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J Thorac Cardiovasc Surg 2007;134:1485-1490
© 2007 The American Association for Thoracic Surgery

General Thoracic Surgery

The evaluation of lymph node metastasis by endobronchial ultrasound-guided transbronchial needle aspiration: Crucial for selection of surgical candidates with metastatic lung tumors

Takahiro Nakajima, MDa, Kazuhiro Yasufuku, MD, PhD, FCCPa,*, Akira Iyoda, MD, PhDa, Shigetoshi Yoshida, MD, PhDa, Makoto Suzuki, MD, PhDa, Yasuo Sekine, MD, PhDa, Kiyoshi Shibuya, MD, PhDa, Kenzo Hiroshima, MD, PhDb, Yukio Nakatani, MD, PhDb, Takehiko Fujisawa, MD, PhDa

a Department of Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
b Department of Diagnostic Pathology, Graduate School of Medicine, Chiba University, Chiba, Japan.

Received for publication January 29, 2007; revisions received July 19, 2007; accepted for publication July 26, 2007.

* Address for reprints: Kazuhiro Yasufuku, MD, PhD, Department of Thoracic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan. (Email: kyasufuku{at}faculty.chiba-u.jp).

Objectives: Pulmonary metastasectomy is accepted as an effective treatment for properly selected patients with metastatic lung tumors. In such patients, the presence of mediastinal and/or hilar lymph node metastasis is a significant negative prognostic factor. The purpose of this study was to evaluate the usefulness of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for the detection of mediastinal and hilar lymph node metastasis in patients with potentially resectable metastatic lung tumors.

Methods: Patients with metastatic lung tumors with radiologically defined mediastinal and/or hilar lymph nodes on chest computed tomographic scans referred to our department for pulmonary resection were retrospectively analyzed. Successful lymph node aspiration was evidenced by the presence of malignant cells or normal lymphocytes. Cytologic and histologic analysis was used to confirm metastasis in surgically resected specimens unless metastasis was proven by EBUS-TBNA.

Results: A total of 106 patients were referred for metastasectomy during the study period. EBUS-TBNA was performed in 60 lymph nodes (37 mediastinal and 23 hilar nodes) from 43 patients. Cytologic and/or histologic samples were diagnostic in 41 (95.3%) patients. EBUS-TBNA detected lymph node metastasis in 23 patients. The sensitivity, specificity, and diagnostic accuracy rate of EBUS-TBNA for diagnosis of mediastinal and hilar lymph node metastasis were 92.0%, 100%, and 95.3%, respectively.

Conclusions: EBUS-TBNA is a highly sensitive modality for the evaluation of mediastinal and hilar lymph node metastasis in patients with metastatic lung tumors. EBUS-TBNA allows preoperative histologic as well as cytologic evaluation of mediastinal and hilar lymph nodes.

Abbreviations and Acronyms CT = computed tomography; EBUS-TBNA = endobronchial ultrasound-guided transbronchial needle aspiration






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