Christina R Bellinger1, Deepankar Sharma2, Jimmy Ruiz3,4, Graham Parks5, Travis Dotson2, Edward F Haponik2. 1. Department of Pulmonary/Critical Care, Wake Forest Baptist Health, Medical Center Blvd, Winston Salem, NC, 27157, USA. cbelling@wakehealth.edu. 2. Department of Pulmonary/Critical Care, Wake Forest Baptist Health, Medical Center Blvd, Winston Salem, NC, 27157, USA. 3. Department of Medicine, Section on Hematology and Oncology Comprehensive Cancer, Center of Wake Forest University, Winston Salem, NC, 27157, USA. 4. W.G. (Bill).Hefner Veteran Administration Medical Center, Salisbury, NC, 28144, USA. 5. Department of Pathology, Wake Forest Baptist Health, Winston Salem, NC, 27157, USA.
Abstract
PURPOSE: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a well-established diagnostic tool for lung cancer, sarcoidosis, and suspected metastatic extrathoracic malignancy. EBUS-TBNA carries a high diagnostic yield, but its negative predictive value (NPV) requires further clarification. METHODS: We reviewed EBUS-TBNA at our cancer center from 2008 to 2015. We identified negative diagnostic samples for adenopathy suspected to represent metastatic disease from extrathoracic malignancy. RESULTS: We reviewed 529 EBUS-TBNAs. Ninety patients underwent EBUS-TBNA sampling of the hilum and/or mediastinum (121 nodes, 14 masses) for suspected extrathoracic malignancy. Thirty-seven patients had negative samples (lymph node, granulomas or non-diagnostic specimens). The overall NPV was 98 %. Granulomas (11 patients, 25 nodes) seen on histology had a 100 % NPV, including those that were FDG-PET (fluorodeoxyglucose positron emission tomography) avid (n = 14 nodes). CONCLUSION: Negative EBUS-TBNA in patients with extrathoracic malignancy and suspected secondary hilar or mediastinal metastases can infer a high NPV especially if granulomas are seen on histology. Larger prospective investigations are needed to confirm the high NPV of EBUS-TBNA with granulomas in extrathoracic malignancies.
PURPOSE: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a well-established diagnostic tool for lung cancer, sarcoidosis, and suspected metastatic extrathoracic malignancy. EBUS-TBNA carries a high diagnostic yield, but its negative predictive value (NPV) requires further clarification. METHODS: We reviewed EBUS-TBNA at our cancer center from 2008 to 2015. We identified negative diagnostic samples for adenopathy suspected to represent metastatic disease from extrathoracic malignancy. RESULTS: We reviewed 529 EBUS-TBNAs. Ninety patients underwent EBUS-TBNA sampling of the hilum and/or mediastinum (121 nodes, 14 masses) for suspected extrathoracic malignancy. Thirty-seven patients had negative samples (lymph node, granulomas or non-diagnostic specimens). The overall NPV was 98 %. Granulomas (11 patients, 25 nodes) seen on histology had a 100 % NPV, including those that were FDG-PET (fluorodeoxyglucose positron emission tomography) avid (n = 14 nodes). CONCLUSION: Negative EBUS-TBNA in patients with extrathoracic malignancy and suspected secondary hilar or mediastinal metastases can infer a high NPV especially if granulomas are seen on histology. Larger prospective investigations are needed to confirm the high NPV of EBUS-TBNA with granulomas in extrathoracic malignancies.
Authors: Horiana B Grosu; David E Ost; Rodolfo C Morice; George A Eapen; Liang Li; Juhee Song; Xiudong Lei; Donald R Lazarus; Roberto F Casal; Carlos A Jimenez Journal: Ann Am Thorac Soc Date: 2015-10
Authors: Zachary S DePew; Wilson I Gonsalves; Anja C Roden; Aaron O Bungum; John J Mullon; Fabien Maldonado Journal: J Bronchology Interv Pulmonol Date: 2012-07
Authors: Jinkyeong Park; Se Jin Jang; Young Soo Park; Yeon-Mok Oh; Tae Sun Shim; Woo Sung Kim; Chang Min Choi Journal: J Korean Med Sci Date: 2011-01-24 Impact factor: 2.153
Authors: Jose Sanz-Santos; Beatriz Cirauqui; Estefania Sanchez; Felipe Andreo; Pere Serra; Eduard Monso; Eva Castellà; Mariona Llatjós; Miguel Mesa; Juan Ruiz-Manzano; Rafael Rosell Journal: Clin Exp Metastasis Date: 2012-11-30 Impact factor: 5.150
Authors: Marcus P Kennedy; Carlos A Jimenez; Ashwini D Mhatre; Rodolfo C Morice; Georgie A Eapen Journal: J Cardiothorac Surg Date: 2008-02-25 Impact factor: 1.637