title: Endobronchial ultrasound-guided transbronchial needle aspiration in the management of previously treated lung cancer.
abstract: BACKGROUND
  This study evaluated the role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the assessment of newly developed mediastinal/hilar abnormalities in patients with previously treated lung cancer.
  
  
  METHODS
  All EBUS-TBNA cases between July 2008 and October 2010 were retrospectively reviewed. Results of EBUS-TBNA in previously treated lung cancer patients were analyzed. Cancer treatments, numbers of stations biopsied, and pathologic results were recorded. Nonmalignant cytopathology was confirmed with clinical follow-up for benign results.
  
  
  RESULTS
  Of 450 patients who underwent EBUS-TBNA, 44 (9.8%) had previous lung cancer treatment, comprising non-small cell lung cancer in 40, small-cell lung cancer in 3, and typical carcinoid in 1. No EBUS-TBNA was performed for lung cancer restaging. Primary treatments included surgical resection in 22, resection with adjuvant/neoadjuvant therapy in 11, chemoradiation in 5, chemotherapy in 4, and radiotherapy in 2. At the primary treatment, 23 of 44 patients had mediastinoscopy. EBUS-TBNA of mediastinal lymph nodes was performed in 40. An average of 1.7 stations were biopsied (range, 1 to 5). The positive EBUS-TBNA in 28 included mediastinal/hilar recurrence of primary lung cancer (ie, same cell type as primary cancer) in 21, and possible new primary lung cancer (ie, different cell type from primary lung cancer) in 7. The sensitivity, specificity, and diagnostic accuracy were 93.1%, 100%, and 95.1%, respectively.
  
  
  CONCLUSIONS
  EBUS-TBNA can differentiate a new primary lung cancer from recurrence of previously treated lung cancer, which will facilitate treatment strategy.
authors: Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors: Masaki
authors: M
authors: Anraku
authors: Andrew F
authors: AF
authors: Pierre
authors: Takahiro
authors: T
authors: Nakajima
authors: Marc
authors: M
authors: de Perrot
authors: Gail E
authors: GE
authors: Darling
authors: Thomas K
authors: TK
authors: Waddell
authors: Shaf
authors: S
authors: Keshavjee
authors: Kazuhiro
authors: K
authors: Yasufuku