Endobronchial ultrasound-guided biopsy for evaluation of suspected lung cancer

Abstract

Purpose

Historically, mediastinoscopy has been the gold standard for lung cancer diagnosis and staging, but mediastinoscopy has many limitations including sensitivity, the limited number of lymph node levels that can be sampled, and safety. Endobronchial ultrasound-guided transbronchial needle aspiration is a relatively new and less-invasive technique being used for lung cancer screening. Many studies have reported that it has similar sensitivity and specificity compared to mediastinoscopy, with a significantly lower complication rate. We performed this review to determine our institution’s experience with endobronchial ultrasound-guided transbronchial needle aspiration in lung cancer diagnosis and staging.

Methods

We reviewed the last 150 patients with suspected lung cancer who underwent endobronchial ultrasound-guided transbronchial needle aspiration procedures in our institution from May 26, 2016 to August 31, 2017.

Results

Ninety-seven of the 150 patients had a confirmed diagnosis of malignancy. Forty patients had a diagnosis other than cancer, and 13 had incomplete information or were lost to follow-up. Endobronchial ultrasound-guided transbronchial needle aspiration was correct in diagnosing malignancy or excluding malignant lymph nodes in 92 of the 97 patients with malignancy. Overall, the sensitivity, specificity, positive-predictive value, and negative-predictive value was 94.0%, 100.0%, 100.0%, and 91.5%, respectively. Only 3 complications were reported: 2 patients suffered minor bleeding, and one suffered major bleeding that resulted in cardiac arrest.

Conclusions

Real-time endobronchial ultrasound-guided transbronchial needle aspiration has a similar sensitivity and specificity to mediastinoscopy in diagnosing malignancy, with fewer complications and more financial benefit.