Diagnosis of Mediastinal Adenopathy—Real-Time Endobronchial Ultrasound Guided Needle Aspiration versus Mediastinoscopy

• Published in: Journal of thoracic oncology 2008-06, Vol.3 (6), p.577-582
• Main Authors: Ernst, Armin, Anantham, Devanand, Eberhardt, Ralf, Krasnik, Mark, Herth, Felix J.F.
• Format: Article
• Language: English
• Subjects: Biopsy, Fine-Needle - methods; Bronchi - diagnostic imaging; Carcinoma, Non-Small-Cell Lung - diagnostic imaging; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - secondary; Cervical mediastinoscopy; Cross-Over Studies; Diagnosis, Differential; Endobronchial ultrasound; Endosonography - methods; Female; Follow-Up Studies; Humans; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - pathology; Lymph Node Excision; Lymph Nodes - diagnostic imaging; Lymph Nodes - pathology; Lymph Nodes - surgery; Lymphatic Metastasis; Male; Mediastinal lymph nodes; Mediastinoscopy - methods; Mediastinum; Middle Aged; Neoplasm Staging - methods; Nonsmall cell lung cancer; Prospective Studies; Reproducibility of Results; Sensitivity and Specificity; Transbronchial needle aspiration
• ISSN: 1556-0864; 1556-1380
• DOI: 10.1097/JTO.0b013e3181753b5e

Real-time endobronchial ultrasound has increased the accuracy of conventional transbronchial needle aspiration biopsy in sampling mediastinal lymph nodes. Nevertheless, direct comparisons with mediastinoscopy are not available to determine the role of endobronchial ultrasound in pathologic staging. To compare the diagnostic yield of endobronchial ultrasound against cervical mediastinoscopy in the diagnosis and staging of radiologically enlarged mediastinal lymph nodes stations accessible by both modalities in patients with suspected nonsmall cell lung cancer. Prospective, crossover trial with surgical lymph node dissection used as the accepted standard. Biopsy results of paratracheal and subcarinal lymph nodes were compared. Sixty-six patients with a mean age 60 ± 10 years were studied. The prevalence of malignancy was 89% (59/66 cases). Endobronchial ultrasound had a higher overall diagnostic yield (91%) compared with mediastinoscopy (78%; p = 0.007) in the per lymph node analysis. There was disagreement in the yield between the two procedures in the subcarinal lymph nodes (24%; p = 0.011). There were no significant differences in the yield at other lymph node stations. The sensitivity, specificity, and negative predictive value of endobronchial ultrasound were 87, 100, and 78%, respectively. The sensitivity, specificity, and negative predictive value of mediastinoscopy were 68, 100, and 59%, respectively. No significant differences were found between endobronchial ultrasound (93%) and mediastinoscopy (82%; p = 0.083) in determining true pathologic N stage (per patient analysis). In suspected nonsmall cell lung cancer, endobronchial ultrasound may be preferred in the histologic sampling of paratracheal and subcarinal mediastinal adenopathy because the diagnostic yield can surpass mediastinoscopy.