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

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.