Usefulness of transbronchial needle aspiration for initial lung cancer staging

INTRODUCTION Besides radiological methods (especially positron emission tomography combined with computed tomography), endoscopic techniques including transbronchial needle aspiration (TBNA) of mediastinal lymph nodes play an important role in lung cancer staging, thus having a significant effect on further patient management. OBJECTIVES The aim of the study was to investigate the diagnostic value of blind TBNA in staging of lung cancer, using systematic mediastinal lymph node dissection (SLND) at thoracotomy as a confirmatory test. PATIENTS AND METHODS Patients with lung cancer and enlarged mediastinal lymph nodes on computed tomography scans underwent TBNA. Non-small cell lung cancer (NSCLC) patients with negative TBNA or with single-level N2 disease underwent thoracotomy with appropriate pulmonary resection and with SLND. RESULTS In 84 lung cancer patients, 166 TBNA were performed. Metastatic lymph node involvement was identified in 57 patients (67.9%). There were 10 patients (11.9%) with small cell lung cancer. Of the 74 NSCLC patients, TBNA revealed metastases in 48 (64.9%). Twenty-four TBNA-negative patients (32.4%) and 4 patients (5.4%) with single-level N2 disease underwent pulmonary resection with SLND. In 8 of 28 operated patients (28.6%), N2 metastatic nodes were identified. The per-patient analysis showed the sensitivity of TBNA to be 81.5%, specificity 100%, accuracy 86.5%, and negative predictive value (NPV) 66.7%. CONCLUSIONS Our results suggest that TBNA may be a useful method for initial NSCLC staging in patients suspected of N2-3 disease. Positive TBNA in 1 station only should not be considered as a true single-level N2 disease, because of a relatively low NPV for TBNA.