Efficacy of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration of Hilar Lymph Nodes for Diagnosing and Staging Cancer

Introduction: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is used mostly in patients with non-small cell lung cancer (NSCLC) to sample mediastinal lymph nodes that are visible oil computed tomography (CT). We sought to determine the efficacy of EBUS-TBNA in sampling enlarged hilar lymph nodes in this patient population. Methods: From January 2004 to May 2007, patients with suspected NSCLC and CT or positron emission tomography (PET) imaging demonstrating enlarged (>1 cm) or PET-positive hilar lymph nodes underwent EBUS-TBNA. Patients with enlarged central mediastinal nodes were excluded. Identifiable lymph nodes at locations 10R, 10L, 11R, and 11L were aspirated. All patients underwent subsequent surgical staging or clinical follow-up as indicated. Diagnoses based oil aspirates were compared with those based on surgical or clinical results. Results: Of 2 13 patients evaluated (mean age, 56 years; 138 men), 188 (mean age, 56.3 years 120 men) were diagnosed with NSCLC and were analyzed, In these patients, 229 lymph nodes, ranging 8 to 20 mm, were detected, and all were sampled. Of the 188 patients, 25 had a single enlarged node in a contralateral hilar position (N3), 40 had multiple enlarged ipsilateral nodes in the NI position, and 123 had an ipsilateral single enlarged node in the NI position. Overall, diagnostic sensitivity of EBUS-TBNA was 91%, specificity was 100%, and the positive predictive value was 92.4%. In the 25 patients with contralateral hilar nodes, sensitivity was 66%, specificity was 100%, and the positive predictive value was 96%. Conclusions: No complications occurred. In experienced hands, EBUS-TBNA of enlarged hilar lymph visible on CT or hilar nodes that are PET scan-positive can provide diagnostic results similar to those for central mediastinal nodes.