Transesophageal needle aspiration and transbronchial needle aspiration using an ultrasound-bronchoscope for mediastinal staging of lung cancer: a randomized study

SESSION TITLE: Accessing the Mediastinum to Pleural Space SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm PURPOSE: The combination of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and transesophageal endoscopic ultrasound with bronchoscope-guided fine needle aspiration (EUS-B-FNA), as well as EBUS-TBNA alone, has been recommended for preoperative mediastinal staging of non-small cell lung cancer (NSCLC). However, to our knowledge, no randomized study has compared these methods. The present study was conducted to compare the sensitivities of EBUS-TBNA and combined EBUS-TBNA and EUS-B-FNA for the detection of N2/N3 disease during preoperative staging of NSCLC. METHODS: In this single-center study, patients with known or suspected, potentially operable NSCLC were recruited and randomized to undergo EBUS-TBNA (EBUS group) or EBUS-TBNA followed by EUS-B-FNA (EBUS-EUS group). The final diagnoses were confirmed by endosonography, surgery, or size stability on chest computed tomography after at least 6 months. The primary endpoint was a comparison of sensitivity between EBUS and EBUS-EUS. RESULTS: In total, 240 patients were enrolled and randomized; among these patients, 219 (EBUS: 105, EBUS-EUS: 114) with NSCLC were included in the analysis. The prevalences of N2/N3 disease were 26.7% in the EBUS group and 25.4% in the EBUS-EUS group. The sensitivities of EBUS and EBUS-EUS for detection of N2/N3 disease were 75.0% and 79.3%, respectively (P = 0.698). In the EBUS-EUS group, EUS-B-FNA solely provided diagnostic results in 2 patients; thus, sensitivity increased from 72.4% to 79.3% by adding EUS-B-FNA to EBUS-TBNA. CONCLUSIONS: The sensitivity of EBUS and EBUS-EUS for diagnosis of N2/N3 disease was not significant, although it increased by 6.9% after the addition of EUS-B-FNA. CLINICAL IMPLICATIONS: The use of EBUS-TBNA alone for preoperative mediastinal staging of NSCLC is a reasonable initial procedure, and sensitivity was optimized by the addition of EUS-B-FNA. DISCLOSURES: No relevant relationships by Masahiko Ando No relevant relationships by Chiyoe Kitagawa No relevant relationships by Yoshihito Kogure No relevant relationships by Hideyuki Niwa Speaker/Speaker's relationship with Olympus Please note: 2021, 2022 Added 03/27/2023 by Masahide Oki, source=Web Response, value=Honoraria
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