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Original Research: INTERVENTIONAL PULMONOLOGY |

Application of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration Following Integrated PET/CT in Mediastinal Staging of Potentially Operable Non-small Cell Lung Cancer

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

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

Correspondence to: Jae Ill Zo, MD, PhD, Center for Lung Cancer, National Cancer Center, 809 Madu-dong, Ilsan-gu, Goyang, Gyeonggi, 411-764, Korea; e-mail: jaylzo@ncc.re.kr


This work was supported by National Cancer Center grant 710620.

The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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


© 2009 American College of Chest Physicians


Chest. 2009;135(5):1280-1287. doi:10.1378/chest.08-2019
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Background:  The role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) following integrated PET/CT scanning in mediastinal staging of non-small cell lung cancer (NSCLC) has not been assessed.

Methods:  We prospectively evaluated the diagnostic values of PET/CT scanning and EBUS-TBNA for mediastinal staging in 117 patients with potentially operable NSCLC with accessible mediastinal lymph nodes (diameter range, 5 to 20 mm) by EBUS-TBNA. Subgroup analysis according to histologic type was performed.

Results:  Of 30 cases of mediastinal metastasis, 27 were confirmed by EBUS-TBNA and 3 were confirmed by surgery. EBUS-TBNA results confirmed all cases with true-positive PET/CT scan findings and six of nine cases with false-negative PET/CT scan findings. The sensitivity, specificity, positive predictive value, negative predictive value (NPV), and accuracy of EBUS-TBNA in the detection of mediastinal metastasis were 90.0%, 100%, 100%, 96.7%, and 97.4%, respectively. For PET/CT scans, the values were 70.0%, 59.8%, 37.5%, 85.2%, and 62.4%, respectively (p = 0.052; p < 0.001; p < 0.001; p = 0.011; p < 0.001, respectively). In adenocarcinoma (n = 55), EBUS-TBNA detected four of six cases with false-negative PET/CT scan findings, and the NPV was higher for EBUS-TBNA than for PET/CT scans (94.6% vs 77.8%, respectively; p = 0.044). In squamous cell carcinoma (n = 53), the NPV of EBUS-TBNA and PET/CT scans were similarly high (97.9% vs 96.3%, respectively; p = 0.689).

Conclusions:  EBUS-TBNA was an effective invasive method following PET/CT scanning in the mediastinal staging of potentially operable NSCLC. In mediastinal PET/CT scan-positive cases, EBUS-TBNA was an excellent tool for detecting mediastinal metastasis. Even in mediastinal PET/CT scan-negative cases, EBUS-TBNA can be useful for confirming mediastinal metastases, especially in adenocarcinoma.

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