The guidelines for staging of lung cancer advise to perform medistinoscopy if EBUS TBNA is negative.The aim of this study is to avaluate the guidelines if EBUS TBNA is performed with biopsy of a least 4R, 4L and 7.
EBUS TBNA was performed on all patients referred to staging of the mediastinum either because of lung cancer or changes suspicious of lung cancer. If EBUS TBNA were without metastases in at least station 4R, 4L and 7 the patients were referred to surgery (VATS/thoracotomy). Station 5 can not be reach by Ebus TBNA.
69 consecutive patients (46 males, 23 females, mean age 66 years (range 40–85)) were included. The sizes of the lymph nodes were mean 17 mm (range 4–7 mm) for station 7.7 mm (range 2–30 mm) for station 4R and mean 6 mm (range 2–21mm) for station 4 L. The final diagnose were cancer in 62 patient and benign in 7 patients (Harmathoma, BOOP, infarct).In 3 patients operation showed metastases to 3 lymph nodes, one in station 4 R and 2 in station 5. The NPV was 0.96.34 PET-CT were performed. 7 PET positive. 2 of these patients were benign and one was false positive. 28 were negative. 2 were benign. 6 were falce negative- 5 with N1 and 1 with N2 disease.
EBUS TBNA is a safe procedure and can be performed in local anaesthesia. Following the guidelines a patient with negative EBUS TBNA should be reffered to mediastinoscopy. We challenge these guidelines with our results.
A proper performed negative EBUS TBNA may not need a mediastinoscopy.
Mark Krasnik, No Financial Disclosure Information; No Product/Research Disclosure Information