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Original Research: INTERVENTIONAL PULMONOLOGY |

Transbronchial and Transesophageal Fine-Needle Aspiration Using an Ultrasound Bronchoscope in Mediastinal Staging of Potentially Operable Lung Cancer

Bin Hwangbo, MD, PhD; Geon-Kook Lee, MD, PhD; Hee Seok Lee, MD; Kun-Young Lim, MD; Soo-Hyun Lee, MD; Hyae-Young Kim, MD, PhD; Hyun Sung Lee, MD, PhD; Moon Soo Kim, MD; Jong Mog Lee, MD; Byung-Ho Nam, PhD; Jae Ill Zo, MD, PhD
Author and Funding Information

From the Center for Lung Cancer (Drs Hwangbo, G.-K. Lee, Hee S. Lee, Lim, H.-Y. Kim, Hyun S. Lee, M. Kim, J. M. Lee, and Zo), the Department of Radiology (Dr S.-H. Lee), Research Institute and Hospital, and the Cancer Biostatistics Branch (Dr Nam), Research Institute for National Cancer Control and Evaluation, National Cancer Center, Goyang, Korea.

Correspondence to: Bin Hwangbo MD, PhD, Center for Lung Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, 410-769, Korea; e-mail: hbb@ncc.re.kr


For editorial comment see page 765

Funding/Support: This work was supported by the National Cancer Center [Grant 710620].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(4):795-802. doi:10.1378/chest.09-2100
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Objective:  We performed this study to evaluate the role of transesophageal endoscopic ultrasound with bronchoscope-guided fine-needle aspiration (EUS-B-FNA) following endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the mediastinal staging of lung cancer.

Methods:  In this prospective study, we applied transbronchial and transesophageal ultrasonography using an ultrasound bronchoscope on patients with confirmed or strongly suspected potentially operable non-small cell lung cancer. Following EBUS-TBNA, EUS-B-FNA was used for mediastinal nodes that were inaccessible or difficult to access by EBUS-TBNA. The accessibility by EBUS-TBNA and EUS-B-FNA to mediastinal nodal stations having at least one node ≥ 5 mm was also checked.

Results:  In 150 patients, we performed EBUS-TBNA and EUS-B-FNA on 299 and 64 mediastinal nodal stations, respectively. Among 143 evaluable patients, EBUS-TBNA diagnosed mediastinal metastasis in 38 patients. EUS-B-FNA identified mediastinal metastasis in three additional patients. Surgery diagnosed mediastinal metastasis in four more patients. The sensitivity, negative predictive value, and diagnostic accuracy of EBUS-TBNA in the detection of mediastinal metastasis were 84.4%, 93.3%, and 95.1%, respectively. These values for the combined approach of EBUS-TBNA and EUS-B-FNA increased to 91.1%, 96.1%, and 97.2%, respectively, although the differences were not statistically significant (P = .332, P = .379, and P = .360, respectively). Among 473 mediastinal nodal stations having at least one node ≥ 5 mm that were evaluated, the proportion of accessible mediastinal nodal stations by EBUS-TBNA was 78.6%, and the proportion increased to 84.8% by combining EUS-B-FNA with EBUS-TBNA (P = .015).

Conclusion:  Following EBUS-TBNA in the mediastinal staging of potentially operable lung cancer, the accessibility to mediastinal nodal stations increased by adding EUS-B-FNA and an additional diagnostic gain might be obtained by EUS-B-FNA.

Trial Registration:  clinicaltrials.gov, NCT00741247

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