Hee Seok Lee1, Geon Kook Lee1, Hyun-Sung Lee1, Moon Soo Kim1, Jong Mog Lee1, Hyae Young Kim1, Byung-Ho Nam2, Jae Ill Zo1, Bin Hwangbo3. 1. Center for Lung Cancer, Research Institute for National Cancer Control and Evaluation, National Cancer Center, Gyeonggi, Korea. 2. Research Institute and Hospital; and Cancer Biostatistics Branch, Research Institute for National Cancer Control and Evaluation, National Cancer Center, Gyeonggi, Korea. 3. Center for Lung Cancer, Research Institute for National Cancer Control and Evaluation, National Cancer Center, Gyeonggi, Korea. Electronic address: hbb@ncc.re.kr.
Abstract
OBJECTIVE: The goal of this study was to determine the optimal number of aspirations per lymph node (LN) station during endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) for maximum diagnostic yield in mediastinal staging of non-small cell lung cancer (NSCLC) in the absence of rapid on-site cytopathologic examination. METHODS: EBUS-TBNA was performed in potentially operable NSCLC patients with mediastinal LNs accessible by EBUS-TBNA (5 to 20 mm). Every target LN station was punctured four times. RESULTS: We performed EBUS-TBNA in 163 mediastinal LN stations in 102 NSCLC patients. EBUS-TBNA confirmed malignancy in 41 LN stations in 30 patients. Two malignant LN stations were missed in two patients. The sensitivity, specificity, positive predictive value, negative predictive value (NPV), and accuracy of EBUS-TBNA in predicting mediastinal metastasis were 93.8%, 100%, 100%, 96.9%, and 97.9%, respectively. Sample adequacy was 90.1% for one aspiration, and it reached 100% for three aspirations. The sensitivity for differentiating malignant from benign LN stations was 69.8%, 83.7%, 95.3%, and 95.3% for one, two, three, and four aspirations, respectively. The NPV was 86.5%, 92.2%, 97.6%, and 97.6% for one, two, three, and four aspirations, respectively. Maximum diagnostic values were achieved in three aspirations. When at least one tissue core was obtained by the first or second aspiration, the sensitivity and NPV of the first two aspirations were 91.9% and 96.0%, respectively. CONCLUSIONS: Optimal results can be obtained in three aspirations per LN station in EBUS-TBNA for mediastinal staging of potentially operable NSCLC. When at least one tissue core specimen is obtained by the first or second aspiration, two aspirations per LN station can be acceptable.
OBJECTIVE: The goal of this study was to determine the optimal number of aspirations per lymph node (LN) station during endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) for maximum diagnostic yield in mediastinal staging of non-small cell lung cancer (NSCLC) in the absence of rapid on-site cytopathologic examination. METHODS: EBUS-TBNA was performed in potentially operable NSCLCpatients with mediastinal LNs accessible by EBUS-TBNA (5 to 20 mm). Every target LN station was punctured four times. RESULTS: We performed EBUS-TBNA in 163 mediastinal LN stations in 102 NSCLCpatients. EBUS-TBNA confirmed malignancy in 41 LN stations in 30 patients. Two malignant LN stations were missed in two patients. The sensitivity, specificity, positive predictive value, negative predictive value (NPV), and accuracy of EBUS-TBNA in predicting mediastinal metastasis were 93.8%, 100%, 100%, 96.9%, and 97.9%, respectively. Sample adequacy was 90.1% for one aspiration, and it reached 100% for three aspirations. The sensitivity for differentiating malignant from benign LN stations was 69.8%, 83.7%, 95.3%, and 95.3% for one, two, three, and four aspirations, respectively. The NPV was 86.5%, 92.2%, 97.6%, and 97.6% for one, two, three, and four aspirations, respectively. Maximum diagnostic values were achieved in three aspirations. When at least one tissue core was obtained by the first or second aspiration, the sensitivity and NPV of the first two aspirations were 91.9% and 96.0%, respectively. CONCLUSIONS: Optimal results can be obtained in three aspirations per LN station in EBUS-TBNA for mediastinal staging of potentially operable NSCLC. When at least one tissue core specimen is obtained by the first or second aspiration, two aspirations per LN station can be acceptable.
Authors: Jessica S Wang Memoli; Ezzat El-Bayoumi; Nicholas J Pastis; Nichole T Tanner; Mario Gomez; J Terrill Huggins; Georgiana Onicescu; Elizabeth Garrett-Mayer; Kent Armeson; Katherine K Taylor; Gerard A Silvestri Journal: Chest Date: 2011-06-02 Impact factor: 9.410
Authors: David E Ost; Armin Ernst; Xiudong Lei; David Feller-Kopman; George A Eapen; Kevin L Kovitz; Felix J F Herth; Michael Simoff Journal: Chest Date: 2011-06-09 Impact factor: 9.410
Authors: C Lim; H S Sekhon; J C Cutz; D M Hwang; S Kamel-Reid; R F Carter; G da Cunha Santos; T Waddell; M Binnie; M Patel; N Paul; T Chung; A Brade; R El-Maraghi; C Sit; M S Tsao; N B Leighl Journal: Curr Oncol Date: 2017-04-27 Impact factor: 3.677