Combined Use of TBNA and EBUS-TBNA in the Preoperative Staging of Lung Cancer Patients

: The identification of the optimal mediastinal staging strategy in lung cancer patients remains an important objective to improve their selection for appropriate treatment. The aim of this study was to analyze our experience with traditional transbronchial needle aspiration (TBNA) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) as minimally invasive alternative procedures to mediastinoscopy in the preoperative staging of lung cancer patients with positive mediastinal positron emission tomography. Forty-four patients staged N2 or N3 after positron emission tomography were included in the study. Traditional TBNA was used in 15 patients to puncture "easy" targets such as the subcarinal lymph nodes. EBUS-TBNA was used in 29 patients to puncture "difficult" targets such as the paratracheal stations. A malignant adenopathy was identified in 39 patients (89%) who avoided a mediastinoscopy and were referred for neoadjuvant chemotherapy or chemoradiotherapy according to their mediastinal status (N2 or N3), as determined on the positron emission tomography image. In the remaining 5 patients (11%), samples were nondiagnostic. These patients underwent mediastinoscopy and subsequent neoadjuvant chemotherapy (3 cases) or surgery (2 cases) according to the presence of an N2 or an N0 disease. The combined use of traditional and EBUS-TBNA avoided a mediastinoscopy in approximately 90% of lung cancer patients referred for surgery with positive mediastinal positron emission tomography, sparing the associated costs and risks of surgical procedures. Traditional and EBUS-TBNA should be considered as complementary methods in the preoperative staging of lung cancer.