TY - JOUR

T1 - Endobronchial Ultrasound-guided Biopsy Performed Under Optimal Conditions in Patients With Known or Suspected Lung Cancer May Render Mediastinoscopy Unnecessary

AU - Clementsen, Paul F

AU - Skov, Birgit G

AU - Vilmann, Peter

AU - Krasnik, Mark

PY - 2014/1

Y1 - 2014/1

N2 - 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.

AB - 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.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Bronchoscopy

KW - Carcinoma, Non-Small-Cell Lung

KW - Cohort Studies

KW - Endoscopic Ultrasound-Guided Fine Needle Aspiration

KW - Female

KW - Humans

KW - Lung Neoplasms

KW - Lymph Nodes

KW - Male

KW - Mediastinoscopy

KW - Mediastinum

KW - Middle Aged

KW - Neoplasm Staging

KW - Retrospective Studies

KW - Sarcoma

KW - Small Cell Lung Carcinoma

KW - Thoracic Surgery, Video-Assisted

U2 - 10.1097/LBR.0000000000000028

DO - 10.1097/LBR.0000000000000028

M3 - Journal article

C2 - 24419182

VL - 21

SP - 21

EP - 25

JO - Journal of Bronchology & Interventional Pulmonology

JF - Journal of Bronchology & Interventional Pulmonology

SN - 1944-6586

IS - 1

ER -