Author of

• 12824

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  P3.21 - Poster Session 3 - Diagnosis and Staging (ID 171)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Prevention & Epidemiology
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12832

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    P3.21-008 - Effective Diagnosis of Postoperative Mediastinal Recurrence of Lung Cancer by Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (ID 2057)

    09:30 - 09:30  |  Author(s): J. Morimoto
    • Abstract

    Background
    Diagnosis of postoperative recurrence of lung cancer usually depends on radiologic examinations. However, the diagnostic yield of radiological examination is limited and it often times show false-positive result. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is well accepted modality for the pre-operative lymph node staging in patients with lung cancer; however, the efficacy of diagnosis for post-operative recurrence still remains unclear. In this study, usefulness of EBUS-TBNA pathologic confirmation of regional node metastasis was investigated in comparison with 18F-fluorodeoxyglucose positron emission tomography (FDG-PET).

    Methods
    The patients who were suspected to have lymph node recurrence by routine chest CT follow-up after radical surgery for lung cancer were retrospectively investigated, and diagnostic yields of FDG-PET and EBUS-TBNA for the recurrence were compared. The cut-off value for positive results by PET was standard uptake value (SUV max) more than 2.5. Rapid on-site cytological evaluation was performed during the procedure of EBUS-TBNA for convenience and pathological diagnosis was employed by independent pathologist. A dedicated 22-gauge needle was used for TBNA. Final decision of presence of nodal recurrence was made based on pathological findings of cancer recurrence for EBUS-TBNA sample, and that of absence of the recurrence was made based on radiologic follow-up for more than 6 month.

    Results
    A total of 40 patients were eligible for this study. The mean duration between thoracotomy and EBUS-TBNA was 23.5 months, and the median follow-up period after EBUS-TBNA was 21.8 months. Diagnostic sensitivity, specificity and accuracy of EBUS-TBNA was 100% for each whereas those of FDG-PET were 95.8%, 12.5%, and 62.5%, respectively. 24 patients with metastatic lymph node confirmed by EBUS-TBNA showed significantly unfavorable prognosis than 16 patients with negative result by EBUS-TBNA (p=0.024). 22 out of the 24 patients who diagnosed as recurrence received anti-cancer treatments properly. 14 patients with positive results by FDG-PET but negative by EBUS-TBNA were determined as negative (false positive) since no deterioration of the nodal status was confirmed by radiological follow-up. Pathological findings of these false-positive lymph nodes showed 12 anthracosis and 2 non-specific granuloma.

    Conclusion
    Minimally-invasive diagnosis by EBUS-TBNA should be indicated when regional lymph node recurrence is suspected since radiologic modalities frequently recognize benign lesions as positive. The accurate diagnosis by EBUS-TBNA reduces fertile cancer treatment and improves patient management. Figure 1