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

R. Ohnishi; I. Yasuda; T. Kato; T. Tanaka; Y. Kaneko; T. Suzuki; S. Yasuda; K. Sano; S. Doi; M. Nakashima; T. Hara; H. Tsurumi; N. Murakami; H. Moriwaki

doi:10.1055/s-0030-1256766

Endoscopy, Table of Contents

Endoscopy 2011; 43(12): 1082-1089
DOI: 10.1055/s-0030-1256766

Original article

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

R. Ohnishi

¹First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan

²Department of Pulmonary Medicine, National Hospital Organization Nagara Medical Center, Gifu, Japan

,

I. Yasuda

¹First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan

,

T. Kato

²Department of Pulmonary Medicine, National Hospital Organization Nagara Medical Center, Gifu, Japan

,

T. Tanaka

³Department of Thoracic Surgery, National Hospital Organization Nagara Medical Center, Gifu, Japan

,

Y. Kaneko

⁴PET Center, Gifu Central Hospital, Gifu, Japan

,

T. Suzuki

²Department of Pulmonary Medicine, National Hospital Organization Nagara Medical Center, Gifu, Japan

,

S. Yasuda

²Department of Pulmonary Medicine, National Hospital Organization Nagara Medical Center, Gifu, Japan

,

K. Sano

²Department of Pulmonary Medicine, National Hospital Organization Nagara Medical Center, Gifu, Japan

,

S. Doi

¹First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan

,

M. Nakashima

¹First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan

,

T. Hara

¹First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan

,

H. Tsurumi

¹First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan

,

N. Murakami

¹First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan

,

H. Moriwaki

¹First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan

› Author Affiliations

Abstract

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.

Full Text

References

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