title: Efficacy and adequacy of conventional transbronchial needle aspiration of IASLC stations 4R, 4L and 7 using endobronchial landmarks provided by the Wang nodal mapping system in the staging of lung cancer.
abstract: BACKGROUND
  The role of transbronchial needle aspiration (TBNA) in the diagnosis and staging of lung cancer has been well established. Recently, the efficacy of conventional TBNA in the staging of lung cancer has been enhanced by the use of endobronchial ultrasound (EBUS)-TBNA. Our study sought to evaluate the adequacy of TBNA of International Association for the Study of Lung Cancer (IASLC) stations 4R, 4L and 7 using endobronchial landmarks provided by the Wang nodal mapping system in the staging of lung cancer.
  
  
  METHODS
  We retrospectively analyzed all bronchoscopic cases with conventional TBNA punctures positive for malignancy at our institution from 1 January to 31 October 2014. The endobronchial puncture site was guided by the Wang nodal mapping system. The Wang stations were correlated with the IASLC lymph node map. No endobronchial ultrasound or rapid on-site evaluation was used. Pathological analysis included cytological and histological examination.
  
  
  RESULTS
  Diagnosis by histological analysis was obtained in 115 (55.3%) out of 208 puncture sites. The metastatic lymph nodes were distributed at IASLC stations 4R (W1, 3, 5) 46.6 %, 7 (W2, 8, 10) 19.7%, 4L (W4, 6) 11.5%, 11R (W7, W9) 11.1% 11L (W11) 9.6%, 2R (high station W3) 0.5%, and the proximal portion of station 8 (station W10 beyond the middle lobe orifice) 1%. No complications were observed.
  
  
  CONCLUSIONS
  IASLC station 4R (W1, 3, 5), 7 (W2, 8, 10) and 4L (W4, 6) are adequate for the staging of lung cancer.
authors.affiliation: Department of Respiratory Medicine Shandong Provincial Hospital Affiliated to Shandong University Jinan China.
authors.forename: Qinghua
authors.initials: Q
authors.lastname: Liu
authors.affiliation: Department of Respiratory Diseases Shanxi Cancer Hospital Taiyuan China.
authors.forename: Songyan
authors.initials: S
authors.lastname: Han
authors.affiliation: Interventional Pulmonology Division of Pulmonary Medicine and Critical Care Johns Hopkins University School of Medicine Baltimore Maryland USA.
authors.forename: Sixto
authors.initials: S
authors.lastname: Arias
authors.affiliation: Division of Pulmonary and Critical Care Medicine University of Tennessee Graduate School of Medicine Knoxville Tennessee USA.
authors.forename: J Francis
authors.initials: JF
authors.lastname: Turner
authors.affiliation: Interventional Pulmonology Division of Pulmonary Medicine and Critical Care Johns Hopkins University School of Medicine Baltimore Maryland USA.
authors.forename: Hans
authors.initials: H
authors.lastname: Lee
authors.affiliation: Interventional Pulmonology Walter Reed National Military Medical Center Bethesda Maryland USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Browning
authors.affiliation: Interventional Pulmonology Division of Pulmonary Medicine and Critical Care Johns Hopkins University School of Medicine Baltimore Maryland USA.
authors.forename: Ko-Pen
authors.initials: KP
authors.lastname: Wang
keywords: Bronchoscopy; EBUS; lung cancer; transbronchial needle aspiration
references.citation: Clin Chest Med. 1999 Mar;20(1):39-51
references.pmid: 10205716
references.citation: J Thorac Oncol. 2009 May;4(5):568-77
references.pmid: 19357537
references.citation: Eur J Cardiothorac Surg. 2009 Sep;36(3):465-8
references.pmid: 19502074
references.citation: Postgrad Med J. 2010 Feb;86(1012):106-15
references.pmid: 20145060
references.citation: Zhonghua Jie He He Hu Xi Za Zhi. 2011 Feb;34(2):120-2
references.pmid: 21426731
references.citation: Respir Care. 2013 Apr;58(4):683-93
references.pmid: 23050747
references.citation: J Bras Pneumol. 2013 Mar-Apr;39(2):226-37
references.pmid: 23670509
references.citation: Respiration. 2013;86(2):123-34
references.pmid: 23817073
references.citation: J Thorac Dis. 2013 Jun;5(3):234-9
references.pmid: 23825753
references.citation: Clin Chest Med. 2013 Sep;34(3):353-63
references.pmid: 23993808
references.citation: J Thorac Dis. 2013 Oct;5(5):678-82
references.pmid: 24255782
references.citation: Cancer Cytopathol. 2014 Aug;122(8):561-76
references.pmid: 24760496
references.citation: J Thorac Dis. 2014 May;6(5):411-5
references.pmid: 24822096
references.citation: J Thorac Dis. 2014 May;6(5):416-20
references.pmid: 24822097
references.citation: J Thorac Dis. 2014 Dec;6(12):1665-7
references.pmid: 25589957
references.citation: Thorac Cancer. 2015 Jul;6(4):464-8
references.pmid: 26273402
references.citation: Thorac Cancer. 2010 Jul;1(2):87-93
references.pmid: 27755777
references.citation: Chest. 1983 Nov;84(5):571-6
references.pmid: 6313305
references.citation: Chest. 1994 Aug;106(2):588-93
references.pmid: 7774342
references.citation: Am Rev Respir Dis. 1993 May;147(5):1251-8
references.pmid: 8484639
references.citation: Chest. 1998 Jul;114(1):4-5
references.pmid: 9674436