title: A prospective controlled trial of endobronchial ultrasound-guided transbronchial needle aspiration compared with mediastinoscopy for mediastinal lymph node staging of lung cancer.
abstract: OBJECTIVE
  The study objective was to compare endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) with mediastinoscopy for mediastinal lymph node staging of potentially resectable non-small cell lung cancer.
  
  
  METHODS
  Patients with confirmed or suspected non-small cell lung cancer who required mediastinoscopy to determine suitability for lung cancer resection were entered into the trial. All patients underwent EBUS-TBNA followed by mediastinoscopy under general anesthesia. If both were negative for N2 or N3 disease, the patient underwent pulmonary resection and mediastinal lymphadenectomy.
  
  
  RESULTS
  Between July 2006 and August 2010, 190 patients were registered in the study, 159 enrolled, and 153 were eligible for analysis. EBUS-TBNA and mediastinoscopy sampled an average of 3 and 4 lymph node stations per patient, respectively. The mean short axis of the lymph node biopsied by EBUS-TBNA was 6.9 ± 2.9 mm. The prevalence of N2/N3 disease was 35% (53/153). There was excellent agreement between EBUS-TBNA and mediastinoscopy for mediastinal staging in 136 patients (91%; Kappa, 0.8; 95% confidence interval, 0.7-0.9). Specificity and positive predictive value for both techniques were 100%. The sensitivity, negative predictive value, and diagnostic accuracy for mediastinal lymph node staging for EBUS-TBNA and mediastinoscopy were 81%, 91%, 93%, and 79%, 90%, 93%, respectively. No significant differences were found between EBUS-TBNA and mediastinoscopy in determining the true pathologic N stage (McNemar's test, P = .78). There were no complications from EBUS-TBNA. Minor complications from mediastinoscopy were observed in 4 patients (2.6%).
  
  
  CONCLUSIONS
  EBUS-TBNA and mediastinoscopy achieve similar results for the mediastinal staging of lung cancer. As performed in this study, EBUS-TBNA can replace mediastinoscopy in patients with potentially resectable non-small cell lung cancer.
authors.affiliation: Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada. kazuhiro.yasufuku@uhn.on.ca
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yasufuku
authors.forename: Andrew
authors.initials: A
authors.lastname: Pierre
authors.forename: Gail
authors.initials: G
authors.lastname: Darling
authors.forename: Marc
authors.initials: M
authors.lastname: de Perrot
authors.forename: Thomas
authors.initials: T
authors.lastname: Waddell
authors.forename: Michael
authors.initials: M
authors.lastname: Johnston
authors.forename: Gilda
authors.initials: G
authors.lastname: da Cunha Santos
authors.forename: William
authors.initials: W
authors.lastname: Geddie
authors.forename: Scott
authors.initials: S
authors.lastname: Boerner
authors.forename: Lisa W
authors.initials: LW
authors.lastname: Le
authors.forename: Shaf
authors.initials: S
authors.lastname: Keshavjee
mesh_terms: D000368:Aged; D001707:Biopsy, Needle / Q000379:methods; D001999:Bronchoscopy; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology*; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008481:Mediastinoscopy; D008482:Mediastinum; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D018084:Ultrasonography, Interventional