PURPOSE: Positron emission tomography with 18-fluorodeoxyglucose (FDG-PET) is more accurate than CT scan for staging of mediastinal and hilar lymph nodes in lung cancer, but in case of positive findings, tissue sampling of lymph nodes is required. The performance of a new technique, real-time guided needle aspiration using endobronchial ultrasound (EBUS-NA), was assessed in this particular clinical setting.
METHODS: All consecutive patients with suspected/proven lung cancer referred for staging and/or diagnosis of mediastinal FDG-PET positive lesions were included. Bronchoscopy was performed using a linear-array ultrasound bronchoscope (BF-UC160F-OL8; Olympus Ltd, Tokyo, Japan), followed by real-time guided NA. Data were prospectively collected. If no diagnosis was reached, further surgical sampling was required.
RESULTS: From December 2004 to February 2006, 51 patients were included. The procedure could be performed under local anaesthesia, on a real outpatient basis, without any complication. The average number of NA samples per patient was 4.9 ± 1.2. In 26 patients, NA showed lymph node metastasis and surgical procedures were eluded in 53% of the patients. The sensitivity, accuracy and negative predictive value of EBUS-NA in the staging of mediastinal hot spots were 90%, 93% and 84%.
CONCLUSION: The present study shows that the new real-time guided EBUS-NA is a very safe and effective method to stage patients with suspected/proven lung cancer and FDG-PET positive mediastinal lymph nodes.
CLINICAL IMPLICATIONS: EBUS-NA should be preferred over mediastinoscopy as the first step in the staging of suspected/confirmed lung cancers with PET positive mediastinal lymph nodes.
DISCLOSURE: Philippe Pierard, None.