Chest
Volume 138, Issue 4, October 2010, Pages 795-802
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Original Research
Interventional Pulmonology
Transbronchial and Transesophageal Fine-Needle Aspiration Using an Ultrasound Bronchoscope in Mediastinal Staging of Potentially Operable Lung Cancer

https://doi.org/10.1378/chest.09-2100Get rights and content

Objective

We performed this study to evaluate the role of transesophageal endoscopic ultrasound with bronchoscope-guided fine-needle aspiration (EUS-B-FNA) following endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the mediastinal staging of lung cancer.

Methods

In this prospective study, we applied transbronchial and transesophageal ultrasonography using an ultrasound bronchoscope on patients with confirmed or strongly suspected potentially operable non-small cell lung cancer. Following EBUS-TBNA, EUS-B-FNA was used for mediastinal nodes that were inaccessible or difficult to access by EBUS-TBNA. The accessibility by EBUS-TBNA and EUS-B-FNA to mediastinal nodal stations having at least one node ≥ 5 mm was also checked.

Results

In 150 patients, we performed EBUS-TBNA and EUS-B-FNA on 299 and 64 mediastinal nodal stations, respectively. Among 143 evaluable patients, EBUS-TBNA diagnosed mediastinal metastasis in 38 patients. EUS-B-FNA identified mediastinal metastasis in three additional patients. Surgery diagnosed mediastinal metastasis in four more patients. The sensitivity, negative predictive value, and diagnostic accuracy of EBUS-TBNA in the detection of mediastinal metastasis were 84.4%, 93.3%, and 95.1%, respectively. These values for the combined approach of EBUS-TBNA and EUS-B-FNA increased to 91.1%, 96.1%, and 97.2%, respectively, although the differences were not statistically significant (P = .332, P = .379, and P = .360, respectively). Among 473 mediastinal nodal stations having at least one node ≥ 5 mm that were evaluated, the proportion of accessible mediastinal nodal stations by EBUS-TBNA was 78.6%, and the proportion increased to 84.8% by combining EUS-B-FNA with EBUS-TBNA (P = .015).

Conclusion

Following EBUS-TBNA in the mediastinal staging of potentially operable lung cancer, the accessibility to mediastinal nodal stations increased by adding EUS-B-FNA and an additional diagnostic gain might be obtained by EUS-B-FNA.

Trial Registration

clinicaltrials.gov, NCT00741247

Section snippets

Patients

We prospectively enrolled consecutive patients with histologically confirmed or strongly suspected potentially operable NSCLC who visited the Center for Lung Cancer of the National Cancer Center in Goyang Korea from August 2008 to March 2009. After staging workup for NSCLC, including CT scans of the chest and upper abdomen, integrated PET-CT scans, and brain MRI (and/or bone scans), we excluded patients who had M1 disease and inoperable T4 disease based on the international system for staging

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration

During the study period, we screened 685 patients with proven or suspected lung cancer. One hundred fifty patients who met the inclusion criteria were enrolled in the study. The characteristics and the clinical courses of the patients are presented in Table 1 and Figure 1, respectively. EBUS was performed on all participants, and EBUS-TBNA was performed on 310 lesions (299 mediastinal nodal stations, 8 N1 nodal stations, and three lung masses). The characteristics of the EBUS-TBNA procedure are

Discussion

To our knowledge, this study is the first prospective investigation demonstrating the usefulness of combining transbronchial and transesophageal fine needle aspiration using an ultrasound bronchoscope in the mediastinal staging of lung cancer. We performed EUS-B-FNA safely, and only one complication was observed after EBUS-TBNA. We observed 6.7% of additional diagnostic gain in detecting mediastinal metastasis by adding EUS-B-FNA to EBUS-TBNA. Although the difference in diagnostic gain did not

Acknowledgments

Author contributions: Dr Hwangbo: contributed to study conception and design, provision of study materials or patients, collection and assembly of data, data analysis and interpretation, manuscript writing, and final approval of the manuscript.

Dr G.-K. Lee: contributed to data analysis and interpretation and final approval of the manuscript.

Dr Hee S. Lee: contributed to provision of study materials or patients and final approval of the manuscript.

Dr Lim: contributed to data analysis and

References (27)

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Funding/Support: This work was supported by the National Cancer Center [Grant 710620].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

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