Ultrasound Guided Transbronchial Needle Aspiration as a Diagnostic Tool for Lung Cancer and Sarcoidosis

Abstract

Introduction: The aim of the study was to assess the diagnostic yield of ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in mediastinal or hilar adenopathy in: (1) staging of non-small cell lung cancer (NSCLC) (97); (2) other malignant neoplasms including: small cell lung cancer (SCLC), metastatic neoplasms and Hodgkin’s disease (16); (3) NSCLC recurrence (7); (4) sarcoidosis and other non-malignant diseases (29). Material and methods: Real time EBUS-TBNA was performed under local anaesthesia and sedation in 149 consecutive patients—237 biopsies in groups of lymph nodes: subcarinal (7)—107, all paratracheal (2R, 2L, 4R, 4L)—86, hilar (10R, 10L)—41 and interlobar (11R, 11L)—3. A mean axis of punctured node was 15 mm (range: 7–42 mm). All negative results were verified by transcervical extended bilateral mediastinal lymphadenectomy (TEMLA), mediastinoscopy or thoracotomy. Results: Lymph node biopsy was technically successful in 92% and was diagnostic in 55% of lung cancer patients and in 85.7% of sarcoidosis patients. In NSCLC staging sensitivity of EBUS-TBNA was 88.7%, specificity 100%, accuracy 92.8% and NPV 83.3% (89.7%, 100%, 94.9% and 90.9% per biopsy), and in the whole group it was 91.5%, 98.7%, 94.6% and 87.3% respectively. In 7.2% of NSCLC staging patients with false negative results of EBUS-TBNA (mainly subcarinal) there was observed partial involvement of metastatic lymph nodes, mean 34.3% (range 10–50%), confirmed by TEMLA. Conclusions: The diagnostic value of EBUS-TBNA is very high in lung cancer, NSCLC staging and sarcoidosis.