Diagnostic performance of endobronchial ultrasound‐guided mediastinal lymph node sampling in early stage non‐small cell lung cancer: A prospective study

摘要

ABSTRACT Background and objective Standard nodal staging of lung cancer consists of positron emission tomography/computed tomography ( PET / CT ), followed by endobronchial ultrasound‐guided transbronchial needle aspiration ( EBUS‐TBNA ) if PET / CT shows mediastinal lymphadenopathy. Sensitivity of EBUS‐TBNA in patients with N0 / N1 disease by PET / CT is unclear and largely based on retrospective studies. We assessed the sensitivity of EBUS‐TBNA in this setting. Methods We enrolled patients with proven or suspected lung cancer staged as N0 / N1 by PET / CT and without metastatic disease ( M0 ), who underwent staging EBUS‐TBNA . Primary outcome was sensitivity of EBUS‐TBNA compared with a composite reference standard of surgical stage or EBUS‐TBNA stage if EBUS demonstrated N2 / N3 disease. Results Seventy‐five patients were included in the analysis. Mean tumour size was 3.52?cm (±1.63). Fifteen of 75 patients (20%) had N2 disease. EBUS‐TBNA identified six while nine were only identified at surgery. Sensitivity of EBUS‐TBNA for N2 disease was 40% (95% CI : 16.3–67.7%). Conclusion A significant proportion of patients with N0 / N1 disease by PET / CT had N2 disease (20%) and EBUS‐TBNA identified a substantial fraction of these patients, thus improving diagnostic accuracy compared with PET / CT alone. Sensitivity of EBUS‐TBNA however appears lower compared with historical data from patients with larger volume mediastinal disease. Therefore, strategies to improve EBUS‐TBNA accuracy in this population should be further explored