title: Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Mediastinal Staging in a Community Medical Center.
abstract: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and positron emission tomography (PET)-computed tomography (CT) are valuable tools for lung cancer staging. Data from tertiary referral centers suggest that these modalities are superior to mediastinoscopy in mediastinal staging.
  
  
  
  To validate EBUS-TBNA for lung cancer staging in a community center with operators with various levels of experience.
  
  
  
  At an 800-bed community hospital, we reviewed all cases where EBUS-TBNA and PET-CT were performed for mediastinal staging by one of seven private practice pulmonologists. Cases were reviewed with lymph node dissection by mediastinoscopy after negative EBUS-TBNA.
  
  
  
  Of the 333 cases that were reviewed, 44 underwent mediastinoscopy after negative EBUS-TBNA. Four patients were positive for malignancy at stations 4R and 7 lymph nodes. In none of these cases did EBUS-TBNA reveal lymphoid tissue confirming the sample location. PET-CT showed mediastinal lymph nodes with increased avidity in two of the false-negative cases. EBUS-TBNA plus PET-CT had a sensitivity, specificity, and negative predictive value of 98.86, 100, and 94.87%, respectively, compared with mediastinoscopy for detecting metastasis.
  
  
  
  EBUS-TBNA is accurate in detecting mediastinal metastasis of lung cancer in the community setting. PET-CT without uptake in lymph nodes reduces the likelihood of malignancy but cannot rule out mediastinal involvement.
authors.affiliation: 1 Walter Reed National Military Medical Center Department of Pulmonary Medicine, Bethesda, Maryland.|2 Wright State University Boonshoft School of Medicine, Dayton, Ohio.|3 Miami Valley Hospital, Dayton, Ohio.
authors.forename: Whittney A
authors.initials: WA
authors.lastname: Warren
authors.affiliation: 2 Wright State University Boonshoft School of Medicine, Dayton, Ohio.|3 Miami Valley Hospital, Dayton, Ohio.|4 Pulmonary and Critical Care Consultants of Dayton, Dayton, Ohio; and.|5 Ephraim McDowell Regional Medical Center, Danville, Kentucky.
authors.forename: Jared T
authors.initials: JT
authors.lastname: Hagaman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000473:pathology*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D019160:Endosonography; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008479:Mediastinal Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D008481:Mediastinoscopy; D008875:Middle Aged; D009367:Neoplasm Staging; D011030:Pneumothorax / Q000209:etiology; D000072078:Positron Emission Tomography Computed Tomography; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D062606:Tertiary Care Centers
keywords: biopsy; lung cancer; non–small cell lung cancer