PURPOSE: The aim of the study was to assess to what extent EBUS-TBNA alone and in combination with EUS FNA could prevent surgical interventions.
METHODS: One hundred consecutive patients scheduled for mediastinoscopy (75%) or thoracotomy (25%) because of lung cancer or suspected lung cancer. In the same anaesthesia as mediastinoscopy 100 patients underwent EBUS TBNA and 90 EUS FNASurgical-pathologic verification occurred when mediastinoscopy and EUS FNA was without malignancy .
RESULTS: In 3 cases we found a false negative mediastinoscopy and EBUS TBNA (one station 6, one metastases in the adrenals and one in station 8). In 11 cases the mediastinoscopy were false negative and in 4 patients EBUS TBNA were false negative. 25 patients would have been referred directly to thoracotomy. 9 thoracotomies could therefore have been avoided with the use of EBUS-TBNA because of false negative CT N0–1Of the 75 patients scheduled for mediastinoscopy 7 patients would have undergone an unnecessary primary thoracotomy with EBUS TBNA alone. With mediastinoscopy alone the numbers would have been 14 unnecessary thoracotomies.Because of positive EBUS TBNA 51 mediastinoscopies could be avoided. The actual guidelines recommend mediastinoscopies when EBUS TBNA is without malignancies. Following these guidelines 49 medistinoscopies should be performed with the results of finding 4 false negative EBUS TBNA (8%). In 90 of these patients EBUS TBNA and medistinoscopy were combined with EUS FNA. Combining EBUS TBNA with EUS FNA results in only 2 cases of false negative endoscopic ultrasound examinations (2%) EUS FNA combined with EBUS TBNA diagnosed malignancies with NPV = 95, PPV = 100 Accurancy = 98.
CONCLUSION: EBUS TBNA as a primary procedure prevent half of the scheduled mediastinoscopies and EBUS TBNA alone results in less unnecessary thoracotomies than mediastinoscopy alone. The combination of EBUS TBNA and EUS FNA improves this result with only 2 false negative results.
CLINICAL IMPLICATIONS: Mediastinoscopy according to the ACCP/ESTS guidelines after a benign EBUS TBNA should be reconsidered.
DISCLOSURE: Mark Krasnik, No Financial Disclosure Information; No Product/Research Disclosure Information