title: MAGE qPCR improves the sensitivity and accuracy of EBUS-TBNA for the detection of lymphatic cancer spread.
abstract: BACKGROUND
  Microscopic examination of histologic slides or cytologic specimens of mediastinal lymph node samples obtained by diagnostic mediastinoscopy or endobronchial ultrasound-guided fine-needle aspiration (EBUS-TBNA) is routinely used for the staging of lung cancer patients. Therefore, we explored whether the detection of tumor-associated mRNA in lymph node samples from patients with suspected lung cancer adds diagnostic accuracy to conventional histopathological staging.
  
  
  METHODS
  We examined 202 lymph nodes obtained by EBUS-TBNA or mediastinoscopy from 89 patients with lung cancer. Lymph node samples from patients with nonmalignant disease were available as controls (60 samples from 31 patients). Real-time quantitative mRNA analysis was performed for melanoma antigen-A genes (MAGE-A 1-6, MAGE-A 12) using a LightCycler 480 instrument.
  
  
  RESULTS
  MAGE transcript levels in control and cancer patients differed widely, and the 95% confidence interval served to define the threshold between negative and positive samples. MAGE 1 to 6 transcripts were detected in 35 of 122 (28.7%) lymph nodes obtained by EBUS-TBNA and 16 of 80 (20.0%) lymph nodes obtained by mediastinoscopy. MAGE 12 transcripts were detected in 10 of 122 (8.2%) lymph nodes obtained by EBUS-TBNA and 9 of 80 (11.3%) lymph nodes obtained by mediastinoscopy. Although the accuracy of histopathological diagnosis after EBUS-TBNA and mediastinoscopy was 69.6% and 84.1%, respectively, it increased to 81.2% and 86.4%, respectively, when combined with MAGE-quantitative polymerase chain reaction.
  
  
  CONCLUSIONS
  The combination of EBUS-TBNA and MAGE-quantitative polymerase chain reaction increases the accuracy of tumor cell detection to the level seen with mediastinoscopy.
authors.affiliation: Department of Pathology, University of Regensburg, Regensburg, Germany.
authors.forename: Beatrix
authors.initials: B
authors.lastname: Cucuruz
authors.forename: Sebastian
authors.initials: S
authors.lastname: Dango
authors.forename: Vindi
authors.initials: V
authors.lastname: Jurinovic
authors.forename: Olga
authors.initials: O
authors.lastname: Mayer
authors.forename: Marie
authors.initials: M
authors.lastname: Follo
authors.forename: Joachim
authors.initials: J
authors.lastname: Böhm
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Freudenberg
authors.forename: Mirjam
authors.initials: M
authors.lastname: Elze
authors.forename: Wulf
authors.initials: W
authors.lastname: Sienel
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Klein
authors.forename: Bernward
authors.initials: B
authors.lastname: Passlick
authors.forename: Bernhard
authors.initials: B
authors.lastname: Polzer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D019160:Endosonography; D019073:HT29 Cells; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008207:Lymphatic Metastasis; D008481:Mediastinoscopy; D058950:Melanoma-Specific Antigens / Q000235:genetics*; D008875:Middle Aged; D016133:Polymerase Chain Reaction / Q000379:methods*; D012333:RNA, Messenger / Q000032:analysis
chemical_list: C072011:MAGEA1 protein, human; D058950:Melanoma-Specific Antigens; D012333:RNA, Messenger