PURPOSE: Mediastinoscopy, thoracotomy or thoracoscopy (M/T) are the gold standards for diagnosing abnormal mediastinal lymphadenopathy and staging early non-small cell lung cancer (NSCLC). We set out to determine whether EBUS-TBNA may avoid the need for more invasive procedures in this setting.
METHODS: We reviewed all patients who underwent EBUS-TBNA procedures from 2006 to 2010 at the University of Miami/Sylvester Comprehensive Cancer Center with suspected cancer, and excluded cases of suspected lymphoma or infection. Patients underwent conventional bronchoscopy (with endobronchial biopsies if indicated) followed by EBUS-guided TBNA. Cases were divided into two groups: (1) Lymph node staging in NSCLC and (2) Suspected NSCLC recurrence or suspected mediastinal metastases from another cancer. In group 1, the accuracy of each lymph node TBNA was analyzed. In group 2, the accuracy of the combined bronchoscopy/EBUS procedure was analyzed. The accuracy of FDG-PET was compared to EBUS-TBNA using McNemar’s test for paired data.
RESULTS: 190 patients were included. Among 99 patients in group 1, 155 lymph nodes were sampled for staging NSCLC, resulting in 75 true positive (TP), 7 false negative (FN), 40 true negative (TN) and 33 non-diagnostic (ND) TBNA’s with a sensitivity of 90% and specificity of 100%. The accuracy of EBUS-TBNA was superior to PET (94% vs 71% p< 0.001) for predicting nodal metastases. In these 99 patients, EBUS-TBNA yielded a positive diagnosis in 63% of cases. In group 2, among 91 patients, there were 49 TP, 9 FN, 28 TN and 5 ND procedures, with a sensitivity of 80% and specificity of 95%. The accuracy of EBUS-TBNA was superior to PET (85% vs 65% p=0.019) in predicting malignancy in this group.
CONCLUSION: EBUS-TBNA was more accurate than PET for mediastinal staging of NSCLC. M/T was avoided in 63% of cases in group 1 and 54% in group 2. The low negative predictive value of EBUS-TBNA suggests that M/T should be pursued in negative or non-diagnostic cases.
CLINICAL IMPLICATIONS: EBUS-TBNA is a useful procedure that can avoid more invasive testing in many patients.
DISCLOSURE: Elio Donna, No Financial Disclosure Information; No Product/Research Disclosure Information