Negative Predictive Value of Granulomas on EBUS-TBNA in Suspected Extrathoracic Malignancy.
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a well-established diagnostic tool for lung cancer, sarcoidosis, and suspected metastatic extrathoracic malignancy. EBUS-TBNA carries a high diagnostic yield, but its negative predictive value (NPV) requires further clarification.



We reviewed EBUS-TBNA at our cancer center from 2008 to 2015. We identified negative diagnostic samples for adenopathy suspected to represent metastatic disease from extrathoracic malignancy.



We reviewed 529 EBUS-TBNAs. Ninety patients underwent EBUS-TBNA sampling of the hilum and/or mediastinum (121 nodes, 14 masses) for suspected extrathoracic malignancy. Thirty-seven patients had negative samples (lymph node, granulomas or non-diagnostic specimens). The overall NPV was 98 %. Granulomas (11 patients, 25 nodes) seen on histology had a 100 % NPV, including those that were FDG-PET (fluorodeoxyglucose positron emission tomography) avid (n = 14 nodes).



Negative EBUS-TBNA in patients with extrathoracic malignancy and suspected secondary hilar or mediastinal metastases can infer a high NPV especially if granulomas are seen on histology. Larger prospective investigations are needed to confirm the high NPV of EBUS-TBNA with granulomas in extrathoracic malignancies.
Department of Pulmonary/Critical Care, Wake Forest Baptist Health, Medical Center Blvd, Winston Salem, NC, 27157, USA. cbelling@wakehealth.edu.
Christina R
CR
Bellinger
Department of Pulmonary/Critical Care, Wake Forest Baptist Health, Medical Center Blvd, Winston Salem, NC, 27157, USA.
Deepankar
D
Sharma
Department of Medicine, Section on Hematology and Oncology Comprehensive Cancer, Center of Wake Forest University, Winston Salem, NC, 27157, USA.|W.G. (Bill).Hefner Veteran Administration Medical Center, Salisbury, NC, 28144, USA.
Jimmy
J
Ruiz
Department of Pathology, Wake Forest Baptist Health, Winston Salem, NC, 27157, USA.
Graham
G
Parks
Department of Pulmonary/Critical Care, Wake Forest Baptist Health, Medical Center Blvd, Winston Salem, NC, 27157, USA.
Travis
T
Dotson
Department of Pulmonary/Critical Care, Wake Forest Baptist Health, Medical Center Blvd, Winston Salem, NC, 27157, USA.
Edward F
EF
Haponik
D000368:Aged; D001999:Bronchoscopy; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods; D005188:False Negative Reactions; D005260:Female; D006099:Granuloma / Q000175:diagnosis / Q000473:pathology*; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D000072281:Lymphadenopathy / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000473:pathology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies
EBUS-TBNA; Extrathoracic malignancy; Granulomas