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The role of endobronchial ultrasonography for mediastinal lymphadenopathy in cases with extrathoracic malignancy

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Abstract

Introduction

Many extrathoracic malignancies can metastasize to lungs and mediastinal lymph nodes. Whether mediastinal lesions are metastasis in these patients changes staging, prognosis, and treatment strategy. In this study, we aimed to find out the contribution of EBUS-TBNA to the diagnosis in cases with extrathoracic malignancy.

Materials and methods

Patients who had been previously diagnosed as extrapulmonary solid organ malignancy and in whom mediastinal or hilar lymphadenopathy developed during their follow-up and EBUS-TBNA was applied for diagnostic purposes were retrospectively included in this study.

Results

A total of 91 patients consisting of 35 females (38.5 %) and 56 males (61.5 %) were included in the study. The mean age of the patients was 60.5 (±11.4). Malignancy was not observed in 54 (59.3 %) patients; primary malignancy metastasis was detected in 33 (36.3 %) patients, and primary lung cancer was detected in 4 (4.4 %) patients with EBUS-TBNA. The sensitivity of EBUS-TBNA in extrathoracic malignancies was determined as 90.2 %; its specificity was determined as 100 %, its negative predictive value as 92.5 %, its positive predictive value as 100 %, and its diagnostic accuracy as 95.6 %. The highest rate was determined in the left lower paratracheal lymph node when they were examined in terms of malignancy detection rate in lymph node stations.

Conclusion

EBUS-TBNA is a minimally invasive method with quite a low complication rate that does not require general anesthesia. It should be the first step method to be used in the diagnosis of mediastinal and hilar lymphadenopathies seen in extrathoracic malignancies since it has high diagnostic accuracy, sensitivity, and specificity. EBUS-TBNA significantly reduces the need for surgical intervention. Further surgical interventions can be planned in patients in whom diagnostic competence is not ensured.

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Authors’ Contribution

Kemal Can Tertemiz, principal study investigator, participated in the design of the study, drafting the manuscript and revising. Aylin Ozgen Alpaydin participated in the design of the study and in drafting the manuscript. Volkan Karacam participated in the design of the study and in drafting the manuscript. All authors read and approved the final manuscript.

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Authors and Affiliations

  1. Department of Pulmonary Diseases, Dokuz Eylul University Medical Faculty, 35340, Balcova, Izmir, Turkey

    Kemal Can Tertemiz & Aylin Ozgen Alpaydin

  2. Thoracic Surgery, Dokuz Eylul University Medical Faculty, Balcova, Izmir, Turkey

    Volkan Karacam

Authors
  1. Kemal Can Tertemiz
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  2. Aylin Ozgen Alpaydin
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  3. Volkan Karacam
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Corresponding author

Correspondence to Kemal Can Tertemiz.

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Disclosures

Drs. Tertemiz, Ozgen Alpaydin, and Karacam have no conflict of interest or financial ties to disclose.

Summary at a Glance

In this study, it is shown that EBUS-TBNA should be the first step method to be used in the diagnosis of mediastinal and hilar lymphadenopathies seen in extrathoracic malignancies since it has high diagnostic accuracy, sensitivity, and specificity. EBUS-TBNA significantly reduces the need for surgical intervention. All coauthors declare that Dr. Kemal Can Tertemiz is responsible for editorial correspondence. This manuscript, including related data, figures, and tables, has not been published previously and that the manuscript is not under consideration elsewhere.

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Tertemiz, K.C., Alpaydin, A.O. & Karacam, V. The role of endobronchial ultrasonography for mediastinal lymphadenopathy in cases with extrathoracic malignancy. Surg Endosc 31, 2829–2836 (2017). https://doi.org/10.1007/s00464-016-5293-z

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  • DOI: https://doi.org/10.1007/s00464-016-5293-z

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