Analysis of Subcarinal Lymph Nodes in (Suspected) Non-Small-Cell Lung Cancer after a Negative Transbronchial Needle Aspiration – What’s Next?

Vol. 71, No. 6, 2004

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Interventional Pulmonology

Analysis of Subcarinal Lymph Nodes in (Suspected) Non-Small-Cell Lung Cancer after a Negative Transbronchial Needle Aspiration - What's Next?
A Preliminary Report
Jouke T. Annema^a, Maud Veseliç^b, Klaus F. Rabe^a

Departments of
^aPulmonology and
^bPathology, Leiden University Medical Center, Leiden, The Netherlands

Address of Corresponding Author

Respiration 2004;71:630-634 (DOI: 10.1159/000081765)

Key Words

Endoscopic ultrasound-guided fine needle aspiration
Non-small-cell lung cancer
Staging
Transbronchial needle aspiration

Abstract

Background: Transbronchial needle aspiration (TBNA) of subcarinal lymph nodes (LN) has a variable yield. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has demonstrated a high accuracy in the analysis of enlarged subcarinal LN. Objective: To assess the diagnostic accuracy of EUS-FNA in the analysis of enlarged subcarinal LN previously staged tumor negative by TBNA. Methods and Patients: In this retrospective study, we included all patients with (suspected) lung cancer and enlarged (>1 cm on CT) subcarinal LNs staged tumor negative by TBNA, who were subsequently staged by EUS-FNA. In addition, surgical-pathological information had to be available in those cases in which EUS-FNA was tumor negative. Results: Subcarinal LN metastases were assessed by EUS-FNA in 10 of 14 patients (71%). In 1 patient granulomas without necrosis were found. The remaining 3 patients staged tumor negative by both TBNA and EUS-FNA had reactive LN tissue, which was confirmed by surgical-pathological staging. Sensitivity, specificity and diagnostic accuracy of EUS in analyzing TBNA-negative LNs was 100% in all. Conclusions: In patients with (suspected) lung cancer and enlarged subcarinal LNs staged tumor negative by TBNA, additional staging by EUS-FNA confirmed subcarinal LN metastasis in 71% of the patients. These data suggest that for the analysis of the subcarinal LNs the real-time controlled technique of EUS-FNA is superior to the 'blind' technique of TBNA.

Author Contacts

Jouke T. Annema, MD
Department of Pulmonology C3 P, Albinusdreef 2
PO Box 9600, Leiden University Medical Center
NL-2300 RC Leiden (The Netherlands)
Tel. +31 71 5262950, Fax +31 71 5266927, E-Mail j.t.annema@lumc.nl

Article Information

Received: September 18, 2003
Accepted after revision: February 25, 2004
Number of Print Pages : 5
Number of Figures : 3, Number of Tables : 1, Number of References : 24

Medline Abstract (ID 15627875)

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