Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Mediastinal Staging in a Community Medical Center.

RATIONALE: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and positron emission tomography (PET)-computed tomography (CT) are valuable tools for lung cancer staging. Data from tertiary referral centers suggest that these modalities are superior to mediastinoscopy in mediastinal staging.

OBJECTIVES: To validate EBUS-TBNA for lung cancer staging in a community center with operators with various levels of experience.

METHODS: At an 800-bed community hospital, we reviewed all cases where EBUS-TBNA and PET-CT were performed for mediastinal staging by one of seven private practice pulmonologists. Cases were reviewed with lymph node dissection by mediastinoscopy after negative EBUS-TBNA.

MEASUREMENTS AND MAIN RESULTS: Of the 333 cases that were reviewed, 44 underwent mediastinoscopy after negative EBUS-TBNA. Four patients were positive for malignancy at stations 4R and 7 lymph nodes. In none of these cases did EBUS-TBNA reveal lymphoid tissue confirming the sample location. PET-CT showed mediastinal lymph nodes with increased avidity in two of the false-negative cases. EBUS-TBNA plus PET-CT had a sensitivity, specificity, and negative predictive value of 98.86, 100, and 94.87%, respectively, compared with mediastinoscopy for detecting metastasis.

CONCLUSIONS: EBUS-TBNA is accurate in detecting mediastinal metastasis of lung cancer in the community setting. PET-CT without uptake in lymph nodes reduces the likelihood of malignancy but cannot rule out mediastinal involvement.