What is the role of endobronchial ultrasound (EBUS) in the staging of non-small cell lung cancer (NSCLC)?

Updated: Apr 24, 2019
  • Author: Narayan Neupane, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Answer

Staging of non-small cell lung cancer (NSCLC)

EBUS-guided transbronchial needle aspiration (TBNA) has higher diagnostic yield than conventional TBNA in all lymph node stations except subcarinal lymph nodes in determining the lymph node involvement in NSCLC. [8] Its ability to precisely visualize the airway wall invasion helps to categorize the tumor (T) component of staging and surgical resection planning. [9] It can be combined with endoscopic ultrasound-guided fine-needle aspiration to near complete sampling of mediastinum using a single endobronchial ultrasound bronchoscope. [10] It can also be used to restage lung cancer in the mediastinum. [11]  A 22- or 21-gauge EBUS needle is recommended for lung cancer diagnosis and staging. [12]  In cases in which additional sample tissue is needed, a 19-gauge needle may provide an increased diagnostic yield. [13, 14]

In a study of 209 patients who underwent sampling of hilar/mediastinal lymph nodes for the diagnosis/staging of lung cancer (99 EBUS-TBNA vs 110 c-TBNA), EBUS-TBNA was found to have significantly better results than conventional TBNA in terms of diagnostic accuracy (94.2% vs 89.7%), sample adequacy (70.3% vs 42%), and sensitivity (93% vs 86.4%) for lymph nodes < 2 cm. There were no significant differences in diagnostic accuracy, adequacy, and sensitivity for lymph nodes ≥2 cm. [15]


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