Transbronchial needle aspiration in lung cancer patients suitable for operation with positive mediastinal positron emission tomography

Background. The objectives of this study were to analyze
our experience with transbronchial needle aspiration
as a minimally invasive procedure alternative to
mediastinoscopy in the preoperative staging of nonsmall
cell lung cancer patients with positive mediastinal
positron emission tomography and to propose a staging
algorithm that combines performance characteristics of
these three methods.
Methods. Fifty-one patients staged N2 or N3 after
positron emission tomography imaging underwent transbronchial
needle aspiration.
Results. A malignant adenopathy was identified in 26
patients (51%) that were excluded from operation and
referred for neoadjuvant chemotherapy or chemoradiotherapy
according to the mediastinal status (N2 or N3), as
determined on the positron emission tomography image.
In the remaining 25 patients (49%), samples were considered
adequate negative in 12 patients, inadequate in 11,
or inconclusive in 2. These patients underwent mediastinoscopy.
Mediastinoscopy showed N2 disease in 19
cases, and the patients received neoadjuvant chemotherapy.
In the remaining 6 cases no mediastinal involvement
was identified and patients underwent operation. Postoperatively,
5 patients were staged N0 and 1 was staged
N2. For transbronchial needle aspiration, sensitivity,
specificity, positive predictive value, negative predictive
value, and accuracy were 76%, 100%, 100%, 33%, and 79%,
respectively.
Conclusions. Transbronchial needle aspiration avoided
a mediastinoscopy in approximately half of lung cancer
patients referred for operation with positive mediastinal
positron emission tomography, sparing the associated
costs and risks of more invasive surgical procedures. The
minimally invasive mediastinal staging algorithm that
we proposed seems to be efficacious and easily applicable
in clinical practice.