ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
A comparision of endobronchial ultrasound-guided transbronchial needle aspiration and integrated positron emission tomography-computed tomography in the diagnosis of malignant mediastinal/hilar lymph nodes
Sevda Şener Cömert1, Benan Çağlayan1, Ali Fidan1, Banu Salepçi1, Coşkun Doğan1, Recep Demirhan2, Dilek Ece3
1Departments of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
2Departments of Thoracic Surgery Dr. Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
3Departments of Pathology, Dr. Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
DOI : 10.5606/tgkdc.dergisi.2012.164
Background: In this study, we aimed to identify the sensitivity, specificity and diagnostic accuracy of integrated positron emission tomographycomputed tomography (PET-CT) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of malignant mediastinal/hilar lymph nodes and to compare with each other.

Methods: Records of 131 patients (96 males, 35 females; mean age 58.3±8.4 years; range 42 to 75 years) with known primary or suspected malignancy who had enlarged and hypermetabolic hilar/mediastinal lymph nodes detected by thoracic CT and at PET-CT and in whom EBUS-TBNA performed for cytologic confirmation of the malignancy between October 2008 and April 2011 were retrospectively analyzed. More invasive procedures including mediastinoscopy/video-assisted thoracoscopic surgery (VATS) were performed in patients who did not receive definite diagnosis using EBUSTBNA. The maximum standardised uptake value (SUVmax) cut-off level of PET-CT was considered ≥3.0. The sensitivity, specificity, diagnostic accuracy, and negative and positive predictive values of PET-CT and EBUS-TBNA in diagnosis of malignant hilar/mediastinal lymph nodes were calculated. The results were compared with each other.

Results: A total of 191 lymph node stations of 131 patients were aspirated from the LN stations. Of the 142 lymph nodes, 134 were diagnosed with malignancy using EBUS-TBNA, while SUVmax value was ≥3.0 in 127 by PET-CT. The sensitivity, spesificity, diagnostic accuracy, and negative and positive predictive values of EBUS-TBNA and PET-CT were 94.3%, 100%, 95.8%, 85.9%, 100% and 89.4%, 18.3%, 71.2%, 37.5%, 76.0%, respectively. With combined use of EBUS-TBNA and PET-CT, the sensitivity increased to 100%.

Conclusion: The sensitivity, specificity, diagnostic accuracy, and negative predictive value and positive predictive value of EBUS-TBNA is higher than PET-CT. Based on conventional data, histological confirmation of PET-CT is necessary in mediastinal staging, due to high level of false positivity of PET-CT. EBUS-TBNA is an effective, reliable and minimally invasive method for histologic confirmation of PET-CT-positive malignant mediastinal/hilar lymph nodes.

Keywords : Endobronchial ultrasonography; fine needle aspiration; lung cancer; lymph node; positron emission tomography-computed tomography; staging
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