Positron emission tomography with 18-fluorodeoxyglucose (FDG-PET) is more accurate than CT scan for staging of mediastinal and hilar lymph nodes. Nevertheless, histological sampling of positive lymph nodes is required to exclude false positives. The diagnostic/staging yield of endobronchial ultrasound (EBUS) guided transbronchial needle aspiration (TBNA) was assessed in this particular clinical setting. The number of avoided surgical procedures was evaluated.
All consecutive patients referred for staging and/or diagnosis of mediastinal FDG-PET positive lesions were included. Data were prospectively collected. TBNA sampling of lymph nodes was performed after EBUS. In case of negative results, further surgical sampling or follow-up allowed to reach the diagnosis.
From January 2003 to June 2004, 33 patients were included. The average number of TBNA samples per patient was 4.2 ± 1.5. Sensitivity of EBUS-TBNA for sampling of positive FDG-PET lymph nodes was 93%, negative predictive value 71% and accuracy was 94%.
The present study shows that TBNA combined with EBUS is a very safe and effective method to assess patients with FDG-PET positive lymph nodes. In 25 (76%) of the 33 patients, surgical staging procedures were suppressed.
EBUS-TBNA should be considered as a primary method of evaluation of FDG-PET positive lymph nodes and may replace the majority of surgical mediastinal staging/diagnostic procedures.
Philippe Pierard, None.