Endobronchial Ultrasound-guided Biopsy Performed Under Optimal Conditions in Patients With Known or Suspected Lung Cancer May Render Mediastinoscopy Unnecessary
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BACKGROUND: Mediastinoscopy is the gold standard for preoperative mediastinal staging of patients with suspected or proven lung cancer. Since the development of endoscopic ultrasound-guided biopsy via the trachea (EBUS-TBNA), this status has been challenged. The purpose of the study was to examine whether mediastinoscopy is necessary, when EBUS-TBNA is performed in a center with (1) a high level of expertise, (2) "bed side" microscopy by a pathologist, (3) general anesthesia, and (4) achievement of representative tissue from station 4R, 7 and 4L, that is, the same mediastinal stations that mediastinoscopy gives access to.
METHODS: A total of 95 consecutive patients with known or suspected lung cancer were referred for staging by EBUS-TBNA, which was performed as described.
RESULTS: Benign and malignant disease was found in the mediastinum of 6 and 13 patients, respectively. The remaining 76 patients were operated, resulting in 9 benign and 67 malignant diagnoses; spread was found to station 4R, 5, and 5 and 6 in 4 patients. The negative predictive value (NPV) was 63/67=0.94. However, if you exclude station 5 and 6, as they cannot be reached by neither EBUS nor mediastinoscopy, NPV was 66/67=0.99. The sensitivity was 0.76, and the specificity was 1.0.
CONCLUSIONS: When EBUS-TBNA is performed under optimal conditions including general anesthesia and "bed side" microscopy performed by a pathologist resulting in representative biopsies from station 4R, 7, and 4L, the NPV is so high that mediastinoscopy seems unnecessary.
Original language | English |
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Journal | Journal of Bronchology & Interventional Pulmonology |
Volume | 21 |
Issue number | 1 |
Pages (from-to) | 21-25 |
Number of pages | 5 |
ISSN | 1944-6586 |
DOIs | |
Publication status | Published - Jan 2014 |
- Adult, Aged, Aged, 80 and over, Bronchoscopy, Carcinoma, Non-Small-Cell Lung, Cohort Studies, Endoscopic Ultrasound-Guided Fine Needle Aspiration, Female, Humans, Lung Neoplasms, Lymph Nodes, Male, Mediastinoscopy, Mediastinum, Middle Aged, Neoplasm Staging, Retrospective Studies, Sarcoma, Small Cell Lung Carcinoma, Thoracic Surgery, Video-Assisted
Research areas
ID: 138179739