Mediastinal lymph nodes must often be biopsied to accurately stage lung cancer. Endobronchial ultrasound-guided, transbronchial needle aspiration (EBUS-TBNA) allows real-time guidance in sampling paratracheal, subcarinal, and hilar lymph nodes, and esophageal, ultrasound-guided-guided fine-needle aspiration (EUS-FNA) can sample mediastinal lymph nodes located adjacent to the esophagus. Mediastinal nodes can be sampled and staged more completely by combining these procedures, but to date, use of two different endoscopes has been required. We examined whether both procedures could be performed with a single EBUS bronchoscope.
Consecutive patients with presumptive evidence of non-small cell lung cancer (NSCLC) underwent mediastinal staging by EBUS-TBNA and EUS-FNA through a single linear ultrasound-bronchoscope. Surgical confirmation and clinical follow-up was the reference standard when indicated.
Among 150 evaluated patients, 139 (91%; 83 male; 56 female; mean age 57.6 y) were diagnosed with NSCLC. In these 139 patients, 619 nodes were endoscopically biopsied: 229 by EUS-FNA and 390 by EBUS-TBNA. Sensitivity was 92% for EUS-FNA and 89% for EBUS-TBNA. The combined approach had a sensitivity of 96% and negative predictive value (95%), values higher than either approach alone. No complications occurred.
The two procedures can easily be performed with a dedicated linear EBUS bronchoscope in one setting. They are complementary and provide better diagnostic accuracy than either one alone.
The combination may be able to replace more invasive methods as a primary staging method for lung cancer patients.
Ralf Eberhardt, No Financial Disclosure Information; No Product/Research Disclosure Information