title: Representativeness of nodal sampling with endobronchial ultrasonography in non-small-cell lung cancer staging.
abstract: The objective of our study was to determine the procedure-related requirements of mediastinal node sampling with endobronchial ultrasonography with real-time transbronchial needle aspiration (EBUS-TBNA) that would provide negative predictive value (NPV) for the identification of stage III disease in non-small-cell lung cancer (NSCLC) high enough to consider the technique equivalent to cervical mediastinoscopy. Representative EBUS-TBNA was defined as a sampling procedure obtaining satisfactory samples from normal nodes in regions 4R, 4L and 7 or diagnosing malignancy in mediastinal nodes. NPV was estimated using the results of postsurgical staging in patients who underwent surgery as a reference. Two-hundred ninety-six patients staged with EBUS-TBNA were included. Representative samples from regions 4R, 4L and 7 showing nonmalignant cytology were obtained from 98 patients (33.1%) and EBUS-TBNA detected N2/N3 disease in 150 (50.7%). Accordingly, an EBUS-TBNA procedure accomplishing the representativeness criteria required for sampling was attained in 248 of the participating patients (83.8%). The NPV of the procedure in this setting was 93.6%, with false-negative results only found in 5 patients, four of them with nodal metastasis out of the reach of EBUS-TBNA (regions 5, 8 and 9). In conclusion, representative sampling of regions 4R, 4L and 7 is achieved in more than 80% of patients staged using EBUS-TBNA, and in the procedures that attain this requirement a NPV >90% for mediastinal malignancy is reached, a figure equivalent to cervical mediastinoscopy.
authors.affiliation: Department of Pneumology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. 34057jss@comb.cat
authors.forename: J
authors.initials: J
authors.lastname: Sanz-Santos
authors.forename: F
authors.initials: F
authors.lastname: Andreo
authors.forename: E
authors.initials: E
authors.lastname: Castellà
authors.forename: M
authors.initials: M
authors.lastname: Llatjós
authors.forename: P López
authors.initials: PL
authors.lastname: de Castro
authors.forename: J
authors.initials: J
authors.lastname: Astudillo
authors.forename: R
authors.initials: R
authors.lastname: García-Luján
authors.forename: P
authors.initials: P
authors.lastname: Serra
authors.forename: E
authors.initials: E
authors.lastname: Monsó
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000556:secondary*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis; D008297:Male; D008482:Mediastinum / Q000000981:diagnostic imaging*; D009367:Neoplasm Staging; D015995:Prevalence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013030:Spain / Q000453:epidemiology; D014463:Ultrasonography / Q000706:statistics & numerical data*