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CC BY-NC-ND 4.0 · Journal of Clinical Interventional Radiology ISVIR 2024; 08(01): 035-043
DOI: 10.1055/s-0044-1779670
Original Article

Role of EBUS-TBNA in Mediastinal Staging of NSCLC Patients

Kunal B. Gala 
1   Division of Interventional Radiology, Department of Radiodiagnosis, Tata Memorial Hospital, affiliated to Department of Radiodiagnosis, Homi Bhabha National University (HBNI), Mumbai, India
,
Nitin S. Shetty 
2   Department of Radiodiagnosis, ACTREC, affiliated to Homi Bhabha National University (HBNI), Mumbai, India
,
Saketh Rao
1   Division of Interventional Radiology, Department of Radiodiagnosis, Tata Memorial Hospital, affiliated to Department of Radiodiagnosis, Homi Bhabha National University (HBNI), Mumbai, India
,
C.S. Pramesh
3   Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Hospital, affiliated to Homi Bhabha National University (HBNI), Mumbai, India
,
Sabita Jiwnani
3   Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Hospital, affiliated to Homi Bhabha National University (HBNI), Mumbai, India
,
Virendra Kumar
3   Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Hospital, affiliated to Homi Bhabha National University (HBNI), Mumbai, India
,
Sandeep Tandon
4   Department of Pulmonary Medicine, Tata Memorial Hospital, affiliated to Homi Bhabha National University (HBNI), Mumbai, India
,
Maheema Bhasker
4   Department of Pulmonary Medicine, Tata Memorial Hospital, affiliated to Homi Bhabha National University (HBNI), Mumbai, India
,
Rajiv Khushal
5   Department of Pathology, Tata Memorial Hospital, affiliated to Homi Bhabha National University (HBNI), Mumbai, India
,
Suyash Kulkarni 
1   Division of Interventional Radiology, Department of Radiodiagnosis, Tata Memorial Hospital, affiliated to Department of Radiodiagnosis, Homi Bhabha National University (HBNI), Mumbai, India
› Author Affiliations Funding None.
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Abstract

Purpose Mediastinal staging in non-small-cell lung carcinoma (NSCLC) is essential for appropriate treatment. Invasive mediastinal staging is necessary and mediastinoscopy has been the gold standard, but it is associated with morbidity. The aim of this study is to evaluate the efficacy of endobronchial ultrasonography transbronchial needle aspiration (EBUS-TBNA), compare it with mediastinoscopy, and assess the endosonographic features of lymph nodes for prediction of metastasis.

Methods This is a retrospective study of 200 patients with NSCLC who underwent EBUS-TBNA from January 2017 to December 2019. The patients with potentially resectable NSCLC who underwent EBUS-TBNA were included. Standard definitions of sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and diagnostic accuracy were used to determine the diagnostic performance of EBUS-TBNA.

Results A total of 200 patients and 616 nodes were studied, out of which 515 were benign and 101 were malignant. Out of 200 cases, 129 (64.5%) had <N2 disease, 59 (29.5%) had N2 disease, and 12 (6%) had N3 disease. EBUS-TBNA had a sensitivity of 78.87%, specificity of 96.12%, NPV of 89.2%, PPV of 91.8%, and accuracy of 90%. Ultrasonography (USG) features of 297 nodes were available and statistical significance was seen in rounded shape, size greater than 10 mm, ill-defined nodal margins, absence of hilum, and hypoechoic echotexture (p < 0.05).

Conclusion EBUS-TBNA is a safe and efficacious procedure for mediastinal sampling of NSCLC patients. Familiarity with endosonographic features of lymph nodes, which can predict malignancy in nodes, may further improve the yield of EBUS-TBNA and reduce under-staging.

Keywords

endobronchial ultrasound - FNA - non-small-cell lung cancer

Ethical Approval

The study was performed after approval from the Institutional Ethics Committee (IEC).




Publication History

Article published online:
06 March 2024

© 2024. Indian Society of Vascular and Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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