clinical suspicion of nodal disease had N2 mediastinal nodal metastases confirmed by mediastinoscopy despite negative EBUS-TBNA.
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Sebastian A
authors.initials: SA
authors.lastname: Defranchi
authors.forename: Eric S
authors.initials: ES
authors.lastname: Edell
authors.forename: Craig E
authors.initials: CE
authors.lastname: Daniels
authors.forename: Udaya B S
authors.initials: UB
authors.lastname: Prakash
authors.forename: Karen L
authors.initials: KL
authors.lastname: Swanson
authors.forename: James P
authors.initials: JP
authors.lastname: Utz
authors.forename: Mark S
authors.initials: MS
authors.lastname: Allen
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Cassivi
authors.forename: Claude
authors.initials: C
authors.lastname: Deschamps
authors.forename: Francis C
authors.initials: FC
authors.lastname: Nichols
authors.forename: K Robert
authors.initials: KR
authors.lastname: Shen
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Wigle
mesh_terms: D044963:Biopsy, Fine-Needle / Q000379:methods*; D001980:Bronchi; D003937:Diagnosis, Differential; D019160:Endosonography / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging / Q000473:pathology; D008481:Mediastinoscopy / Q000379:methods*; D009367:Neoplasm Staging / Q000379:methods; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity