title: Endoscopic ultrasound-guided fine needle aspiration and endobronchial ultrasound-guided transbronchial needle aspiration: Are two better than one in mediastinal staging of non-small cell lung cancer?
abstract: OBJECTIVE
  The role of combined endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) with a single bronchoscope is poorly understood. The purpose of the present study was to elucidate the roles of EBUS-TBNA and EUS-FNA with a single bronchoscope in the preoperative hilar and mediastinal staging of non-small cell lung cancer (NSCLC).
  
  
  METHODS
  A total of 150 patients with potentially resectable known or suspected NSCLC were enrolled in our prospective study. EBUS-TBNA was performed, followed by EUS-FNA, with an EBUS bronchoscope for N2 and N3 nodes≥5 mm in the shortest diameter on ultrasound images, in a single session.
  
  
  RESULTS
  EBUS-TBNA was performed for 257 lymph nodes and EUS-FNA for 176 lymph nodes. Of the 150 patients, 146 had a final diagnosis of NSCLC. Of these 146 patients, 33 (23%) had N2 and/or N3 nodal metastases. The sensitivity of EBUS-TBNA, EUS-FNA, and the combined approach per patient was 52%, 45%, and 73%, respectively (EBUS-TBNA vs the combined approach, P=.016, McNemar's test). The corresponding negative predictive value was 88%, 86%, and 93%. Two patients (1%) developed severe cough from EBUS-TBNA.
  
  
  CONCLUSIONS
  The combined endoscopic approach with EBUS-TBNA and EUS-FNA is a safe and accurate method for preoperative hilar and mediastinal staging of NSCLC, with better results than with each technique by itself.
authors.affiliation: Department of Respiratory Medicine, Nagoya Medical Center, Nagoya, Japan. Electronic address: masahideo@aol.com.
authors.forename: Masahide
authors.initials: M
authors.lastname: Oki
authors.affiliation: Department of Respiratory Medicine, Nagoya Medical Center, Nagoya, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Saka
authors.affiliation: Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Ando
authors.affiliation: Department of Respiratory Medicine, Nagoya Medical Center, Nagoya, Japan.
authors.forename: Chiyoe
authors.initials: C
authors.lastname: Kitagawa
authors.affiliation: Department of Respiratory Medicine, Nagoya Medical Center, Nagoya, Japan.
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Kogure
authors.affiliation: Department of Thoracic Surgery, Nagoya Medical Center, Nagoya, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Seki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle / Q000379:methods; D001999:Bronchoscopy; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008207:Lymphatic Metastasis; D008482:Mediastinum / Q000473:pathology*; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D018084:Ultrasonography, Interventional