PURPOSE:A tissue diagnosis of mediastinal nodes is frequently needed for accurate lung cancer staging. Many methods for staging exist. Endobronchial ultrasound-guided TBNA (EBUS-TBNA) allows real-time controlled tissue sampling of paratracheal, subcarinal and hilar lymph nodes. Mediastinal lymph nodes located adjacent to the oesophagus can be assessed by endoesophageal ultrasound-guided fine needle aspiration (EUS-FNA). Until now in all published series an EBUS and an EUS scope was used. The aim of trial was to determinate the value of endoultrasound staging in using the EBUS scope for both approaches.
METHODS:Patients with enlarged medistinal or hilar nodes, highly suspicious for NSCLC underwent an EBUS-TBNA and an EUS FNA, both procedures with the EBUS-TBNA scope. Out come measurement was sensitivity for detecting lymph node metastases, using pathologic confirmation and clinical follow-up. Lymph node stations were classified according to the ATS scheme.
RESULTS:Among 150 patients who met the study criteria, 146 (97%) (89 male, 57 female, mean age 57.6 y.) had a NSCLC and were included in the analysis. A total of 219 lesions were sampled by EUS−FNA (n = 89) and EBUS−TBNA (n = 147). EBUS-FNA was more sensitive than EUS FNA (93 vs 90%). The combination of EUS-FNA and EBUS-TBNA had the highest estimated sensitivity 95% and negative predictive value (92%) compared with either method alone. No complications occurred.
CONCLUSION:EUS−FNA and EBUS−TBNA appear to be complementary methods. In experienced hands, enlarged mediastinal lymph nodes may be aspirated with either the endobronchial or endoesophageal approach.
CLINICAL IMPLICATIONS:EUS plus EBUS seems to be the most effective approach for lymph node staging in patients with suspected lung cancer.
DISCLOSURE:Felix Herth, None.