Endoscopy 2011; 43(12): 1082-1089
DOI: 10.1055/s-0030-1256766
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Combined endobronchial and endoscopic ultrasound-guided fine needle aspiration for mediastinal nodal staging of lung cancer

R. Ohnishi
1  First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
2  Department of Pulmonary Medicine, National Hospital Organization Nagara Medical Center, Gifu, Japan
,
I. Yasuda
1  First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
,
T. Kato
2  Department of Pulmonary Medicine, National Hospital Organization Nagara Medical Center, Gifu, Japan
,
T. Tanaka
3  Department of Thoracic Surgery, National Hospital Organization Nagara Medical Center, Gifu, Japan
,
Y. Kaneko
4  PET Center, Gifu Central Hospital, Gifu, Japan
,
T. Suzuki
2  Department of Pulmonary Medicine, National Hospital Organization Nagara Medical Center, Gifu, Japan
,
S. Yasuda
2  Department of Pulmonary Medicine, National Hospital Organization Nagara Medical Center, Gifu, Japan
,
K. Sano
2  Department of Pulmonary Medicine, National Hospital Organization Nagara Medical Center, Gifu, Japan
,
S. Doi
1  First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
,
M. Nakashima
1  First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
,
T. Hara
1  First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
,
H. Tsurumi
1  First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
,
N. Murakami
1  First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
,
H. Moriwaki
1  First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
› Author Affiliations
Further Information

Publication History

submitted 03 February 2011

accepted after revision17 June 2011

Publication Date:
04 October 2011 (online)

Background: Recently, transesophageal endoscopic ultrasound-guided fine-needle aspiration (EUS–FNA) has been evaluated for mediastinal nodal staging (N staging) of lung cancer, as this technique is less invasive than mediastinoscopy and possibly more accurate than 18F-fluorodeoxyglucose positron emission tomography with computed tomography (PET–CT). However, EUS–FNA does not provide access to pretracheal and hilar lymph nodes. More recently, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS–TBNA) has been introduced as a novel technique for accessing pretracheal and hilar lymph nodes. Although the combined endoscopic approach of EUS–FNA and EBUS–TBNA is presumably more accurate than PET–CT, only a few reports have quantitatively evaluated its diagnostic ability. Therefore, we prospectively assessed the diagnostic yield of this combined endoscopic approach for mediastinal N staging of lung cancer.

Methods: A consecutive series of 120 patients with suspected resectable lung cancer on CT findings underwent PET–CT and combined EUS–FNA/EBUS–TBNA. The accuracy and other diagnostic indices of the combined approach in mediastinal N staging were compared with those of PET–CT.

Results: Among the enrolled patients, a final pathological N stage was established in 110 patients. The accuracy of the combined approach using EUS–FNA and EBUS–TBNA was significantly higher than that of PET–CT (90.0 % vs. 73.6 %; P < 0.0001). The sensitivity, specificity, and positive and negative predictive values were respectively 71.8 %, 100 %, 100 %, and 86.6 % for the combined approach vs. 47.4 %, 87.5 %, 66.7 %, and 75.9 % for PET–CT.

Conclusions: The combined endoscopic approach using EUS–FNA and EBUS–TBNA provided excellent diagnostic performance. Therefore, this approach is strongly recommended before surgery or mediastinoscopy to avoid futile thoracotomy and surgical intervention.