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Abstract: Slide Presentations |

MEDIASTINOSCOPY IN PATIENTS WITH LUNG CANCER AND NEGATIVE ENDOBRONCHIAL ULTRASOUND GUIDED NEEDLE ASPIRATION FREE TO VIEW

Sebastian A. Defranchi, MD*; Eric S. Edell, MD; Craig E. Daniels, MD; David E. Midthun, MD; Udaya B. Prakash, MD; Otis B. Rickman, DO; Karen L. Swanson, DO; Mark S. Allen, MD; Stephen D. Cassivi, MD; Francis C. Nichols, MD; K. R. Shen, MD; Dennis A. Wigle, MD
Author and Funding Information

Mayo Clinic, Rochester, MN


Chest


Chest. 2008;134(4_MeetingAbstracts):s36003. doi:10.1378/chest.134.4_MeetingAbstracts.s36003
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Abstract

PURPOSE:Endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) has been proposed as a safe, less-invasive alternative to surgical mediastinoscopy for mediastinal staging. We evaluated the negative predictive value (NPV) of EBUS-TBNA compared to mediastinoscopy for ruling out metastatic N2 disease in patients with lung cancer.

METHODS:Retrospective review of cases with a suspected or confirmed diagnosis of lung cancer undergoing mediastinoscopy following a negative EBUS-TBNA at our institution between June 2006 and February 2008.

RESULTS:494 patients underwent EBUS-TBNA. 35 patients with a suspected or confirmed diagnosis of lung cancer had a negative EBUS-TBNA and underwent subsequent mediastinoscopy. Mediastinoscopy was performed for findings suspicious of N2 disease based on non-invasive imaging (CT or CT-PET). Mediastinoscopy found metastatic nodes in 12 of 35 patients (34%). The patient-specific NPV of EBUS-TBNA in this scenario was 66%. On average, mediastinoscopy sampled more lymph node stations per patient than EBUS-TBNA (1.5 vs. 2.2). EBUS-TBNA and mediastinoscopy sampled the same lymph node station in 44 occasions. Average lymph node size for these 44 stations was 12.7 mm (range 5 to 30 mm). PET evaluated 42/44 lymph node stations (95%) and was positive in 24 (57%). Mediastinoscopy found lymph node metastasis in nine cases, for a nodal-specific NPV of EBUS-TBNA of 80%. Station 4R was sampled 21 times (48%), followed by station 7 in 17 occasions (39%). The NPV at station 4R was 71%, while in station 7 it was 88%.

CONCLUSION:EBUS-TBNA can effectively sample mediastinal lymph node stations in patients with lung cancer. However, in this early experience, 34% of patients with high clinical suspicion of nodal disease had N2 mediastinal nodal metastases confirmed by mediastinoscopy despite negative EBUS-TBNA.

CLINICAL IMPLICATIONS:When EBUS-TBNA is negative in patients with lung cancer and the clinical suspicion of mediastinal disease is high, mediastinoscopy should be performed.

DISCLOSURE:Sebastian Defranchi, No Financial Disclosure Information; No Product/Research Disclosure Information

Tuesday, October 28, 2008

10:30 AM - 12:00 PM


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