Endobronchial ultrasonography for lung cancer staging in negative mediastinum on computed tomography

Abstract

Lung cancer is the most common cause of cancer –related deaths. Chest CT scan is frequently unreliable in staging mediastinal lymph node metastases of lung cancer, since interpretation relies on lesion size. EBUS offers a unique way of imaging and parabronchial structures. The procedure is safe, minimally invasive and does not require general anesthesia or hospitalization. The complication rate is extremely low. Subjects and methods: This study was conducted on eleven patients who were found without CT evidence of enlarged mediastinal lymph nodes. Bronchoscopy and EBUS were performed for the diagnosis of lung cancer. TBLB of detected mediastinal lymph nodes was performed. CT guided biopsies were done for non-diagnosed cases. Results: In this study bronchogenic carcinoma was diagnosed by bronchoscopic biopsy in 6 cases (54.5%), by EBUS-TBNA in 2 cases (18.2%), and by CT guided biopsy in 3 cases (27.3%). From the eleven patients with negative CT scan, EBUS of mediastinal L.N was positive in four cases (36.4%). The first case showed 2 small subcarinal L.N station (7) and 2 right hilar lymph node stations (10R). In the second case EBUS detected 2 subcarinal lymph node stations (7) and one left hilar station (10L). In the third case there was one subcarinal lymph node station (7). The fourth case showed a left hilar lymph node station (10L). Conclusions: EBUS is safe and minimally invasive technique in the detection of mediastinal lymph metastasis. EBUS in combination with conventional radiologic tools may contribute to improve diagnosis and staging of lung cancer.

Keywords

• EBUS
• Lung cancer
• Staging