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Ann Thorac Surg. 2010 Aug;90(2):427-34. doi: 10.1016/j.athoracsur.2010.04.062.

The true false negative rates of esophageal and endobronchial ultrasound in the staging of mediastinal lymph nodes in patients with non-small cell lung cancer.

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1
JH Estes Endowed Chair for Lung Cancer Research, University of Alabama at Birmingham, Birmingham, AL 35294, USA. robert.cerfolio@ccc.uab.edu

Abstract

BACKGROUND:

Accurate false negative rates for endobronchial ultrasound (EBUS) and esophageal ultrasound (EUS) for mediastinal (N2) lymph nodes are unknown.

METHODS:

A retrospective review of patients with non-small cell lung cancer (NSCLC) underwent integrated positron emission tomography and computed tomography (PET/CT) and CT scan. All suspicious N2 lymph nodes were biopsied before thoracotomy. The EBUS was performed for suspicious nodes in stations 2R, 4R, 4L, 5, and 7; the EUS was performed for 4L, 4R, 5, 7, 8, and 9. Mediastinoscopy was performed in selected patients if they were negative by EUS/EBUS; if N2 negative, all patients underwent thoracotomy with complete thoracic lymphadenectomy.

RESULTS:

There were 425 patients over a 2-year period, and 234 had suspected N2 disease. Of these patients, 72 had an EBUS; 16 were positive for N2 disease and 12 were false negative (7 patients at station 4R/4L, 4 patients at station 7; patient sensitivity 57%, negative predictive value 79%, accuracy 83%). Seventy-nine patients had EUS; 20 patients were positive for N2 disease and 12 were false negative (4 patients at station 4R/4L, 4 patients at station 7; patient sensitivity 63%, negative predictive value 80%, accuracy 85%). One hundred and forty-six patients had mediastinoscopy, which revealed N2 or N3 disease in 42 patients, and 7 were false negative (patient sensitivity 88%, negative predictive value 93%, accuracy 95%).

CONCLUSIONS:

Both EBUS and EUS are useful initial tests to biopsy suspicious N2 mediastinal lymph nodes; however, as EBUS and EUS have high false negative rates, especially at stations 4R and 7, mediastinoscopy is still required for patients with suspicious nodal disease in these stations.

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