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Lung Cancer |

Minimally Invasive Endobronchial Ultrasound Guided Transbronchial Needle Aspiration With Positron Emission Tomography-Computed Tomography Is Sufficient for Mediastinal Nodal Staging in Lung Cancer FREE TO VIEW

Whittney Warren, DO; Jared Hagaman, MD
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Wright State University Internal Medicine, Beavercreek, OH


Chest. 2015;148(4_MeetingAbstracts):564A. doi:10.1378/chest.2251575
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Abstract

SESSION TITLE: Lung Cancer Screening & Diagnosis Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and positron emission tomography-computed tomography (PET-CT) are valuable tools for lung cancer staging. Data from tertiary referral centers suggest these modalities are superior to mediastinoscopy in mediastinal staging. These findings have not been validated in a community center with operators of varying experience and skill level.

METHODS: At an 800-bed, urban community hospital, we retrospectively reviewed all cases in which both EBUS-TBNA and PET-CT were performed for mediastinal staging. EBUS-TBNA was performed by one of seven private practice pulmonologists. We reviewed cases to find those that went on to have surgical lymph node dissection by mediastinoscopy following an EBUS-TBNA that was negative for mediastinal involvement.

RESULTS: Three hundred and thirty three patients had EBUS-TBNA and PET-CT, of which 52 underwent mediastinoscopy following a negative EBUS-TBNA. Four of these patients had mediastinoscopy positive for malignancy after a negative EBUS-TBNA. All false negative cases involved station 4 and 7 lymph nodes. In none of the cases did EBUS-TBNA reveal lymphoid tissue confirming the location of the sample. PET-CT showed mediastinal lymph nodes with increased avidity in two of the four false negative cases. When comparing all EBUS-TBNA cases to surgical lymph node dissection as a gold standard for detecting mediastinal metastasis, EBUS-TBNA plus PET-CT had a sensitivity, specificity and NPV of 97.2%, 100% and 94.1% respectively.

CONCLUSIONS: EBUS-TBNA is highly accurate in detecting mediastinal metastasis of lung cancer. Confirmation of sample location with detection of lymphoid tissue on samples is critical to the reliability of negative findings. PET-CT without uptake in lymph nodes reduces likelihood of malignancy but cannot be used to rule out mediastinal involvement.

CLINICAL IMPLICATIONS: Negative EBUS-TBNA with confirmation of lymphoid tissue on samples can preclude the need for mediastinoscopy in lung cancer staging, even when performed in community centers by operators with varying experience and skill levels.

DISCLOSURE: The following authors have nothing to disclose: Whittney Warren, Jared Hagaman

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