Evaluation of mediastinal lymph nodes with endobronchial ultrasound: The thoracic surgeon's perspective

Andrade, Rafael S.; Groth, Shawn S.; Rueth, Natasha M.; D'Cunha, Jonathan; Pambuccian, Stefan E.; Maddaus, Michael A.

doi:10.1016/j.jtcvs.2009.11.017

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 139, Issue 3 , Pages 578-583, March 2010

Evaluation of mediastinal lymph nodes with endobronchial ultrasound: The thoracic surgeon's perspective

Rafael S. Andrade, MD
- Department of Surgery, Division of General Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, Minn
- Address for reprints: Rafael S. Andrade, MD, Division of General Thoracic and Foregut Surgery, MMC 207, 420 Delaware St SE, Minneapolis, MN 55455.
Shawn S. Groth, MD
- Department of Surgery, Division of General Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, Minn
Natasha M. Rueth, MD
- Department of Surgery, Division of General Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, Minn
Jonathan D'Cunha, MD, PhD
- Department of Surgery, Division of General Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, Minn
Stefan E. Pambuccian, MD
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minn
Michael A. Maddaus, MD, FACS
- Department of Surgery, Division of General Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, Minn

Received 2 May 2009; received in revised form 29 October 2009; accepted 13 November 2009.

Objective

The objectives of our study are to (1) describe our experience with endobronchial ultrasound-guided fine-needle aspiration of mediastinal lymph nodes and (2) illustrate how thoracic surgeons facile with ultrasound-guided fine-needle aspiration have the potential to streamline patient care.

Methods

We performed a retrospective review of all patients within our prospectively maintained database who underwent endobronchial ultrasound-guided fine-needle aspiration of mediastinal lymph nodes by thoracic surgeons at the University of Minnesota from September 1, 2006, to April 15, 2009. We included patients in our analysis if (1) their malignancy diagnosis was based on immediate endobronchial ultrasound-guided fine-needle aspiration cytology or (2) they underwent a confirmatory procedure (ie, mediastinoscopy or thoracoscopy) that sampled the same mediastinal lymph node stations biopsied by endobronchial ultrasound-guided fine-needle aspiration to verify normal, benign, or nondiagnostic endobronchial ultrasound-guided fine-needle aspiration findings. We also collected data on additional diagnostic or therapeutic procedures performed in the same anesthesia setting as endobronchial ultrasound-guided fine-needle aspiration.

Results

Over the study period, 192 patients underwent endobronchial ultrasound-guided fine-needle aspiration; 98 patients met our inclusion criteria. We achieved a sensitivity of 87.9%, specificity of 97.4%, and diagnostic accuracy of 91.7%. For patients undergoing lung cancer staging, we sampled a mean of 3.0 ± 0.9 mediastinal lymph node stations. Half of our patients underwent an additional diagnostic or therapeutic procedure at the time of endobronchial ultrasound-guided fine-needle aspiration.

Conclusion

Thoracic surgeons who perform endobronchial ultrasound-guided fine-needle aspiration can achieve excellent sensitivity, specificity, and diagnostic accuracy while adhering to sound oncologic principles. Endobronchial ultrasound-guided fine-needle aspiration adds to the thoracic surgeon's unique capacity to expedite a diagnostic workup and treatment, thereby streamlining patient care.

CTSNet classification: 13, 28

Abbreviations and Acronyms: EBUS-FNA, endobronchial ultrasound-guided fine-needle aspiration, EUS, endoscopic ultrasound, FN, false negative, FP, false positive, MLN, mediastinal lymph node, NPV, negative predictive value, NSCLC, non–small cell lung cancer, ROSE, rapid on-site evaluation, TN, true negative, TP, true positive