Results of Echoendoscopic Ultrasound in Mediastinal Nodal Staging of Lung Cancer

Aim : To evaluate the sensitivity and predictive negative value (PNV) of endobronchial ultrasound (EBUS) in patients with non small cell lung cancer (NSCLC). Methods : Descriptive retrospective transversal study of all performed EBUS in a tertiary hospital during a 3 year period, for mediastinal nodal staging of NSCLC with fluorodeoxyglucose positron emission tomography positive nodes. Cases were considered positive (PC) when nodal metastases was demonstrated. If not, were considered as non-positive cases (NPC) and a mediastinoscopy was performed, if the clinical situation of the patient allowed the procedure. Results : A total number of 41 patients were evaluated, 34 of them male and 7 female. Mean age was 65,39 years old. EBUS results were: 22 PC and 19 NPC. Mediastinoscopy was performed to the NPC supporting the negative result in 14 cases, but showed a positive result in other 3 cases. In 2 cases no additional testing was done. We found 3 false negative cases (17,64%), a VPN of 82% and a sensitivity of 88% for EBUS in our patient series. EBUS was able to stage 20 cases as N2 and 2 cases as N3. In four N2 staged cases a neoadyuvant therapy was applied and then a mediastinoscopy was performed previous to the surgery. Conclusions : In this patient series EBUS allowed us to avoid more than a 50% of prognostic mediastinoscopies in NSCLC, given the high NPV and sensitivity we obteined with this technique. In cases staged as N2 responding to neoadyuvant therapy, a mediastinal reevaluation can be performed through a mediastinoscopy.