• Niels J M Claessens, Klaartje W Maas, J A Alain Kummer, and Franz M N H Schramel.
• Sint Antonius Ziekenhuis, Afd. Longziekten, Nieuwegein, the Netherlands.
• Ned Tijdschr Geneeskd. 2012 Jan 1;156(46):A4741.

ObjectiveTo determine the diagnostic yield of endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) and to investigate the number of cervical mediastinoscopies that could be avoided when this technique was used as the initial modality in the invasive mediastinal staging of lung cancer.DesignRetrospective cohort study.MethodAt the St. Antonius Hospital, Nieuwegein, the Netherlands, results from all patients who had undergone EBUS-TBNA for mediastinal staging in lung cancer from September 2008 to January 2011 were collected. If metastases in the mediastinal lymph nodes had been demonstrated by EBUS-TBNA, no indication for additional mediastinoscopy ensued. The diagnostic yield of EBUS-TBNA as well as the number of mediastinoscopies that had been avoided, were calculated.ResultsEBUS-TBNA had been used for mediastinal staging in lung cancer in 77 patients. In 39 of these 77 patients (51%), mediastinal lymph node metastases was found using EBUS-TBNA and mediastinoscopy could thus be avoided. In 9 out of 38 (24%) patients whose EBUS-TBNA cytology results were found to be either benign or not representative, mediastinoscopy or endoscopic ultrasound eventually did reveal mediastinal lymph node metastases. In 13 of these 38 patients (34%), no additional cytologic or histologic testing was performed. Diagnostic yield was calculated for the two scenarios. The sensitivity and negative-predictive values for EBUS-TBNA were 64-81% and 42-76%, respectively.ConclusionIn more than 50% of lung cancer patients with suspected mediastinal lymph node metastases, cervical mediastinoscopy can be avoided when EBUS-TBNA is used. This examination is the technique of first choice for the invasive staging of the mediastinum in lung cancer, but it can not replace mediastinoscopy completely.

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