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Diagnostic value of EBUS-TBNA for lung cancer with non-enlarged lymph nodes: a study in a tuberculosis-endemic country.

Kuo CH, Chen HC, Chung FT, Lo YL, Lee KY, Wang CW, Kuo WH, Yen TC, Kuo HP - PLoS ONE (2011)

Bottom Line: Compared to CT-based nodal assessment, PET yielded a positive diagnostic impact in 36.9% nodes, a negative diagnostic impact in 46.2% nodes, and no diagnostic impact in 16.9% nodes.Patients with lymph nodes showing negative PET diagnostic impact had a high incidence of previous pulmonary TB.Multivariate analysis indicated that detection of hilar nodes on PET was an independent predictor of negative diagnostic impact of PET.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University School of Medicine, Taipei, Taiwan.

ABSTRACT

Background: In tuberculosis (TB)-endemic areas, contrast-enhanced computed tomography (CT) and positron emission tomography (PET) findings of lung cancer patients with non-enlarged lymph nodes are frequently discrepant. Endobronchial ultrasound-guided transbronchial aspiration (EBUS-TBNA) enables real-time nodal sampling, and thereby improves nodal diagnosis accuracy. This study aimed to compare the accuracy of nodal diagnosis by using EBUS-TBNA, and PET.

Methods: We studied 43 lung cancer patients with CT-defined non-enlarged mediastinal and hilar lymph nodes and examined 78 lymph nodes using EBUS-TBNA.

Results: The sensitivity, specificity, positive predictive value, and negative predictive value of EBUS-TBNA were 80.6%, 100%, 100%, and 85.7%, respectively. PET had low specificity (18.9%) and a low positive predictive value (44.4%). The diagnostic accuracy of EBUS-TBNA was higher than that of PET (91% vs. 47.4%; p<0.001). Compared to CT-based nodal assessment, PET yielded a positive diagnostic impact in 36.9% nodes, a negative diagnostic impact in 46.2% nodes, and no diagnostic impact in 16.9% nodes. Patients with lymph nodes showing negative PET diagnostic impact had a high incidence of previous pulmonary TB. Multivariate analysis indicated that detection of hilar nodes on PET was an independent predictor of negative diagnostic impact of PET.

Conclusion: In a TB-endemic area with a condition of CT-defined non-enlarged lymph node, the negative diagnostic impact of PET limits its clinical usefulness for nodal staging; therefore, EBUS-TBNA, which facilitates direct diagnosis, is preferred.

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Related in: MedlinePlus

A representative case of a PET scan with negative impact.(A) The contrast-enhanced CT scan shows small lymph nodes measuring 0.8×0.6 cm in the subcarinal area. (B) The PET scan shows increased FDG uptake at the corresponding site (gall bladder uptake due to cholecystitis). (C) The subcarinal lymph node was later targeted by EBUS-TBNA(D) A tissue core, which revealed granulomatous inflammation consisting of epithelioid histiocytes (upper right; H&E stain, 200×) was obtained.
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pone-0016877-g002: A representative case of a PET scan with negative impact.(A) The contrast-enhanced CT scan shows small lymph nodes measuring 0.8×0.6 cm in the subcarinal area. (B) The PET scan shows increased FDG uptake at the corresponding site (gall bladder uptake due to cholecystitis). (C) The subcarinal lymph node was later targeted by EBUS-TBNA(D) A tissue core, which revealed granulomatous inflammation consisting of epithelioid histiocytes (upper right; H&E stain, 200×) was obtained.

Mentions: Compared to CT-based nodal assessment, 24 nodes detected by PET were true-positive, yielding a 36.9% positive impact incidence (Table 3). Thirty nodes detected by PET were false-positive, which accounted for a 46.2% negative impact incidence. Seven and 4 lymph nodes were PET-true-negative and PET-false-negative, respectively, and were together responsible for a 16.9% incidence of no impact. Patients with lymph nodes yielding negative PET scan diagnostic impact were thoroughly investigated to rule out the presence of pulmonary diseases other than lung cancer. Of the 17 patients examined, 7 (41.2%) had previous pulmonary TB, 3 (17.6%) had pneumoconiosis, 1 (5.9%) had pulmonary fibrosis, and 6 (35.3%) had no history of pulmonary disease. Rrepresentative cases of PET-negative diagnostic impact due to previous pulmonary TB with granulomatous nodal inflammation and anthracosilicosis diagnosed by EBUS-TBNAare shown in Fig. 2 and 3.


Diagnostic value of EBUS-TBNA for lung cancer with non-enlarged lymph nodes: a study in a tuberculosis-endemic country.

Kuo CH, Chen HC, Chung FT, Lo YL, Lee KY, Wang CW, Kuo WH, Yen TC, Kuo HP - PLoS ONE (2011)

A representative case of a PET scan with negative impact.(A) The contrast-enhanced CT scan shows small lymph nodes measuring 0.8×0.6 cm in the subcarinal area. (B) The PET scan shows increased FDG uptake at the corresponding site (gall bladder uptake due to cholecystitis). (C) The subcarinal lymph node was later targeted by EBUS-TBNA(D) A tissue core, which revealed granulomatous inflammation consisting of epithelioid histiocytes (upper right; H&E stain, 200×) was obtained.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3045379&req=5

pone-0016877-g002: A representative case of a PET scan with negative impact.(A) The contrast-enhanced CT scan shows small lymph nodes measuring 0.8×0.6 cm in the subcarinal area. (B) The PET scan shows increased FDG uptake at the corresponding site (gall bladder uptake due to cholecystitis). (C) The subcarinal lymph node was later targeted by EBUS-TBNA(D) A tissue core, which revealed granulomatous inflammation consisting of epithelioid histiocytes (upper right; H&E stain, 200×) was obtained.
Mentions: Compared to CT-based nodal assessment, 24 nodes detected by PET were true-positive, yielding a 36.9% positive impact incidence (Table 3). Thirty nodes detected by PET were false-positive, which accounted for a 46.2% negative impact incidence. Seven and 4 lymph nodes were PET-true-negative and PET-false-negative, respectively, and were together responsible for a 16.9% incidence of no impact. Patients with lymph nodes yielding negative PET scan diagnostic impact were thoroughly investigated to rule out the presence of pulmonary diseases other than lung cancer. Of the 17 patients examined, 7 (41.2%) had previous pulmonary TB, 3 (17.6%) had pneumoconiosis, 1 (5.9%) had pulmonary fibrosis, and 6 (35.3%) had no history of pulmonary disease. Rrepresentative cases of PET-negative diagnostic impact due to previous pulmonary TB with granulomatous nodal inflammation and anthracosilicosis diagnosed by EBUS-TBNAare shown in Fig. 2 and 3.

Bottom Line: Compared to CT-based nodal assessment, PET yielded a positive diagnostic impact in 36.9% nodes, a negative diagnostic impact in 46.2% nodes, and no diagnostic impact in 16.9% nodes.Patients with lymph nodes showing negative PET diagnostic impact had a high incidence of previous pulmonary TB.Multivariate analysis indicated that detection of hilar nodes on PET was an independent predictor of negative diagnostic impact of PET.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University School of Medicine, Taipei, Taiwan.

ABSTRACT

Background: In tuberculosis (TB)-endemic areas, contrast-enhanced computed tomography (CT) and positron emission tomography (PET) findings of lung cancer patients with non-enlarged lymph nodes are frequently discrepant. Endobronchial ultrasound-guided transbronchial aspiration (EBUS-TBNA) enables real-time nodal sampling, and thereby improves nodal diagnosis accuracy. This study aimed to compare the accuracy of nodal diagnosis by using EBUS-TBNA, and PET.

Methods: We studied 43 lung cancer patients with CT-defined non-enlarged mediastinal and hilar lymph nodes and examined 78 lymph nodes using EBUS-TBNA.

Results: The sensitivity, specificity, positive predictive value, and negative predictive value of EBUS-TBNA were 80.6%, 100%, 100%, and 85.7%, respectively. PET had low specificity (18.9%) and a low positive predictive value (44.4%). The diagnostic accuracy of EBUS-TBNA was higher than that of PET (91% vs. 47.4%; p<0.001). Compared to CT-based nodal assessment, PET yielded a positive diagnostic impact in 36.9% nodes, a negative diagnostic impact in 46.2% nodes, and no diagnostic impact in 16.9% nodes. Patients with lymph nodes showing negative PET diagnostic impact had a high incidence of previous pulmonary TB. Multivariate analysis indicated that detection of hilar nodes on PET was an independent predictor of negative diagnostic impact of PET.

Conclusion: In a TB-endemic area with a condition of CT-defined non-enlarged lymph node, the negative diagnostic impact of PET limits its clinical usefulness for nodal staging; therefore, EBUS-TBNA, which facilitates direct diagnosis, is preferred.

Show MeSH
Related in: MedlinePlus