Mediastinoscopy in patients with lung cancer and negative endobronchial ultrasound guided needle aspiration

Sebastian A. Defranchi, Eric Edell, Craig E. Daniels, Udaya B S Prakash, Karen L. Swanson, James P Utz, Mark S. Allen, Stephen D. Cassivi, Claude Deschamps, Francis C. Nichols, K. Robert Shen, Dennis A Wigle

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Abstract

Background: Endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) has been proposed as a safe, less-invasive alternative to mediastinoscopy to stage mediastinal lymph nodes in patients with lung cancer. We evaluated the negative predictive value of EBUS-TBNA in lung cancer patients suspected of having N2 nodal metastases. Methods: This study is a single-institution retrospective review of cases with suspected or confirmed lung cancer undergoing mediastinoscopy after a negative EBUS-TBNA between June 2006 and February 2008. Results: A total of 494 patients underwent EBUS-TBNA during the study period. Twenty-nine patients with suspected or confirmed lung cancer had a negative EBUS-TBNA and underwent subsequent mediastinoscopy. Mediastinoscopy was performed for findings suspicious of N2 disease based on noninvasive imaging. Mediastinoscopy found metastatic nodes in eight of 29 patients (28%) for a patient-specific negative predictive value of EBUS-TBNA of 72% (95% CI, 56% to 89%). Mediastinal lymph node dissection found four further patients with positive N2 nodes (19%). The EBUS-TBNA and mediastinoscopy sampled the same lymph node station on 36 occasions in the 29 patients. The average lymph node size was 10 mm. Mediastinoscopy was positive in 5 of 36 stations, for a nodal-specific negative predictive value of EBUS-TBNA of 86% (95% CI, 75% to 97%). Conclusions: Endobronchial ultrasound with transbronchial needle aspiration can effectively sample mediastinal lymph node stations in patients with lung cancer. However, in this early experience, 28% of patients with high clinical suspicion of nodal disease had N2 mediastinal nodal metastases confirmed by mediastinoscopy despite negative EBUS-TBNA.

Original languageEnglish (US)
Pages (from-to)1753-1757
Number of pages5
JournalAnnals of Thoracic Surgery
Volume90
Issue number6
DOIs
StatePublished - Dec 2010

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Mediastinoscopy
Needles
Lung Neoplasms
Lymph Nodes
Neoplasm Metastasis
Lymph Node Excision

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Mediastinoscopy in patients with lung cancer and negative endobronchial ultrasound guided needle aspiration. / Defranchi, Sebastian A.; Edell, Eric; Daniels, Craig E.; Prakash, Udaya B S; Swanson, Karen L.; Utz, James P; Allen, Mark S.; Cassivi, Stephen D.; Deschamps, Claude; Nichols, Francis C.; Shen, K. Robert; Wigle, Dennis A.

In: Annals of Thoracic Surgery, Vol. 90, No. 6, 12.2010, p. 1753-1757.

Research output: Contribution to journalArticle

Defranchi, SA, Edell, E, Daniels, CE, Prakash, UBS, Swanson, KL, Utz, JP, Allen, MS, Cassivi, SD, Deschamps, C, Nichols, FC, Shen, KR & Wigle, DA 2010, 'Mediastinoscopy in patients with lung cancer and negative endobronchial ultrasound guided needle aspiration', Annals of Thoracic Surgery, vol. 90, no. 6, pp. 1753-1757. https://doi.org/10.1016/j.athoracsur.2010.06.052
Defranchi, Sebastian A. ; Edell, Eric ; Daniels, Craig E. ; Prakash, Udaya B S ; Swanson, Karen L. ; Utz, James P ; Allen, Mark S. ; Cassivi, Stephen D. ; Deschamps, Claude ; Nichols, Francis C. ; Shen, K. Robert ; Wigle, Dennis A. / Mediastinoscopy in patients with lung cancer and negative endobronchial ultrasound guided needle aspiration. In: Annals of Thoracic Surgery. 2010 ; Vol. 90, No. 6. pp. 1753-1757.
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title = "Mediastinoscopy in patients with lung cancer and negative endobronchial ultrasound guided needle aspiration",
abstract = "Background: Endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) has been proposed as a safe, less-invasive alternative to mediastinoscopy to stage mediastinal lymph nodes in patients with lung cancer. We evaluated the negative predictive value of EBUS-TBNA in lung cancer patients suspected of having N2 nodal metastases. Methods: This study is a single-institution retrospective review of cases with suspected or confirmed lung cancer undergoing mediastinoscopy after a negative EBUS-TBNA between June 2006 and February 2008. Results: A total of 494 patients underwent EBUS-TBNA during the study period. Twenty-nine patients with suspected or confirmed lung cancer had a negative EBUS-TBNA and underwent subsequent mediastinoscopy. Mediastinoscopy was performed for findings suspicious of N2 disease based on noninvasive imaging. Mediastinoscopy found metastatic nodes in eight of 29 patients (28{\%}) for a patient-specific negative predictive value of EBUS-TBNA of 72{\%} (95{\%} CI, 56{\%} to 89{\%}). Mediastinal lymph node dissection found four further patients with positive N2 nodes (19{\%}). The EBUS-TBNA and mediastinoscopy sampled the same lymph node station on 36 occasions in the 29 patients. The average lymph node size was 10 mm. Mediastinoscopy was positive in 5 of 36 stations, for a nodal-specific negative predictive value of EBUS-TBNA of 86{\%} (95{\%} CI, 75{\%} to 97{\%}). Conclusions: Endobronchial ultrasound with transbronchial needle aspiration can effectively sample mediastinal lymph node stations in patients with lung cancer. However, in this early experience, 28{\%} of patients with high clinical suspicion of nodal disease had N2 mediastinal nodal metastases confirmed by mediastinoscopy despite negative EBUS-TBNA.",
author = "Defranchi, {Sebastian A.} and Eric Edell and Daniels, {Craig E.} and Prakash, {Udaya B S} and Swanson, {Karen L.} and Utz, {James P} and Allen, {Mark S.} and Cassivi, {Stephen D.} and Claude Deschamps and Nichols, {Francis C.} and Shen, {K. Robert} and Wigle, {Dennis A}",
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T1 - Mediastinoscopy in patients with lung cancer and negative endobronchial ultrasound guided needle aspiration

AU - Defranchi, Sebastian A.

AU - Edell, Eric

AU - Daniels, Craig E.

AU - Prakash, Udaya B S

AU - Swanson, Karen L.

AU - Utz, James P

AU - Allen, Mark S.

AU - Cassivi, Stephen D.

AU - Deschamps, Claude

AU - Nichols, Francis C.

AU - Shen, K. Robert

AU - Wigle, Dennis A

PY - 2010/12

Y1 - 2010/12

N2 - Background: Endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) has been proposed as a safe, less-invasive alternative to mediastinoscopy to stage mediastinal lymph nodes in patients with lung cancer. We evaluated the negative predictive value of EBUS-TBNA in lung cancer patients suspected of having N2 nodal metastases. Methods: This study is a single-institution retrospective review of cases with suspected or confirmed lung cancer undergoing mediastinoscopy after a negative EBUS-TBNA between June 2006 and February 2008. Results: A total of 494 patients underwent EBUS-TBNA during the study period. Twenty-nine patients with suspected or confirmed lung cancer had a negative EBUS-TBNA and underwent subsequent mediastinoscopy. Mediastinoscopy was performed for findings suspicious of N2 disease based on noninvasive imaging. Mediastinoscopy found metastatic nodes in eight of 29 patients (28%) for a patient-specific negative predictive value of EBUS-TBNA of 72% (95% CI, 56% to 89%). Mediastinal lymph node dissection found four further patients with positive N2 nodes (19%). The EBUS-TBNA and mediastinoscopy sampled the same lymph node station on 36 occasions in the 29 patients. The average lymph node size was 10 mm. Mediastinoscopy was positive in 5 of 36 stations, for a nodal-specific negative predictive value of EBUS-TBNA of 86% (95% CI, 75% to 97%). Conclusions: Endobronchial ultrasound with transbronchial needle aspiration can effectively sample mediastinal lymph node stations in patients with lung cancer. However, in this early experience, 28% of patients with high clinical suspicion of nodal disease had N2 mediastinal nodal metastases confirmed by mediastinoscopy despite negative EBUS-TBNA.

AB - Background: Endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) has been proposed as a safe, less-invasive alternative to mediastinoscopy to stage mediastinal lymph nodes in patients with lung cancer. We evaluated the negative predictive value of EBUS-TBNA in lung cancer patients suspected of having N2 nodal metastases. Methods: This study is a single-institution retrospective review of cases with suspected or confirmed lung cancer undergoing mediastinoscopy after a negative EBUS-TBNA between June 2006 and February 2008. Results: A total of 494 patients underwent EBUS-TBNA during the study period. Twenty-nine patients with suspected or confirmed lung cancer had a negative EBUS-TBNA and underwent subsequent mediastinoscopy. Mediastinoscopy was performed for findings suspicious of N2 disease based on noninvasive imaging. Mediastinoscopy found metastatic nodes in eight of 29 patients (28%) for a patient-specific negative predictive value of EBUS-TBNA of 72% (95% CI, 56% to 89%). Mediastinal lymph node dissection found four further patients with positive N2 nodes (19%). The EBUS-TBNA and mediastinoscopy sampled the same lymph node station on 36 occasions in the 29 patients. The average lymph node size was 10 mm. Mediastinoscopy was positive in 5 of 36 stations, for a nodal-specific negative predictive value of EBUS-TBNA of 86% (95% CI, 75% to 97%). Conclusions: Endobronchial ultrasound with transbronchial needle aspiration can effectively sample mediastinal lymph node stations in patients with lung cancer. However, in this early experience, 28% of patients with high clinical suspicion of nodal disease had N2 mediastinal nodal metastases confirmed by mediastinoscopy despite negative EBUS-TBNA.

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