title: Determinants of false-negative results in non-small-cell lung cancer staging by endobronchial ultrasound-guided needle aspiration.
abstract: OBJECTIVE
  False-negative results of endobronchial ultrasound-guided transbronchial needle aspiration in non-small-cell lung cancer staging have shown significant variability in previous studies. The aim of this study was to identify procedure- and tumour-related determinants of endobronchial ultrasound-guided transbronchial needle aspiration false-negative results.
  
  
  METHODS
  We conducted a prospective study that included non-small-cell lung cancer patients staged as N0/N1 by endobronchial ultrasound-guided transbronchial needle aspiration and undergoing therapeutic surgery. The frequency of false-negative results in the mediastinum was calculated. Procedure-related, first, and tumour-related, second, determinants of false-negative results in stations reachable and non-reachable by endobronchial ultrasound were determined by multivariate logistic regression.
  
  
  RESULTS
  False-negative endobronchial ultrasound-guided transbronchial needle aspiration results were identified in 23 of 165 enrolled patients (13.9%), mainly in stations reachable by endobronchial ultrasound (17 cases, 10.3%). False-negative results were related to the extensiveness of endobronchial ultrasound sampling: their prevalence was low (2.4%) when sampling of three mediastinal stations was satisfactory, but rose above 10% when this requirement was not fulfilled (P = 0.043). In the multivariate analysis, abnormal mediastinum on computer tomography/positron emission tomography [odds ratio (OR) 7.77, 95% confidence interval (CI) 2.19-27.51, P = 0.001] and extensiveness of satisfactory sampling of mediastinal stations (OR 0.37, 95% CI 0.16-0.89, P = 0.026) were statistically significant risk factors for false-negative results in stations reachable by endobronchial ultrasound. False-negative results in non-reachable nodes were associated with a left-sided location of the tumour (OR 10.11, 95% CI 1.17-87.52, P = 0.036).
  
  
  CONCLUSIONS
  The presence of false-negative ultrasound-guided transbronchial needle aspiration results were observed in nearly 15% of non-small-cell lung cancer patients but in only 3% when satisfactory samples were obtained from three mediastinal stations. False-negative results in stations reachable by endobronchial ultrasound were associated with the extensiveness of sampling, and in stations out of reach of endobronchial ultrasound with left-sided tumours. These results suggest that satisfactory sampling of at least three mediastinal stations by EBUS-TBNA may be a quality criterion to be recommended for EBUS-TBNA staging.
authors.affiliation: Hospital Universitari Germans Trias i Pujol, Badalona, Spain 34057jss@comb.cat.
authors.forename: José
authors.initials: J
authors.lastname: Sanz-Santos
authors.affiliation: Hospital Universitari del Parc Taulí, Sabadell, Spain Departament de Medicina, Universitat Autónoma de Barcelona, Bellaterra, Spain.
authors.forename: Mireia
authors.initials: M
authors.lastname: Serra
authors.affiliation: Hospital Universitari del Parc Taulí, Sabadell, Spain Ciber de Enfermedades Respiratorias-Ciberes, Bunyola, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Gallego
authors.affiliation: Hospital Universitari del Parc Taulí, Sabadell, Spain.
authors.forename: Concepción
authors.initials: C
authors.lastname: Montón
authors.affiliation: Ciber de Enfermedades Respiratorias-Ciberes, Bunyola, Spain Hospital Universitari Son Espases, Palma de Mallorca, Spain.
authors.forename: Borja
authors.initials: B
authors.lastname: Cosio
authors.affiliation: Hospital Universitari Son Espases, Palma de Mallorca, Spain Ciber de Enfermedades Respiratorias-Ciberes, Bunyola, Spain Institut Universitari de Ciències de la Salut, Palma de Mallorca, Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Sauleda
authors.affiliation: Complexo Hospitalario Universitario de Vigo, Vigo, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Fernández-Villar
authors.affiliation: Ciber de Enfermedades Respiratorias-Ciberes, Bunyola, Spain Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Ricardo
authors.initials: R
authors.lastname: García-Luján
authors.affiliation: Ciber de Enfermedades Respiratorias-Ciberes, Bunyola, Spain Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: de Miguel
authors.affiliation: Complejo Asistencial de Salamanca, Salamanca, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Cordovilla
authors.affiliation: Complejo Asistencial de Salamanca, Salamanca, Spain.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Varela
authors.affiliation: Hospital Universitari La Fe, Valencia, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Cases
authors.affiliation: Hospital Universitari Germans Trias i Pujol, Badalona, Spain Departament de Medicina, Universitat Autónoma de Barcelona, Bellaterra, Spain Ciber de Enfermedades Respiratorias-Ciberes, Bunyola, Spain.
authors.forename: Felipe
authors.initials: F
authors.lastname: Andreo
authors.affiliation: Hospital Universitari del Parc Taulí, Sabadell, Spain Departament de Medicina, Universitat Autónoma de Barcelona, Bellaterra, Spain Ciber de Enfermedades Respiratorias-Ciberes, Bunyola, Spain.
authors.forename: Eduard
authors.initials: E
authors.lastname: Monsó
mesh_terms: D000368:Aged; D001707:Biopsy, Needle / Q000379:methods*; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000592:standards*; D011446:Prospective Studies; D012307:Risk Factors; D018084:Ultrasonography, Interventional / Q000379:methods*
keywords: Endobronchial ultrasound-guided transbronchial needle aspiration; False negative; Mediastinum; Non-small-cell lung cancer; Staging