title: Endobronchial ultrasonography-guided transbronchial needle aspiration biopsy for preoperative nodal staging of lung cancer in a veteran population.
abstract: OBJECTIVE
  Recently, preoperative lung cancer staging has evolved to include endobronchial ultrasonography-guided transbronchial needle aspiration (EBUS-TBNA) biopsies of the hilar and mediastinal lymph nodes, but the feasibility and usefulness of the procedure have not been well studied in the veteran population.
  
  
  OBJECTIVE
  To determine the safety and effectiveness of EBUS-TBNA as a key component of a preoperative staging algorithm for lung cancer in veterans.
  
  
  METHODS
  Review of a prospectively maintained thoracic surgery database that includes patients who underwent lung resection for lung cancer between January 1, 2009, and December 31, 2012, at a single Veterans Affairs medical center among a consecutive cohort of 166 patients with clinically early-stage (I or II) lung cancer who underwent lobectomy with nodal dissection.
  
  
  METHODS
  Endobronchial ultrasonography-guided transbronchial needle aspiration mediastinal staging (EBUS group) in 62 patients (37.3%) was compared with noninvasive nodal staging plus integrated positron emission tomography-computed tomography only (PET/CT-only group) in 104 patients (62.7%). The accuracy of nodal staging was assessed by comparison with the final pathological staging after complete nodal dissection (the gold standard).
  
  
  METHODS
  Primary outcomes were feasibility, safety, accuracy, and negative predictive value of EBUS-TBNA for preoperative nodal staging. A secondary outcome was the rate of nontherapeutic lung resection for occult N2 disease, with comparison between the EBUS group and the PET/CT-only group.
  
  
  RESULTS
  No significant complications were attributable to the EBUS-TBNA procedure. In the EBUS group, 258 lymph node stations were sampled. N1 hilar metastases were diagnosed in 8 patients (12.9%) before surgery, and the remainder were staged N0. Accuracy and negative predictive value of EBUS-TBNA were 93.5% (58 of 62) and 92.6% (50 of 54), respectively. The overall rate of nontherapeutic lung resection performed in patients with occult N2 disease was 10.8% (18 of 166) (8.1% in the EBUS group and 12.5% in the PET/CT-only group) (P = .37).
  
  
  CONCLUSIONS
  A preoperative lung cancer staging strategy that includes EBUS-TBNA seems to be safe and effective in a veteran population, resulting in a low rate of nontherapeutic operations because of occult N2 nodal disease.
authors.affiliation: Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas2Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
authors.forename: Lorraine D
authors.initials: LD
authors.lastname: Cornwell
authors.forename: Faisal G
authors.initials: FG
authors.lastname: Bakaeen
authors.forename: Charlie K W
authors.initials: CK
authors.lastname: Lan
authors.forename: Shuab
authors.initials: S
authors.lastname: Omer
authors.forename: Ourania
authors.initials: O
authors.lastname: Preventza
authors.forename: Brent
authors.initials: B
authors.lastname: Pickrell
authors.forename: Alex
authors.initials: A
authors.lastname: Nguyen
authors.forename: Roberto F
authors.initials: RF
authors.lastname: Casal
mesh_terms: D000368:Aged; D000465:Algorithms; D015331:Cohort Studies; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy; D011237:Predictive Value of Tests; D014728:Veterans