[Results of endobronchial ultrasound-guided transbronchial needle aspiration in lung cancer: importance of the lymph node involvement prevalence].
OBJECTIVE
We studied the non-surgical invasive staging by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and we detailed the differences of our series, in order to understand the criteria allowing to achieve a better performance.


METHODS
Retrospective observational study conducted between 2007 and 2011, including all patients with proven NSCLC who underwent EBUS-TBNA.


RESULTS
For the 92 EBUS-TBNA performed, we found a sensitivity of 78%, a specificity of 93%, a positive predictive value (PPV) of 98%, a negative predictive value (NPV) of 45%, an accuracy of 80% and a prevalence of lymph node involvement at 84%. A learning curve has been demonstrated and a significant difference was found based on the number of punctures by procedure (P=0.02) or on histological type (P=0.02). By analyzing the data of the literature, we have been able to demonstrate that the accuracy and the negative predictive value are correlated with the prevalence. If we take into account this correlation, we can consider the results of our study close to those of the literature.


CONCLUSIONS
We highlighted a number of criteria that will influence the diagnostic yield of EBUS-TBNA. While some have already been described, other criteria such as histological type or patient selection criteria are less discussed. The key point is the correlation between the prevalence and EBUS-TBNA results. Results of the assessment of lymph node involvement techniques should be interpreted according to the prevalence of lymph node involvement.
Service de chirurgie thoracique, université de Picardie, hôpital Sud, CHU d'Amiens, avenue René-Laennec, 80054 Amiens cedex 1, France.
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De Dominicis
Service de chirurgie thoracique, université de Picardie, hôpital Sud, CHU d'Amiens, avenue René-Laennec, 80054 Amiens cedex 1, France.
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Fourdrain
Service de chirurgie thoracique, université de Picardie, hôpital Sud, CHU d'Amiens, avenue René-Laennec, 80054 Amiens cedex 1, France.
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Iquille
Service de pneumologie et de réanimation respiratoire, université de Picardie, hôpital Sud, CHU d'Amiens, avenue René-Laennec, 80054 Amiens, France.
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Toublanc
Service de pneumologie et de réanimation respiratoire, université de Picardie, hôpital Sud, CHU d'Amiens, avenue René-Laennec, 80054 Amiens, France.
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François
Service de pneumologie et de réanimation respiratoire, université de Picardie, hôpital Sud, CHU d'Amiens, avenue René-Laennec, 80054 Amiens, France.
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Basille
Service de chirurgie thoracique, université de Picardie, hôpital Sud, CHU d'Amiens, avenue René-Laennec, 80054 Amiens cedex 1, France.
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Monconduit
Service de chirurgie thoracique, université de Picardie, hôpital Sud, CHU d'Amiens, avenue René-Laennec, 80054 Amiens cedex 1, France.
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Merlusca
Service de pneumologie et de réanimation respiratoire, université de Picardie, hôpital Sud, CHU d'Amiens, avenue René-Laennec, 80054 Amiens, France.
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Jounieaux
Service de pneumologie et de réanimation respiratoire, université de Picardie, hôpital Sud, CHU d'Amiens, avenue René-Laennec, 80054 Amiens, France.
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Andrejak
Service de chirurgie thoracique, université de Picardie, hôpital Sud, CHU d'Amiens, avenue René-Laennec, 80054 Amiens cedex 1, France. Electronic address: berna.pascal@chu-amiens.fr.
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Berna
D000368:Aged; D044963:Biopsy, Fine-Needle / Q000379:methods*; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000473:pathology*; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D015995:Prevalence; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018084:Ultrasonography, Interventional / Q000379:methods*
CT scan; Cancer bronchique non à petite cellule; EBUS-TBNA; Médiastinoscopie; N; Non-small-cell lung cancer; PET scan; TDM; TEP scan