A combined approach of endobronchial and endoscopic ultrasound-guided needle aspiration for TNM lung cancer staging – A three years experience

Introduction: The aim of the trial was to assess the utility of the combined endobronchial (EBUS) and endoscopic (EUS) ultrasound-guided needle aspiration (CUS-NA) for TNM lung cancer (LC) staging. Methods: The CUS-NA were being performed under mild sedation in consecutive LC patients (pts) with enlarged or normal mediastinal nodes on CT scans. All non-small cell LC pts with negative CUS-NA underwent subsequently the transcervical extended bilateral mediastinal lymphadenectomy (TEMLA) as a confirmatory test and if negative underwent systematic lymph node dissection (SLND) by thoracotomy. Results: From Jan. 2008 to Dec. 2010 in 588 LC pts who underwent CUS-NA there were 1529 mediastinal nodes biopsied (EBUS-TBNA – 805, EUS-FNA – 724). The CUS-NA revealed metastases in 273/588 pts (46.4%) and a prevalence was 52.3%. In 272 CUS-NA negative pts and in 5 pts suspected for metastases, who underwent subsequent TEMLA and SLND metastatic nodes were diagnosed in 35 pts (5.9%), in whom double or multilevel N2 disease was found in 14 of them (2.4%). A diagnostic sensitivity, specificity, accuracy, PPV and NPV of CUS-NA were 88.6%, 98.2%, 92.7%, 98.2%% and 88.6%, respectively. In pts with nodes highly suspected for metastases by echosonography positive results were obtained by both methods in 96.7% and in all small cell LC pts. The results of EUS-FNA of left suprarenals (M1-staging) impacted on surgery in 24 pts (4.1%). The CUS-NA influenced on T-staging in 38 pts (6.5%). No severe complications of CUS-NA were observed. Conclusions: The CUS-NA is especially effective for mediastinal N staging but it also plays an additional role for TM staging in LC patients.