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Correspondence |

Endobronchial Ultrasound-Guided Biopsy of Mediastinal and Hilar Lymph NodesEndobronchial Ultrasound and False Positives: A Word on False Positives FREE TO VIEW

Raymond A Dieter Jr, MD, FCCP
Author and Funding Information

From the Center for Surgery and DuPage Medical Group.

Correspondence to: Raymond A. Dieter Jr, MD, FCCP, Center for Surgery, 475 E Diehl Rd, Naperville, IL 60563; e-mail: lnickerson@centerforsurgery.com


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(5):1355. doi:10.1378/chest.12-1494
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To the Editor:

The article by Wang Memoli et al1 in an issue of CHEST (December 2011) on the use of endobronchial ultrasound (EBUS) to predict lymph node metastasis due to lung cancer was well presented and helpful for the interpretation and diagnosis of metastatic carcinoma. The authors discussed the widely accepted criteria suggestive of metastatic malignancy, including a positive PET scan and a short-axis lymph node diameter >1 cm on CT scan. Although these criteria are strongly suggestive, they do not prove that the patient in fact has metastatic nodal disease.

Further diagnostic or interventional studies may be necessary to confirm or disprove the presence of metastatic lung cancer.2 Such studies may include mediastinoscopy or needle biopsy either percutaneously or through EBUS. Each technique has limitations regarding its diagnostic accuracy and risk for complications. False-negative as well as false-positive results may be obtained. Each situation must be interpreted with this in mind for the benefit of the patient and the best therapeutic program to recommend.

We recently evaluated a patient with adenocarcinoma of the right-side lung. The PET scan was interpreted as positive for bilateral hilar and mediastinal node metastasis. EBUS biopsy specimens from both the right-side and the left-side paratracheal and hilar areas demonstrated malignant cells in the right-side biopsy specimen and none in the left. The patient was informed of this finding and told that nonoperative therapy was recommended. She came to us for a consultation. We believed, on review, that the nodes were negative and recommended surgery. During right-side thoracotomy, 18 hilar and mediastinal lymph nodes were removed along with the involved lobe. All lymph nodes were negative for tumor presence. On review of the original EBUS biopsy specimen, lymphoid cells were present along with malignant cells, thus leading to the diagnosis of nodal metastasis. In retrospect, it appears that the false-positive study suggesting metastatic disease resulted from the EBUS needle passing through the node and into the lung or parenchymal tumor, thus the misinterpretation of positive nodal metastasis and the different therapeutic program being recommended.

Wang Memoli JS. El-Bayoumi E, Pastis NJ, et al. Using endobronchial ultrasound features to predict lymph node metastasis in patients with lung cancer. Chest. 2011;140(6):1550-1556. [CrossRef] [PubMed]
 
Ost DE, Ernst A, Lei X, et al; AQuIRE Bronchoscopy Registry. Diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration: results of the AQuIRE Bronchoscopy Registry. Chest. 2011;140(6):1557-1566. [CrossRef] [PubMed]
 

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References

Wang Memoli JS. El-Bayoumi E, Pastis NJ, et al. Using endobronchial ultrasound features to predict lymph node metastasis in patients with lung cancer. Chest. 2011;140(6):1550-1556. [CrossRef] [PubMed]
 
Ost DE, Ernst A, Lei X, et al; AQuIRE Bronchoscopy Registry. Diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration: results of the AQuIRE Bronchoscopy Registry. Chest. 2011;140(6):1557-1566. [CrossRef] [PubMed]
 
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