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

Sebastian A. Defranchi, Eric S. 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

Research output: Contribution to journalArticlepeer-review

49 Scopus citations

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 1 2010

ASJC Scopus subject areas

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

Fingerprint Dive into the research topics of 'Mediastinoscopy in patients with lung cancer and negative endobronchial ultrasound guided needle aspiration'. Together they form a unique fingerprint.

Cite this