Originally published as JCO Early Release 10.1200/JCO.2007.14.9229 on June 2 2008

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Endobronchial Ultrasound With Transbronchial Needle Aspiration for Restaging the Mediastinum in Lung Cancer

Felix J.F. Herth, Jouke T. Annema, Ralf Eberhardt, Kazuhiro Yasufuku, Armin Ernst, Mark Krasnik, Robert C. Rintoul

From the Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Germany; Division of Pulmonary Medicine, Leiden University Medical Center, Leiden, the Netherlands; Department of Thoracic Surgery, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan; Interventional Pulmonology, Pulmonary and Critical Care Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Surgical Gastroenterology, Gentofte University Hospital, Copenhagen, Denmark; and Department of Thoracic Oncology, Papworth Hospital, Cambridge, United Kingdom

Corresponding author: Felix J.F. Herth, MD, Department of Internal Medicine, Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Amalienstr 5, D-69126, Heidelberg, Germany; e-mail: Felix.Herth{at}thoraxklinik-heidelberg.de

Purpose: To investigate the sensitivity and accuracy of endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA) for restaging the mediastinum after induction chemotherapy in patients with non–small-cell lung cancer (NSCLC).

Patients and Methods: One hundred twenty-four consecutive patients with tissue-proven stage IIIA-N2 disease who were treated with induction chemotherapy and who had undergone mediastinal restaging by EBUS-TBNA were reviewed. On the basis of computed tomography, 58 patients were classified as having stable disease and 66 were judged to have had a partial response. All patients subsequently underwent thoracotomy with attempted curative resection and a lymph node dissection regardless of EBUS-TBNA findings.

Results: Persistent nodal metastases were detected by using EBUS-TBNA in 89 patients (72%). Of the 35 patients in whom no metastases were assessed by EBUS-TBNA, 28 were found to have residual stage IIIA-N2 disease at thoracotomy. The majority (91%) of these false negative results were due to nodal sampling error rather than detection error. Overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of EBUS-TBNA for mediastinal restaging after induction chemotherapy were 76%, 100%, 100%, 20%, and 77%, respectively.

Conclusion: EBUS-TBNA is a sensitive, specific, accurate, and minimally invasive test for mediastinal restaging of patients with NSCLC. However, because of the low negative predictive value, tumor-negative findings should be confirmed by surgical staging before thoracotomy.

published online ahead of print at www.jco.org on June 2, 2008.

Supported in part by Olympus Ltd, Tokyo, Japan (loan of the endobronchial ultrasound probe for the duration of the study).

Presented in part at the European Respiratory Society Meeting, September 17, 2007, Stockholm, Sweden, and at the World Lung Cancer Conference, September 2-5, 2007, Seoul, Korea.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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