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Endobronchial ultrasound-transbronchial needle aspiration: effectiveness and accuracy in non-small cell lung cancer staging

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Abstract

Introduction

Endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) has a cardinal role in the diagnosis and staging of non-small cell lung cancer (NSCLC), providing an accurate nodal staging in a less invasive way than surgical biopsy. The aim of this study was to assess the diagnostic accuracy of EBUS-TBNA in the pre-operative NSCLC mediastinal staging, as well as to evaluate EBUS-TBNA specificity and sensibility in our cohort.

Methods

We retrospectively analyzed data of NSCLC patients who underwent EBUS-TBNA followed by major pulmonary resection between January 2020 and December 2022. EBUS-TBNA was performed in patients with NSCLC (central T ≤ 3 cm, peripheral/central T > 3 cm), following the ESTS guidelines. The target nodes were selected on the basis of their radiologic/metabolic characteristics. Each procedure was conducted together with rapid on-site cytological evaluation (ROSE).

Results

Twenty-five patients were included (M/F = 17/8). At least three needle passages on each target lymph node were performed. No complications during or after the procedures occurred. We found a 100% correspondence between ROSE on the sampled nodes and postoperative pathologic findings. An upstaging occurred in three cases (12%) because of the involvement of stations 5 and 6 (not accessible via EBUS), while the only case of downstaging (N2 → N0, 4%) was probably due to intercurrent neoadjuvant chemotherapy. In all cases, EBUS-TBNA has proved to achieve a diagnostic procedure on the target nodes.

Conclusions

EBUS-TBNA is a safe and effective procedure that offers high sensitivity and specificity when performed together with ROSE, which improves the accuracy of sampling. Doubt on nodal stations 5 and 6 involvement should be settled by other techniques.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author, E.G., on reasonable request.

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Funding

No funds, grants, or other support was received.

Author information

Author notes

  1. Maria Giovanna Mastromarino and Elena Guerrini have equally contributed to this work.

Authors and Affiliations

  1. Division of Thoracic Surgery, Cardiac, Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy

    Maria Giovanna Mastromarino, Elena Guerrini, Giacomo Rabazzi, Vittorio Aprile, Stylianos Korasidis, Marco Lucchi & Marcello Carlo Ambrogi

  2. Thoracic Endoscopy Unit, Cardiac, Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy

    Diana Bacchin, Alessandro Picchi, Olivia Fanucchi & Alessandro Ribechini

  3. Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy

    Elena Guerrini, Giacomo Rabazzi, Diana Bacchin, Greta Alì, Marco Lucchi & Marcello Carlo Ambrogi

  4. Unit of Pathological Anatomy, University Hospital of Pisa, Pisa, Italy

    Greta Alì

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  1. Maria Giovanna Mastromarino
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Contributions

Conceptualization: MGM, EG, and DB. Data curation: EG, GR, and AP. Formal Analysis: MGM, EG, DB, and VA. Funding acquisition: n.a. Investigation: EG, GR, DB, and GA. Methodology: MGM, DB, and OF. Project administration: ML, MCA, AP, and OF. Resources: MGM, SK, MCA, ML, and GA. Software: DB and EG. Supervision: MGM, ML, and AR. Validation: MCA, ML, and AR. Visualization: all the authors. Writing—original draft: MGM, EG, and DB. Writing—review and editing: all the authors.

Corresponding author

Correspondence to Elena Guerrini.

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Competing interests

The authors have no competing interests to declare that are relevant to the content of this article.

Ethics approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments. Ethical approval was waived by the local Ethics Committee of University Hospital of Pisa in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

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Mastromarino, M.G., Guerrini, E., Rabazzi, G. et al. Endobronchial ultrasound-transbronchial needle aspiration: effectiveness and accuracy in non-small cell lung cancer staging. Updates Surg (2024). https://doi.org/10.1007/s13304-024-01777-8

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