title: Endobronchial ultrasound-guided biopsy performed under optimal conditions in patients with known or suspected lung cancer may render mediastinoscopy unnecessary.
abstract: BACKGROUND
  Mediastinoscopy is the gold standard for preoperative mediastinal staging of patients with suspected or proven lung cancer. Since the development of endoscopic ultrasound-guided biopsy via the trachea (EBUS-TBNA), this status has been challenged. The purpose of the study was to examine whether mediastinoscopy is necessary, when EBUS-TBNA is performed in a center with (1) a high level of expertise, (2) "bed side" microscopy by a pathologist, (3) general anesthesia, and (4) achievement of representative tissue from station 4R, 7 and 4L, that is, the same mediastinal stations that mediastinoscopy gives access to.
  
  
  METHODS
  A total of 95 consecutive patients with known or suspected lung cancer were referred for staging by EBUS-TBNA, which was performed as described.
  
  
  RESULTS
  Benign and malignant disease was found in the mediastinum of 6 and 13 patients, respectively. The remaining 76 patients were operated, resulting in 9 benign and 67 malignant diagnoses; spread was found to station 4R, 5, and 5 and 6 in 4 patients. The negative predictive value (NPV) was 63/67=0.94. However, if you exclude station 5 and 6, as they cannot be reached by neither EBUS nor mediastinoscopy, NPV was 66/67=0.99. The sensitivity was 0.76, and the specificity was 1.0.
  
  
  CONCLUSIONS
  When EBUS-TBNA is performed under optimal conditions including general anesthesia and "bed side" microscopy performed by a pathologist resulting in representative biopsies from station 4R, 7, and 4L, the NPV is so high that mediastinoscopy seems unnecessary.
authors.affiliation: *Department of Pulmonary Medicine, Gentofte Hospital Departments of †Pathology §Thoracic Surgery, Rigshospitalet, University of Copenhagen, Denmark ‡Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Paul F
authors.initials: PF
authors.lastname: Clementsen
authors.forename: Birgit G
authors.initials: BG
authors.lastname: Skov
authors.forename: Peter
authors.initials: P
authors.lastname: Vilmann
authors.forename: Mark
authors.initials: M
authors.lastname: Krasnik
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001999:Bronchoscopy / Q000379:methods* / Q000592:standards; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008481:Mediastinoscopy / Q000379:methods*; D008482:Mediastinum / Q000473:pathology*; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012509:Sarcoma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D055752:Small Cell Lung Carcinoma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D020775:Thoracic Surgery, Video-Assisted