EBUS‐TBNA for mediastinal staging of centrally located T1N0M0 non‐small cell lung cancer clinically staged with PET/CT

Abstract Background and Objective To evaluate the diagnostic accuracy and clinical usefulness of endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) for mediastinal staging of centrally located T1N0M0 non‐small cell lung cancer (NSCLC) clinically staged with positron emission tomography/computed tomography (PET/CT). Methods We conducted a study that included patients with centrally located T1N0M0 NSCLC, clinically staged with PET/CT who underwent EBUS‐TBNA for mediastinal staging. Patients with negative EBUS‐TBNA underwent mediastinoscopy, video‐assisted mediastinoscopic lymphadenectomy (VAMLA) and/or lung resection with systematic nodal dissection, that were considered the gold standard. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), overall accuracy of EBUS‐TBNA for diagnosing mediastinal metastases (N2 disease) and the number needed to treat (NNT: number of patients needed to undergo EBUS‐TBNA to avoid a case of pathologic N2 disease after resection) were calculated. Results One‐hundred eighteen patients were included. EBUS‐TBNA proved N2 disease in four patients. In the remaining 114 patients who underwent mediastinoscopy, VAMLA and/or resection there were two cases of N2 (N2 prevalence 5.1%). The sensitivity, specificity, NPV, PPV and overall accuracy for diagnosing mediastinal metastases (N2 disease) were of 66%, 100%, 98%, 100% and 98%, respectively. The NNT was 31 (95% CI: 15–119). Conclusion EBUS‐TBNA in patients with central clinically staged T1N0M0 NSCLC presents a good diagnostic accuracy for mediastinal staging, even in a population with low prevalence of N2 disease. Therefore, its indication should be considered in the management of even these early lung cancers.