title: EBUS-TBNA in elderly patients with lung cancer: safety and performance outcomes.
abstract: BACKGROUND
  Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) enables minimally invasive lymph node sampling during bronchoscopy under conscious sedation. The primary purpose of this study was to investigate the safety profile of EBUS-TBNA in an elderly population. The secondary aim was to assess the efficacy of EBUS-TBNA for nodal staging and pathological diagnosis in elderly patients with primary lung cancer.
  
  
  METHODS
  This was a prospective cohort study of patients undergoing EBUS-TBNA, between March 2010 and August 2012, at a single U.K. hospital site. Procedure and outcome data including 6-month follow-up were collected prospectively. Patients were divided into less than 70 (<70yrs) or 70 and older (≥70yrs) age categories for analysis.
  
  
  RESULTS
  Four hundred and fifty-one patients underwent EBUS-TBNA during the study period. Mean age of the patients was 66.9 ± 11.9 years, 43.9% (n=198) of them were aged ≥70yrs. Older patients (≥70yrs) had a worse performance status (p=0.0001) and required significantly lower levels of sedation (p<0.000001) but had similar overall complication rates (<70yrs 8.7% versus ≥70yrs 5.1%; p=0.13) and tolerated the procedure better than younger patients (p=0.036). Sensitivity (92.9% versus 86.4%; p=0.12) was equivalent, but negative predictive value (91.8% versus 73.9%; p=0.001) and diagnostic accuracy (96.0% versus 90.2%; p=0.02) of nodal sampling in patients with confirmed or suspected lung cancer (n=273) was higher in the ≥70yrs cohort (n=131, 48.0%). However, the prevalence of nodal malignancy was significantly different between the two groups as was the proportion of patients subject to surgical lymph node sampling after negative EBUS-TBNA. EBUS-TBNA samples produced low non-small-cell lung cancer-not otherwise specified rates (6.9%) and high levels of successful epidermal growth factor receptor mutation analysis (97.5%) irrespective of age category.
  
  
  CONCLUSIONS
  EBUS is a safe and well-tolerated procedure in elderly patients, which facilitates accurate pathological diagnosis and minimally invasive staging in patients with lung cancer.
authors: *North West Lung Centre, University Hospital of South Manchester, The University of Manchester, Wythenshawe, United Kingdom; †The Institute of Inflammation and Repair, The University of Manchester, Manchester, United Kingdom; and ‡Department of Pathology, University Hospital of South Manchester, The University of Manchester, Wythenshawe, United Kingdom.
authors: Matthew
authors: M
authors: Evison
authors: Philip A J
authors: PA
authors: Crosbie
authors: Julie
authors: J
authors: Martin
authors: Paul
authors: P
authors: Bishop
authors: Helen
authors: H
authors: Doran
authors: Leena
authors: L
authors: Joseph
authors: Anshuman
authors: A
authors: Chaturvedi
authors: Philip V
authors: PV
authors: Barber
authors: Richard
authors: R
authors: Booton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005260:Female; D005500:Follow-Up Studies; 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; D011379:Prognosis; D011446:Prospective Studies; D012449:Safety; D055815:Young Adult