Ten-year review of endobronchial ultrasound-guided transbronchial needle aspiration for lymph node staging in lung cancer: Comparison with guidelines.

Objective: To demonstrate our endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) results and review in detail the recommendations of the American College of Chest Physicians (ACCP) guidelines and local clinical practice at a tertiary Thoracic Oncology center. Methods: Consecutive patients diagnosed with non-small cell lung cancer (NSCLC) between September 2008 and December 2017 who underwent EBUS-TBNA of mediastinal and hilar lymph nodes (LNs) for diagnosis and staging were enrolled. Systematic LN staging was performed. All patients were classified into 2 groups on the basis of the ACCP guidelines. Patients with clinical N0 (cN0) and peripheral NSCLC measuring 3 cm or less, for whom LN staging is not recommended, were classified into group A (n = 43). Patients with cN1-3, central, and/or NSCLC measuring more than 3 cm, for whom LN staging is recommended, were classified into group B (n = 626). Results: In total, 669 patients were included. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of LN staging were 85.0%, 100%, 100%, 84.7%, and 91.8%, respectively. In total, 11% of group A patients had N2 disease and 4% had N3 disease; however, only 1 of these cases was detected using EBUS-TBNA. Conclusions: Occult N2 disease is common in patients diagnosed as cN0 with peripheral <3 cm NSCLC. Further studies are needed to evaluate patient and tumor characteristics associated with occult LN metastasis in this patient population. Nevertheless, careful consideration should be given to the potential presence of LN metastasis within group A.