title: Endobronchial ultrasound-guided transbronchial needle aspiration of hilar and mediastinal lymph nodes detected on 18F-fluorodeoxyglucose positron emission tomography/computed tomography.
abstract: OBJECTIVE
  Endobronchial ultrasound-guided transbronchial needle aspiration is of diagnostic value in hilar/mediastinal (N1/N2) lymph node staging. We assessed the utility of endobronchial ultrasound-guided transbronchial needle aspiration in lung cancer patients with N1/N2 lymph nodes detected on (18)F-fluorodeoxyglucose positron emission tomography/computed tomography.
  
  
  METHODS
  Fifty lung cancer patients with N1/N2 disease on (18)F-fluorodeoxyglucose positron emission tomography/computed tomography underwent endobronchial ultrasound-guided transbronchial needle aspiration for pathological lymph nodes between November 2012 and April 2015. The diagnostic performance of endobronchial ultrasound-guided transbronchial needle aspiration, lymph node site and size, number of needle passes and complications were evaluated retrospectively from patients' medical records. Malignancy was defined as a maximum standardized uptake value (SUVmax) >2.5.
  
  
  RESULTS
  The median longest diameter of the 61 lymph nodes (29 subcarinal, 21 right lower paratracheal, 6 left lower paratracheal, 4 right hilar and 1 upper paratracheal) was 23.4 mm (range: 10.4-45.7); the median number of needle passes was 2 (range: 1-5). There were no severe complications. A definitive diagnosis was made by endobronchial ultrasound-guided transbronchial needle aspiration in 39 patients (31 adenocarcinomas, 3 small-cell carcinomas, 2 squamous-cell carcinomas, 3 large-cell neuroendocrine carcinomas). In the remaining 11 patients, the diagnosis was indefinite: insufficient endobronchial ultrasound-guided transbronchial needle aspiration material was collected in two patients and non-specific lymphadenopathy was confirmed by endobronchial ultrasound-guided transbronchial needle aspiration or thoracotomy in the other nine patients. The mean lymph node SUVmax was 7.09 (range: 2.90-26.9) and was significantly higher in true-positive than in false-positive nodes (P < 0.05, t-test). Non-specific lymphadenopathy was diagnosed by expert visual interpretation of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography images in five of the nine patients.
  
  
  CONCLUSIONS
  Endobronchial ultrasound-guided transbronchial needle aspiration accurately diagnoses N1/N2 disease detected on (18)F-fluorodeoxyglucose positron emission tomography/computed tomography.
authors.affiliation: Department of Respiratory Medicine, Okayama University Hospital, Okayama d-minami@bj8.so-net.ne.jp.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Minami
authors.affiliation: Department of General Internal Medicine 4, Kawasaki Medical School, Okayama.
authors.forename: Nagio
authors.initials: N
authors.lastname: Takigawa
authors.affiliation: Department of Respiratory Medicine, Okayama University Hospital, Okayama.
authors.forename: Naohiro
authors.initials: N
authors.lastname: Oda
authors.affiliation: Department of Respiratory Medicine, Okayama University Hospital, Okayama.
authors.forename: Takashi
authors.initials: T
authors.lastname: Ninomiya
authors.affiliation: Department of Respiratory Medicine, Okayama University Hospital, Okayama.
authors.forename: Toshio
authors.initials: T
authors.lastname: Kubo
authors.affiliation: Department of Respiratory Medicine, Okayama University Hospital, Okayama.
authors.forename: Kadoaki
authors.initials: K
authors.lastname: Ohashi
authors.affiliation: Department of Respiratory Medicine, Okayama University Hospital, Okayama.
authors.forename: Akiko
authors.initials: A
authors.lastname: Sato
authors.affiliation: Department of Respiratory Medicine, Okayama University Hospital, Okayama.
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Hotta
authors.affiliation: Department of Respiratory Medicine, Okayama University Hospital, Okayama.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tabata
authors.affiliation: Okayama Diagnostic Imaging Center, Okayama, Japan.
authors.forename: Mitsumasa
authors.initials: M
authors.lastname: Kaji
authors.affiliation: Department of Respiratory Medicine, Okayama University Hospital, Okayama.
authors.forename: Mitsune
authors.initials: M
authors.lastname: Tanimoto
authors.affiliation: Department of Respiratory Medicine, Okayama University Hospital, Okayama.
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Kiura
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001999:Bronchoscopy; D018287:Carcinoma, Large Cell / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D018288:Carcinoma, Small Cell / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000737:chemistry*; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008482:Mediastinum / Q000473:pathology; D008875:Middle Aged; D009367:Neoplasm Staging; D000072078:Positron Emission Tomography Computed Tomography; D012372:ROC Curve; D012189:Retrospective Studies; D013908:Thoracotomy
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: 18F-fluorodeoxyglucose positron emission tomography/computed tomography; endobronchial ultrasound-guided transbronchial biopsy; endoscopy-respiratory tract; lung cancer; lung-RadOncol; radiology-PET