Pulmonary Procedures |

Are Biopsy Negative or Nondiagnostic Lymph Nodes on EBUS Truly Negative? FREE TO VIEW

Suzanne Simkovich, MD; Nichole Tanner, MD; Jack Yang, MD; Paul Nietert, PhD; Clayton Shamblin, MD; Stephanie Shaftman, MMSc; Hiren Mehta, MD; Gerard Silvestri, MD
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Medical University of South Carolina, Charleston, SC

Chest. 2013;144(4_MeetingAbstracts):815A. doi:10.1378/chest.1704357
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SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 27, 2013 at 03:00 PM - 04:00 PM

PURPOSE: Endobronchial Ultrasound (EBUS) is a highly sensitive diagnostic tool for staging lung cancer and evaluating thoracic lymphadenopathy. Little is known about the negative predictive value of EBUS in nodes with a negative or unsatisfactory cytopathologic diagnosis. This study was conducted to attempt to resolve the uncertainty surrounding non-diagnostic EBUS.

METHODS: A database of 1418 lymph nodes sampled from 737 patients who underwent EBUS at the Medical University of South Carolina from January 2008 to June 2011 was created. All lymph nodes with a cytopatologic diagnosis of negative, atypical cells, suspicious, and unsatisfactory were evaluated. Patients with malignancy diagnosed in another node sampled during the same procedure (n= 409), those who received chemotherapy/radiation (n=4), those who died (n=25) and those lost to follow-up (n=164) were excluded from the analysis. A chart review was conducted on the remaining 244 patients. Each node was followed for up to one year with imaging (CT chest, PET scan) and/or invasive procedures (biopsy, surgery). True negative was defined as nodes that did not enlarge on repeat imaging or were negative with repeat biopsy or surgery.

RESULTS: 508 lymph nodes from 244 patients were followed for up to one year. The average patient age was 63.4 years (SD 12.7) and 60.3% (n=147) were male. The pathologic diagnoses of the lymph nodes included negative (n=411, 81%), unsatisfactory (n=85, 17%), atypical cells (n=8, 1.6%), and suspicious (n=4, 0.8%). Follow up with imaging was conducted in 108 (44.3%) patients. Nine (3.4%) patients had biopsies performed and 77 (31.6%) patients underwent a subsequent surgery with lymph node sampling. 468 nodes met the definition of true negative resulting in a NPV of 92.1% with a 95%CI of 89.8% to 94.5%.

CONCLUSIONS: The vast majority of lymph nodes sampled during EBUS with a pathologic diagnosis of negative, unsatisfactory for evaluation, atypical cells, and suspicious are likely to be truly negative.

CLINICAL IMPLICATIONS: These findings suggest that a more conservative approach to following these lymph nodes may be appropriate.

DISCLOSURE: The following authors have nothing to disclose: Suzanne Simkovich, Nichole Tanner, Jack Yang, Paul Nietert, Clayton Shamblin, Stephanie Shaftman, Hiren Mehta, Gerard Silvestri

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