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Pulmonary Procedures |

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Complete Nodal Staging of Lung Cancer in Patients With N0 Disease by CT and Integrated PET/CT

Philip Ong; George Eapen; Donald Lazarus; Venkata Bandi; Sarah Perusich; Luis Tamara; Lorraine Cornwell; Angela Zhu; Roberto Casal
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Baylor College of Medicine, Houston, TX


Chest. 2014;146(4_MeetingAbstracts):751A. doi:10.1378/chest.1993517
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Abstract

SESSION TITLE: EBUS Insights

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 26, 2014 at 01:30 PM - 03:00 PM

PURPOSE: The role of EBUS-TBNA for staging of lung cancer in patients with radiographically N0 disease is still unclear. The available data is scant, from a single institution, and it does not involve the use of “integrated” PET-CT.

METHODS: Retrospective review of EBUS-TBNA performed for lung cancer staging at Michael Debakey VA Medical Center from 08/2009 to 03/2014. Patients with radiographic N0 disease (lymph nodes ≤1cm in the short axis and SUV max ≤2.5 by PET/CT) were included. Primary outcome was sensitivity and negative predictive value of EBUS-TBNA. The gold standard was surgical pathology or 6 months radiological follow-up.

RESULTS: Ninety seven patients were identified. Primary tumors were: adenocarcinoma =46, squamous cell=39, others=12. These tumors were centrally located in 22% and median tumor size was 3 cm (range, 1-10 cm). A total of 406 LN were sampled by EBUS-TBNA (4.2 ± 1.4 per patient), mean diameter was 8mm. Of 97 patients, 45 (46%) underwent surgery, 30 (31%) stereotactic radiation, and 22 (23%) chemo-radiation. Twenty two patients (22.7%) were ultimately upstaged from radiographic staging. Ten (10.3%) identified by EBUS (N1=6, N2=3, N3=1), an additional 11 patients (11.3%) identified at surgical resection (N1 intralobar= 6, N1 extralobar= 1, and N2=4 [two stations 7, two stations 5- 6]), and 1 upstaged during follow-up. False negative rate of EBUS-TBNA was 4.1% when excluding patients with occult disease “outside” the reach of EBUS. EBUS-TBNA sensitivity to detect lymph node metastases was 45.5% (95%CI 25.1 - 67.3) and NPV was 86.2% (95%CI 76.8 to 92.4).

CONCLUSIONS: This is the first report of EBUS-TBNA in patients with N0 disease by “integrated” PET-CT. Both sensitivity and NPV of EBUS-TBNA were lower than previously reported in patients with normal mediastinum by CT or PET.

CLINICAL IMPLICATIONS: EBUS-TBNA may still play a role in the nodal staging of patients with lung cancer and clinical N0 disease, particularly in patients who will not undergo nodal dissection. Prospective studies are needed to evaluate the role of EBUS in these patients.

DISCLOSURE: The following authors have nothing to disclose: Philip Ong, George Eapen, Donald Lazarus, Venkata Bandi, Sarah Perusich, Luis Tamara, Lorraine Cornwell, Angela Zhu, Roberto Casal

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