Original article
General thoracic
Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in the Management of Previously Treated Lung Cancer

Presented at the Forty-seventh Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 31-Feb 2, 2011.
https://doi.org/10.1016/j.athoracsur.2011.03.007Get rights and content

Background

This study evaluated the role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the assessment of newly developed mediastinal/hilar abnormalities in patients with previously treated lung cancer.

Methods

All EBUS-TBNA cases between July 2008 and October 2010 were retrospectively reviewed. Results of EBUS-TBNA in previously treated lung cancer patients were analyzed. Cancer treatments, numbers of stations biopsied, and pathologic results were recorded. Nonmalignant cytopathology was confirmed with clinical follow-up for benign results.

Results

Of 450 patients who underwent EBUS-TBNA, 44 (9.8%) had previous lung cancer treatment, comprising non-small cell lung cancer in 40, small-cell lung cancer in 3, and typical carcinoid in 1. No EBUS-TBNA was performed for lung cancer restaging. Primary treatments included surgical resection in 22, resection with adjuvant/neoadjuvant therapy in 11, chemoradiation in 5, chemotherapy in 4, and radiotherapy in 2. At the primary treatment, 23 of 44 patients had mediastinoscopy. EBUS-TBNA of mediastinal lymph nodes was performed in 40. An average of 1.7 stations were biopsied (range, 1 to 5). The positive EBUS-TBNA in 28 included mediastinal/hilar recurrence of primary lung cancer (ie, same cell type as primary cancer) in 21, and possible new primary lung cancer (ie, different cell type from primary lung cancer) in 7. The sensitivity, specificity, and diagnostic accuracy were 93.1%, 100%, and 95.1%, respectively.

Conclusions

EBUS-TBNA can differentiate a new primary lung cancer from recurrence of previously treated lung cancer, which will facilitate treatment strategy.

Section snippets

Patients and Methods

This single-center, retrospective study with prospective follow-up was approved by the Research Ethics Board of University Health Network, the University of Toronto. All EBUS-TBNA procedures performed at the Toronto General Hospital, University of Toronto between July 2008 and October 2010 were identified from our database. Age, sex, history of cancer before EBUS-TBNA, type of cancer, cancer stage, type of treatment, and follow-up information, including cancer recurrence, were collected from

Results

During the study period, 456 EBUS-TBNA procedures were performed in 450 patients. Patient characteristics and the indication of EBUS-TBNA are reported in Table 1. The leading indication of EBUS-TBNA in our institution was lung cancer staging, followed by the assessment of mediastinal/hilar lymphadenopathy. In 13 patients with a lung mass suspicious of cancer, EBUS-TBNA was done to obtain cytologic diagnosis because EBUS allowed visualization of centrally located lesions for biopsy.

Of 450

Comment

New mediastinal/hilar lymphadenopathy after primary therapy in patients with lung cancer is common, but it is still a challenge to reach a definitive diagnosis of mediastinal/hilar cancer recurrence with the current imaging modalities, including CT scan and PET scan. Those who underwent surgical resection of lung cancer are often not good candidates for surgical staging because they may have undergone mediastinal lymphadenectomy or mediastinoscopy at the time of their initial treatment. Repeat

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