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Sebastien Gilbert
David O. Wilson
Neil A. Christie
James D. Luketich
Rodney J. Landreneau
Matthew J. Schuchert
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J Thorac Cardiovasc Surg 2009;137:413-418
© 2009 The American Association for Thoracic Surgery

General Thoracic Surgery

Should endobronchial ultrasonography be part of the thoracic surgeon's armamentarium?

Sebastien Gilbert, MDa,*, David O. Wilson, MD, MPHb, Neil A. Christie, MDa, James D. Luketich, MDa, Rodney J. Landreneau, MDa, John M. Close, MS, PMSDc, Matthew J. Schuchert, MDa

a University of Pittsburgh, Heart, Lung and Esophageal Institute, Pittsburgh, Pennsylvania
b Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
c School of Dental Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania

Received for publication May 2, 2008; revisions received August 19, 2008; accepted for publication September 16, 2008.

* Address for reprints: Sebastien Gilbert, MD, UPMC Presbyterian, Suite C-800, 200 Lothrop St, Pittsburgh, PA 15213. (Email: gilberts{at}upmc.edu).

Objective: The study objective was to determine the clinical usefulness and accuracy of endobronchial ultrasound-guided needle aspiration of mediastinal and hilar lymph nodes.

Methods: A retrospective analysis of a thoracic surgery unit's experience was performed.

Results: In a period of 19 months, 75 patients underwent the procedure (mean age = 65.5 ± 1.6 years; male to female = 2:1) most commonly for mediastinal lymphadenopathy in the setting of diagnosed or suspected lung cancer. It was diagnostic in 68.9% after rapid on-site evaluation and 74.3% after final cytologic examination. The rapid on-site evaluation and final cytology results were discordant in 16.2% (P < .001). In 50 cases, the needle aspirate cytology could be compared with pathology results. The sensitivity and specificity for the diagnosis of cancer were 85% and 100%, respectively. The false-negative rate endobronchial ultrasound cytology was 8.1%. Mediastinal lymph node station 7 was most commonly biopsied. The stations with the highest diagnostic yield were: 11R, 3, 10L, and 7. Of the patients with a positive positron emission tomography scan with suspected clinical stage III lung cancer, cancer was downstaged in 40% after endobronchial ultrasound.

Conclusion: Endobronchial ultrasound-guided needle aspiration is a clinically useful minimally invasive option for lung cancer staging and evaluation of mediastinal lymphadenopathy. The procedure should be considered complementary to mediastinoscopy.

Abbreviations and Acronyms CT = computed tomography; EBUS = endobronchial ultrasound-guided transbronchial needle aspiration; PET = positron emission tomography; ROSE = rapid on-site evaluation






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