Post-operative lymph node recurrence is defined through radiological examinations or serum tumor markers, since biopsy is often a challenge in post-operative patients with lung cancer. We have previously reported utility of EBUS-TBNA (endobronchial ultrasound-guided transbronchial needle aspiration) as a safe and minimally invasive diagnostic procedure for the evaluation of para-bronchial lesion. Through this study, we investigated the efficacy of EBUS-TBNA for detection of regional lymph node recurrence in post-operative patients.
A retrospective chart review of patients who underwent EBUS-TBNA for lymph node staging of lung cancer at Chiba Cancer Center from April 2008 to April 2009 was performed. 228 patients underwent EBUS-TBNA, out of which 15 patients were examined for the evaluation of lymph node recurrence. We analyzed the background, EBUS-TBNA result and the clinical outcome based on the EBUS-TBNA results in these cases.
There were 12 men and 3 women (mean age 68 years). Histological diagnoses were 7 adenocarcinoma, 6 squamous cell carcinoma, 1 large cell carcinoma and 1 undefined. Initial staging classification was stage I (9 cases), II (1 case) and III (5 cases). All cases showed mediastinal lymphadenopathy on CT scan and a lung lesion was detected in 6 cases. Seven out of 9 patients showed abnormal studies on positron emission tomography scan. The mean number of involved nodal stations was 2.3 per patient, in which aspiration biopsy was performed in 1.9 stations.EBUS-TBNA revealed malignancy in 7 patients, of which 6 patients were determined as recurrent disease, however one was defined as second primary cancer based on histological type. In 8 patients that were defined as non-cancerous nodes, 4 were subjected to further examinations or to treatments for other lesions, and 4 were subjected to routine follow-up with disease-free condition.
EBUS-TBNA is useful for the evaluation of post-operative nodal status in patients with lung cancer with a very high yield.
EBUS-TBNA enables accurate diagnosis of mediastinal lymph node recurrence and leads to appropriate clinical decision during post-operative follow-up of lung cancer.
Yuichi Sakairi, Grant monies (from industry related sources) KY has received unrestricted grants from Olympus Medical Systems for continuing medical education.; No Product/Research Disclosure Information