title: Comparison between endobronchial ultrasound-guided transbronchial needle aspiration and 18F-fluorodeoxyglucose positron emission tomography in the diagnosis of postoperative nodal recurrence in patients with lung cancer.
abstract: OBJECTIVE
  Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has a high diagnostic value for preoperative mediastinal staging in patients with lung cancer. In this study, the utility of EBUS-TBNA for the pathological diagnosis of postoperative lymph node recurrence was investigated and compared with that of (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET).
  
  
  METHODS
  Patients who received both EBUS-TBNA and FDG-PET for the diagnosis of postoperative lymph node recurrence were retrospectively investigated. They underwent routine chest computed tomography (CT) follow-up after thoracotomy, and when hilar or mediastinal lymph nodes showed enlargement on CT compared with the previous chest CT, they were referred for FDG-PET and EBUS-TBNA. We compared the diagnostic performance of these two modalities. In addition, pathological findings of the biopsied sample were evaluated precisely and compared with the results of FDG-PET. Positivity for hypermetabolism on FDG-PET was defined as a standardized uptake value (SUV) greater than 2.5.
  
  
  RESULTS
  A total of 40 patients were retrospectively reviewed. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of EBUS-TBNA were 100% for each parameter, whereas those of FDG-PET were 95.8, 12.5, 62.2, 66.7 and 62.5%, respectively. The SUV of true-positive nodes was significantly higher than that of false-positive nodes (P = 0.001). Twenty-two of 24 patients who were confirmed for recurrence by EBUS-TBNA underwent anticancer treatment. The pathological diagnoses of 14 false-positive cases by FDG-PET were chronic inflammation in 12 and non-specific granuloma in 2.
  
  
  CONCLUSIONS
  The diagnostic yield of EBUS-TBNA is higher than that of FDG-PET when postoperative lymph node recurrence is suspected.
authors.affiliation: Department of General Thoracic Surgery, Chiba University, Chiba, Japan.
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Department of General Thoracic Surgery, Chiba University, Chiba, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Sakairi
authors.affiliation: Department of General Thoracic Surgery, Chiba University, Chiba, Japan tnakajima76@hotmail.com.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Nakajima
authors.affiliation: Department of General Thoracic Surgery, Chiba University, Chiba, Japan.
authors.forename: Hidemi
authors.initials: H
authors.lastname: Suzuki
authors.affiliation: Department of General Thoracic Surgery, Chiba University, Chiba, Japan.
authors.forename: Tetsuzo
authors.initials: T
authors.lastname: Tagawa
authors.affiliation: Department of General Thoracic Surgery, Chiba University, Chiba, Japan.
authors.forename: Takekazu
authors.initials: T
authors.lastname: Iwata
authors.affiliation: Department of General Thoracic Surgery, Chiba University, Chiba, Japan.
authors.forename: Teruaki
authors.initials: T
authors.lastname: Mizobuchi
authors.affiliation: Department of General Thoracic Surgery, Chiba University, Chiba, Japan.
authors.forename: Shigetoshi
authors.initials: S
authors.lastname: Yoshida
authors.affiliation: Department of Diagnostic, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Nakatani
authors.affiliation: Department of General Thoracic Surgery, Chiba University, Chiba, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Yoshino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000379:methods*; D001999:Bronchoscopy / Q000379:methods*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000473:pathology; D049268:Positron-Emission Tomography / Q000379:methods*; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: Bronchoscopy/bronchus; Diagnosis; Endobronchial ultrasound-guided transbronchial needle aspiration; Lung cancer; Lymph nodes; Metastasis/metastasectomy