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Background  Endobronchial ultrasound‐guided transbronchial needle aspiration ( EBUS ‐ TBNA ) diagnoses and stages mediastinal lymph node pathology. This retrospective study determined the relationship between  EBUS ‐ TBNA  utility and non‐small cell lung cancer ( NSCLC ) stage, lymph node size, and positron emission tomography ( PET) standard uptake values (SUV),  and the utility of neck ultrasound in bulky mediastinal disease.    Methods  Data of 284 consecutive patients who had undergone  EBUS ‐ TBNA  was collected .  Two hundred patients had suspected  NSCLC,  with 148 confirmed  NSCLC  cases. The diagnostic utility of  EBUS ‐ TBNA  was determined according to  NSCLC  stage,  EBUS  lymph node size,  PET SUV , use in distal metastases, and mutation testing. The utility of neck ultrasound for  N 3 disease was calculated in patients with bulky mediastinal disease.    Results   EBUS ‐ TBNA  was well tolerated with 97% sensitivity in distant metastatic disease, avoiding the need for distal metastases biopsy in 81% of cases. It had equivalent diagnostic accuracy in all  NSCLC  stages and in lymph nodes <10 mm, <20 mm or >20 mm (sensitivity >92% in all cases), with no mutation testing failures.  EBUS ‐ TBNA  had 33% sensitivity in  PET  indolent ( SUV  < 4) nodes and 79% sensitivity in  PET  active nodes ( SUV  > 4).  EBUS ‐ TBNA  diagnosed 12 cases of lymphoma without flow cytometry.    Conclusions  The use of  EBUS ‐ TBNA  meant that distant metastatic biopsy was avoided in 81% of cases, performing well irrespective of cancer stage, node size, and facilitating mutation testing. Neck ultrasound failed to detect  N 3 disease in patients with bulky mediastinal disease.  EBUS ‐ TBNA  had a sensitivity of 33% for metastases in  PET  negative nodes, highlighting  PET  limitations.

thoracic cancer

Relationship between endobronchial ultrasound‐guided ( EBUS )‐transbronchial needle aspiration utility and computed tomography staging, node size at  EBUS,  and positron emission tomography scan node  standard uptake values: A  retrospective analysis