PURPOSE:Endobronchial ultrasound (EBUS) has recently been developed as a new tool in the diagnosis and staging of lung cancer and other malignancies. Initial results have been reported from centers with extensive experience with EBUS. This study was performed to describe the results from a single center recently beginning EBUS procedures.
METHODS:Consecutive patients undergoing endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for the diagnosis and staging of known or suspected malignancy as well as undiagnosed mediastinal/hilar adenopathy from February 2007 to April 2008 were included in this study. A positive biopsy result was considered a true positive. True negative and false negative biopsy results were based on surgical biopsies, additional imaging, and radiographic follow-up. Inadequate specimens were considered false negatives.
RESULTS:55 patients underwent EBUS-TBNA. Most patients had known or suspected lung cancer (N=34). 14 patients had suspected metastatic disease from other solid tumors or lymphoma. 7 patients had undiagnosed adenopathy from possible nonmalignant etiologies. Biopsies were obtained from stations 7 (N=24), 4R (N=21), 4 L (N=3), 10L (N=4), 10R (N=5), and 2R (N=1). Of the 60 sampled lymph nodes, 7% were less than 1 cm, 55% were 1.0–1.9 cm, 23% were 2.0–2.9 cm, and 15% were 3 cm or larger. Three parenchymal masses that were adjacent to a bronchus were also biopsied via EBUS-TBNA. Sensitivity was 87%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 71%. Of the 6 false negative results, 5 were due to inadequate specimens.
CONCLUSION:EBUS-TBNA had a high sensitivity for establishing a diagnosis of malignancy and staging patients with lung cancer. Results from this study are consistent with that reported from centers with extensive experience with EBUS. The yield from EBUS-guided TBNA is higher than the historical yield of blind TBNA performed at our institution.
CLINICAL IMPLICATIONS:EBUS-TBNA is highly effective in mediastinal and hilar node sampling to evaluate the etiolgy for intrathoracic adenopathy and provide staging for patients with lung cancer.
DISCLOSURE:Michael Jantz, No Financial Disclosure Information; No Product/Research Disclosure Information