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