TY - JOUR
T1 - Multicentric study of endobronchial ultrasound-transbronchial needle aspiration for lung cancer staging in Italy
AU - Rotolo, Nicola
AU - Imperatori, Andrea
AU - Nosotti, Mario
AU - Santambrogio, Luigi
AU - Palleschi, Alessandro
AU - Dominioni, Lorenzo
AU - Crosta, Giorgio
AU - Foccoli, Pierfranco
AU - Pariscenti, Gianluca
AU - Passera, Eliseo
AU - Bortolotti, Luigi
AU - Falezza, Giovanni
AU - Infante, Maurizio
AU - Daffrè, Elisa
AU - Cattoni, Maria
AU - Rosso, Lorenzo
PY - 2017/5/1
Y1 - 2017/5/1
N2 - Background: Multi-institutional studies of endobronchial-ultrasound transbronchial needle aspiration (EBUS-TBNA) for mediastinal staging in lung cancer are scarce. It is unclear if the high diagnostic performance of EBUS-TBNA reported by experts' guidelines can be generally achieved. Methods: This is a retrospective study performed in five tertiary referral centers of thoracic surgery in Italy, to assess the EBUS-TBNA diagnostic performance in patients with non-small cell lung cancer (NSCLC). Patient inclusion criteria were: both genders; > 18 years old; with suspect/confirmed NSCLC; undergoing EBUSTBNA for mediastinal node enlargement at computed tomography (size > 1 cm, ≤3 cm) and/or pathological uptake at positron emission tomography. Altogether we included 485 patients [male, 366; female, 119; median age, 68 years (IQR, 61-74 years)] undergoing mediastinal staging between January 2011 and July 2016. All EBUS-TBNAs were performed by experienced bronchoscopists, without pre-defined quality standards. Depending on usual practice in each center, EBUS-TBNA was done under conscious sedation, with 21- or 22-Gauge (G) needle, and specimen preparation was cell-block, or cytology slides, or core-tissue. Sampling was classified inadequate in absence of lymphocytes, or when sample was insufficient. We analyzed the EBUSTBNA procedural steps likely to influence the rate of adequate samplings (diagnostic yield). Results: EBUS-TBNA sensitivity, negative predictive value (NPV) and accuracy respectively were 90%, 78% and 93% in the whole cohort. At multivariate analysis, use of 21-G needle was associated with better diagnostic yield (P < 0.001). Center and specimen processing technique were not independent factors affecting EBUS-TBNA diagnostic yield. Conclusions: In this multicentric study, EBUS-TBNA was a highly sensitive and accurate method for NSCLC mediastinal node staging. Results indicate better performance of EBUS-TBNA with 21-G needle, and suggest that specimen processing technique could be chosen according to the local practice preference.
AB - Background: Multi-institutional studies of endobronchial-ultrasound transbronchial needle aspiration (EBUS-TBNA) for mediastinal staging in lung cancer are scarce. It is unclear if the high diagnostic performance of EBUS-TBNA reported by experts' guidelines can be generally achieved. Methods: This is a retrospective study performed in five tertiary referral centers of thoracic surgery in Italy, to assess the EBUS-TBNA diagnostic performance in patients with non-small cell lung cancer (NSCLC). Patient inclusion criteria were: both genders; > 18 years old; with suspect/confirmed NSCLC; undergoing EBUSTBNA for mediastinal node enlargement at computed tomography (size > 1 cm, ≤3 cm) and/or pathological uptake at positron emission tomography. Altogether we included 485 patients [male, 366; female, 119; median age, 68 years (IQR, 61-74 years)] undergoing mediastinal staging between January 2011 and July 2016. All EBUS-TBNAs were performed by experienced bronchoscopists, without pre-defined quality standards. Depending on usual practice in each center, EBUS-TBNA was done under conscious sedation, with 21- or 22-Gauge (G) needle, and specimen preparation was cell-block, or cytology slides, or core-tissue. Sampling was classified inadequate in absence of lymphocytes, or when sample was insufficient. We analyzed the EBUSTBNA procedural steps likely to influence the rate of adequate samplings (diagnostic yield). Results: EBUS-TBNA sensitivity, negative predictive value (NPV) and accuracy respectively were 90%, 78% and 93% in the whole cohort. At multivariate analysis, use of 21-G needle was associated with better diagnostic yield (P < 0.001). Center and specimen processing technique were not independent factors affecting EBUS-TBNA diagnostic yield. Conclusions: In this multicentric study, EBUS-TBNA was a highly sensitive and accurate method for NSCLC mediastinal node staging. Results indicate better performance of EBUS-TBNA with 21-G needle, and suggest that specimen processing technique could be chosen according to the local practice preference.
KW - Accuracy
KW - Diagnostic yield
KW - Endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA)
KW - Lung cancer staging
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U2 - 10.21037/jtd.2017.04.26
DO - 10.21037/jtd.2017.04.26
M3 - Article
AN - SCOPUS:85019558116
VL - 9
SP - S370-S375
JO - Journal of Thoracic Disease
JF - Journal of Thoracic Disease
SN - 2072-1439
ER -