PURPOSE: The utility of endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) in lung cancer staging has been defined. We investigated the yield of EBUS-TBNA in a heterogeneous population of patients with mediastinal lymphadenopathy secondary to suspected cancer (lung and nonlung) or recurrence after therapy in a large academic cancer institute.
METHODS: A retrospective review was performed of all patients referred to our institution between August 2005 and September 2006 for real-time EBUS-TBNA for the investigation of mediastinal lymphadenopathy. EBUS-TBNA was performed in all cases using a linear array ultrasonic bronchscope (Olympus XBF-UC 160F) under intravenous anesthesia with on-site cytopathologic support for assessment of specimen adequacy. The EBUS-TBNA result was categorized as malignant, benign disease, normal/benign hyperplasia or inadequate. These results were compared to a reference standard of definitive pathological tissue diagnosis or a composite of ≥6 month's clinical follow-up with radiographic imaging.
RESULTS: 153 patients underwent 154 EBUS-TBNA procedures for mediastinal adenopathy. Adequate lymphoid tissue was obtained in 147/154 (95.5%) procedures. The 144 patients in whom a reference standard was available (n=107 definitive pathological tissue diagnosis) are included in the following analysis. EBUS -TBNA was positive in 59/70 (84.3%) patients ultimately diagnosed with malignant mediastinal lymphadenopathy. EBUS TBNA was definitive in 18/24 (75%) patients with benign disease. Of the remaining 50 patients that were found to have normal lymphoid tissue or benign hyperplasia, EBUS-TBNA obtained adequate sample in 46 (92%).
CONCLUSION: In a heterogeneous population of lung and nonlung cancer patients in an academic cancer institute, EBUS-TBNA is a minimally invasive accurate diagnostic technique with a high yield in patients with mediastinal lymphadenopathy and may obviate the need for invasive procedures such as mediastinoscopy.
CLINICAL IMPLICATIONS: Predictors for positive EBUS-TBNA yield including cancer history and treatment, lymph node pathology, size, site and PET-SUV are currently being analyzed.
DISCLOSURE: Marcus Kennedy, No Financial Disclosure Information; No Product/Research Disclosure Information