0
Pulmonary Procedures |

Are Biopsy Negative or Nondiagnostic Lymph Nodes on EBUS Truly Negative?

Suzanne Simkovich, MD; Nichole Tanner, MD; Jack Yang, MD; Paul Nietert, PhD; Clayton Shamblin, MD; Stephanie Shaftman, MMSc; Hiren Mehta, MD; Gerard Silvestri, MD
Author and Funding Information

Medical University of South Carolina, Charleston, SC


Chest. 2013;144(4_MeetingAbstracts):815A. doi:10.1378/chest.1704357
Text Size: A A A
Published online

Abstract

SESSION TITLE: EBUS and Lung Cancer

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

No Product/Research Disclosure Information


Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543