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Original Research: INTERVENTIONAL PULMONOLOGY |

Combined Endoscopic-Endobronchial Ultrasound-Guided Fine-Needle Aspiration of Mediastinal Lymph Nodes Through a Single Bronchoscope in 150 Patients With Suspected Lung Cancer

Felix J. F. Herth, MD, FCCP; Mark Krasnik, MD; Nicolas Kahn, MD; Ralf Eberhardt, MD; Armin Ernst, MD, FCCP
Author and Funding Information

From the Department of Pulmonary and Critical Care Medicine (Drs Herth, Kahn, Eberhardt, and Ernst), Thoraxklinik, Heidelberg, Germany; the Department of Thoracic Surgery (Dr Krasnik), Gentofte Hospital, Copenhagen, Denmark; and the Division of Interventional Pulmonology (Dr Ernst), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA.

Correspondence: Armin Ernst, MD, FCCP, Interventional Pulmonology, Beth Israel Deaconess Medical Center/Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; e-mail: aernst@bidmc.harvard.edu


For editorial comment see page 765

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):790-794. doi:10.1378/chest.09-2149
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Background:  For mediastinal lymph nodes, biopsies must often be performed to accurately stage lung cancer. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) allows real-time guidance in sampling paratracheal, subcarinal, and hilar lymph nodes, and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) can sample mediastinal lymph nodes located adjacent to the esophagus. Nodes can be sampled and staged more completely by combining these procedures, but to date use of two different endoscopes has been required. We examined whether both procedures could be performed with a single endobronchial ultrasound bronchoscope.

Methods:  Consecutive patients with a presumptive diagnosis of non-small cell lung cancer (NSCLC) underwent endoscopic staging by EBUS-TBNA and EUS-FNA through a single linear ultrasound bronchoscope. Surgical confirmation and clinical follow-up was used as the reference standard.

Results:  Among 150 evaluated patients, 139 (91%; 83 men, 56 women; mean age 57.6 years) were diagnosed with NSCLC. In these 139 patients, 619 nodes were endoscopically biopsied: 229 by EUS-FNA and 390 by EBUS-TBNA. Sensitivity was 89% for EUS-FNA and 92% for EBUS-TBNA. The combined approach had a sensitivity of 96% and a negative predictive value of 95%, values higher than either approach alone. No complications occurred.

Conclusions:  The two procedures can easily be performed with a dedicated linear endobronchial ultrasound bronchoscope in one setting and by one operator. They are complementary and provide better diagnostic accuracy than either one alone. The combination may be able to replace more invasive methods as a primary staging method for patients with lung cancer.

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