title: Combined transbronchial needle aspiration and PET/CT for mediastinal staging of lung cancer.
abstract: In this study, we aimed to evaluate the performance of transbronchial needle aspiration (TBNA) combined with positron emission tomography/computed tomography (PET/CT) for the staging of lung cancer. Twenty-five patients having lymphadenopathies greater than 1 cm on thorax CT and maximum standardized uptake value (SUVmax) ≥ 2.5 on PET/CT were included in this prospective study performed between March 2006 and March 2008. Forty-three lymphnode stations were sampled by using TBNA. Surgical histology, as confirmed by mediastinoscopy, was accepted as the "gold standard". The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of combined TBNA and PET/CT for correct lymph node staging were 67%, 100%, 100%, 76% and 84%; respectively. The initial clinical staging was downstaged after TBNA in 13/19 (69%) patients with adequate TBNA samples, whereas staging was correct in 17/19 (89%) patients assessed by combined TBNA and PET/CT. Staging was completed by TBNA, without mediastinoscopy, in 6/25 (24%) patients. Among the clinical factors that were assessed, only the PET SUVmax was associated with positive TBNA results [odds ratio (OR) 1.27, 95% CI 1.004-1.61, p= 0.046]. A PET SUVmax ≥ 5 was eleven times more likely in patients with positive TBNA results [OR 10.68, 95% CI 1.91-59.62, p< 0.01]. In conclusion, the combination of TBNA with PET/CT increased the sensitivity of TBNA. Combined TBNA and PET/CT may also allow adequate mediastinal staging of lung cancer in most patients with enlarged lymph nodes, and reduce the need for mediastinoscopy. The SUVmax cut off point for a positive TBNA result was ≥ 5.
authors.affiliation: Department of Chest Diseases, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey. serminborekci@yahoo.com.tr
authors.forename: Sermin
authors.initials: S
authors.lastname: Börekçi
authors.forename: Osman
authors.initials: O
authors.lastname: Elbek
authors.forename: Nazan
authors.initials: N
authors.lastname: Bayram
authors.forename: Nevin
authors.initials: N
authors.lastname: Uysal
authors.forename: Kemal
authors.initials: K
authors.lastname: Bakır
authors.forename: Sabri
authors.initials: S
authors.lastname: Zincirkeser
authors.forename: Maruf
authors.initials: M
authors.lastname: Sanlı
authors.forename: Oner
authors.initials: O
authors.lastname: Dikensoy
authors.forename: Erhan
authors.initials: E
authors.lastname: Ekinci
mesh_terms: D001707:Biopsy, Needle; D001999:Bronchoscopy; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008481:Mediastinoscopy; D008482:Mediastinum; D008875:Middle Aged; D064847:Multimodal Imaging; D009367:Neoplasm Staging / Q000379:methods; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D055752:Small Cell Lung Carcinoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D014057:Tomography, X-Ray Computed