Skip to main content

Advertisement

SpringerLink
Log in

Negative Predictive Value of Granulomas on EBUS-TBNA in Suspected Extrathoracic Malignancy

  • Published:
Lung Aims and scope Submit manuscript

Abstract

Purpose

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a well-established diagnostic tool for lung cancer, sarcoidosis, and suspected metastatic extrathoracic malignancy. EBUS-TBNA carries a high diagnostic yield, but its negative predictive value (NPV) requires further clarification.

Methods

We reviewed EBUS-TBNA at our cancer center from 2008 to 2015. We identified negative diagnostic samples for adenopathy suspected to represent metastatic disease from extrathoracic malignancy.

Results

We reviewed 529 EBUS-TBNAs. Ninety patients underwent EBUS-TBNA sampling of the hilum and/or mediastinum (121 nodes, 14 masses) for suspected extrathoracic malignancy. Thirty-seven patients had negative samples (lymph node, granulomas or non-diagnostic specimens). The overall NPV was 98 %. Granulomas (11 patients, 25 nodes) seen on histology had a 100 % NPV, including those that were FDG-PET (fluorodeoxyglucose positron emission tomography) avid (n = 14 nodes).

Conclusion

Negative EBUS-TBNA in patients with extrathoracic malignancy and suspected secondary hilar or mediastinal metastases can infer a high NPV especially if granulomas are seen on histology. Larger prospective investigations are needed to confirm the high NPV of EBUS-TBNA with granulomas in extrathoracic malignancies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

EBUS-TBNA:

Endobronchial ultrasound-guided transbronchial needle aspiration

NPV:

Negative predictive value

FDG-PET:

Fluorodeoxyglucose positron emission tomography

CT:

Computed tomography

SUV:

Maximum standardized uptake value

References

  1. Navani N, Nankivell M, Woolhouse I et al (2011) Endobronchial ultrasound-guided transbronchial needle aspiration for the diagnosis of intrathoracic lymphadenopathy in patients with extrathoracic malignancy: a multicenter study. J Thorac Oncol 6:1505–1509

    Article  PubMed  PubMed Central  Google Scholar 

  2. Sanz-Santos J, Cirauqui B, Sanchez E et al (2013) Endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of intrathoracic lymph node metastases from extrathoracic malignancies. Clin Exp Metastasis 30:521–528

    Article  PubMed  PubMed Central  Google Scholar 

  3. Rintoul RC, Ahmed R, Doughert B, Carroll NR (2015) Linear endobronchial ultrasonography: a novelty turned necessity for mediastinal nodal assessment. Thorax 70:175–180

    Article  PubMed  Google Scholar 

  4. Suen JS, Forse MS, Hyland RH et al (1990) The malignancy-sarcoidosis syndrome. Chest 98:1300–1302

    Article  CAS  PubMed  Google Scholar 

  5. Brinker H (1986) Sarcoid reactions in malignant tumours. Cancer Treat Rev 13:147–156

    Article  Google Scholar 

  6. DePew ZS, Gonsalves WI, Roden AC et al (2012) Granulomatous inflammation detected by endobronchial ultrasound-guided transbronchial needle aspiration in patients with a concurrent diagnosis of cancer: a clinical conundrum. J Bronchol Interv Pulmonol 19:176–181

    Article  Google Scholar 

  7. Tomimaru Y, Higashiyama M, Okami J et al (2007) Surgical results of lung cancer with sarcoid reaction in regional lymph nodes. Jpn J Clin Oncol 37:90–95

    Article  PubMed  Google Scholar 

  8. Trisolini R, Cancellieri A, Petelli M et al (2009) May sarcoidal reaction and malignant features coexist in regional lymph nodes of non-small cell lung cancer patients? Lung Cancer 66:272–273

    Article  PubMed  Google Scholar 

  9. Steinfort DP, Irving LB (2009) Sarcoidal reactions in regional lymph nodes of patients with non0small cell lung cancer: incidence and implications for minimally invasive staging with endobronchial ultrasound. Lung Cancer 66:305–308

    Article  PubMed  Google Scholar 

  10. Kennedy MP, Jimenez CA, Mhatre AD et al (2008) Clinical implications of granulomatous inflammation detected by endobronchial ultrasound transbronchial needle aspiration in patients with suspected cancer recurrence in the mediastinum. J Cardiothorac Surg 3:8

    Article  PubMed  PubMed Central  Google Scholar 

  11. Park J, Jang SJ, Park YS et al (2011) Endobronchial ultrasound-guided transbronchial needle biopsy for diagnosis of mediastinal lymphadenopathy in patients with extrathoracic malignancy. J Korean Med Sci 26:274–278

    Article  PubMed  PubMed Central  Google Scholar 

  12. Grosu HB, Ost DE, Morice RC et al (2015) Mediastinal granulomatous inflammation and overall survival in patients with a history of malignancy. Ann ATS 12:1534–1541

    Article  Google Scholar 

  13. Butt S, Alzebdeh R, Kable TD et al (2011) Non-caseating granulomas in patients after the diagnosis of cancer: clinical characteristics and outcome. Sarcoidosis Vasc Diffuse Lung Dis 28:44–49

    CAS  PubMed  Google Scholar 

  14. Riquet M, Berna P, Brian E et al (2009) Intrathoracic lymph node metastases from extrathoracic carcinoma: the place for surgery. Ann Thorac Surg 88:200–205

    Article  PubMed  Google Scholar 

Download references

Author's Contribution

Christina R. Bellinger: guarantor, study design, data collection and analysis, paper composition, editing paper; Deepankar Sharma: data collection, paper composition; Jimmy Ruiz: paper composition, editing; Graham Parks: cytopathology images and descriptions, editing paper; Edward F. Haponik: editing paper; Travis Dotson: data collection, editing paper.

Author information

Authors and Affiliations

  1. Department of Pulmonary/Critical Care, Wake Forest Baptist Health, Medical Center Blvd, Winston Salem, NC, 27157, USA

    Christina R. Bellinger, Deepankar Sharma, Travis Dotson & Edward F. Haponik

  2. Department of Medicine, Section on Hematology and Oncology Comprehensive Cancer, Center of Wake Forest University, Winston Salem, NC, 27157, USA

    Jimmy Ruiz

  3. W.G. (Bill).Hefner Veteran Administration Medical Center, Salisbury, NC, 28144, USA

    Jimmy Ruiz

  4. Department of Pathology, Wake Forest Baptist Health, Winston Salem, NC, 27157, USA

    Graham Parks

Authors
  1. Christina R. Bellinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Deepankar Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jimmy Ruiz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Graham Parks
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Travis Dotson
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Edward F. Haponik
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christina R. Bellinger.

Ethics declarations

Conflict of interest

None.

Additional information

Approval from Institutional Review Board at Wake Forest University, ID IRB00013684.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bellinger, C.R., Sharma, D., Ruiz, J. et al. Negative Predictive Value of Granulomas on EBUS-TBNA in Suspected Extrathoracic Malignancy. Lung 194, 387–391 (2016). https://doi.org/10.1007/s00408-016-9878-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00408-016-9878-z

Keywords

Search

Navigation