title: Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in the Nodal Staging of Stereotactic Ablative Body Radiotherapy Patients.
abstract: BACKGROUND
  Patients with non-small cell lung cancer (NSCLC) being evaluated for stereotactic ablative body radiotherapy (SABR) are typically staged noninvasively with positron emission tomography/computed tomography (PET/CT). Incorporating endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) into the staging workup of these patients has not been evaluated. Our primary objective was to compare the performance of PET/CT with EBUS-TBNA for intrathoracic nodal assessment among SABR-eligible patients.
  
  
  METHODS
  This was a retrospective study consisting of two parts. First, we assessed the concordance for nodal metastasis of PET/CT and EBUS-TBNA. Second, we evaluated clinical outcomes among patients who underwent SABR with and without a prior EBUS-TBNA.
  
  
  RESULTS
  We identified 246 eligible patients. Compared with PET/CT, EBUS-TBNA led to a stage shift in 48 of 246 patients (19%). Of 174 N0 patients by PET/CT, 6 (3.4%) had nodal metastasis on EBUS-TBNA. Among 72 clinical N1 patients, 36 (50%) were downstaged to N0 after EBUS-TBNA, therefore becoming eligible for SABR. Concordance between PET/CT and EBUS-TBNA for nodal metastasis was 83% (κ = 0.53). Clinical outcomes of patients who underwent SABR with or without a prior EBUS-TBNA did not differ significantly.
  
  
  CONCLUSIONS
  Concordance of PET/CT and EBUS-TBNA for nodal disease was only moderate. Incorporating EBUS-TBNA into the staging workup was beneficial in identifying occult nodal metastasis that would otherwise be left untreated with SABR and in expanding the pool of potentially SABR-eligible patients.
authors.affiliation: Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas; Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile.
authors.forename: Macarena R
authors.initials: MR
authors.lastname: Vial
authors.affiliation: Department of Respiratory Medicine, Cork University Hospital/University College Cork, Ireland.
authors.forename: Kashif A
authors.initials: KA
authors.lastname: Khan
authors.affiliation: Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Oisin
authors.initials: O
authors.lastname: O'Connell
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: S Andrew
authors.initials: SA
authors.lastname: Peng
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Gomez
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Joe Y
authors.initials: JY
authors.lastname: Chang
authors.affiliation: Department of Thoracic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: David C
authors.initials: DC
authors.lastname: Rice
authors.affiliation: Department of Thoracic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Reza
authors.initials: R
authors.lastname: Mehran
authors.affiliation: Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Carlos J
authors.initials: CJ
authors.lastname: Jimenez
authors.affiliation: Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Horiana B
authors.initials: HB
authors.lastname: Grosu
authors.affiliation: Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: David E
authors.initials: DE
authors.lastname: Ost
authors.affiliation: Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: geapen@mdanderson.org.
authors.forename: George A
authors.initials: GA
authors.lastname: Eapen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology* / Q000532:radiotherapy; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000532:radiotherapy; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D000072078:Positron Emission Tomography Computed Tomography; D016634:Radiosurgery; D012189:Retrospective Studies; D016019:Survival Analysis