Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2022; 10(36): 13227-13238
Published online Dec 26, 2022. doi: 10.12998/wjcc.v10.i36.13227
Endobronchial ultrasound-guided transbronchial needle aspiration in intrathoracic lymphadenopathy with extrathoracic malignancy
Shi-Jie Li, Qi Wu
Shi-Jie Li, Endoscopy Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, China
Qi Wu, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, China
Author contributions: Li SJ and Wu Q carried out the studies; Li SJ performed the analyses and collected the data; Li SJ drafted the manuscript; Wu Q conceived and designed the study; All authors approved the final draft submitted.
Supported by The Wu Jieping Medical Foundation Special Fund for Clinical Research, No. 320.6750.2021-04-71; Open Research Fund of NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, No. KF202101; and Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences, No. 2020-PT330-003.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Peking University Cancer Hospital (Approval No. 2018YJZ72).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: Contact lishijie@bjmu.edu.cn to obtain the anonymized dataset.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qi Wu, MD, Chief Physician, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, No. 8 Fucheng Road, Haidian District, Beijing 100142, China. wuqi1973@bjmu.edu.cn
Received: July 7, 2022
Peer-review started: July 7, 2022
First decision: October 27, 2022
Revised: November 7, 2022
Accepted: December 5, 2022
Article in press: December 5, 2022
Published online: December 26, 2022
Processing time: 172 Days and 6.1 Hours
Abstract
BACKGROUND

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for the diagnosis of mediastinal and hilar lymph is poorly studied in patients with extrathoracic malignancies.

AIM

To evaluate the value of EBUS-TBNA for the diagnosis of enlarged intrathoracic lymph nodes in patients with extrathoracic malignancies.

METHODS

This was a retrospective study of patients with extrathoracic malignancies who were referred to Peking University Cancer Hospital from January 2013 to December 2018 for EBUS-TBNA due to intrathoracic lymphadenopathy. The specimens were defined as positive for malignancy, negative for non-malignancy (tuberculosis, sarcoidosis, etc.), and without a definitive diagnosis. Sensitivity, negative predictive value (NPV) for malignancy, and overall accuracy were calculated. Complications were recorded.

RESULTS

A total of 80 patients underwent EBUS-TBNA and had a final diagnosis, among which 50 (62.5%) were diagnosed with extrathoracic malignancy with intrathoracic lymph nodes metastasis, 14 (17.5%) were diagnosed with primary lung cancer with nodal involvement, and 16 (20.0%) exhibited benign behavior including tuberculosis, sarcoidosis and reactive lymphadenitis or who had benign follow-up. The diagnostic sensitivity, NPV, and accuracy of EBUS-TBNA for intrathoracic lymphadenopathy in patients with extrathoracic malignancy were 93.8% (n = 60/64), 80.0% (n = 16/20), and 95.0% (n = 76/80), respectively. In the multivariate analysis, longer short axis of the lymph node (OR: 1.200, 95%CI: 1.024-1.407; P = 0.024) and synchronous lung lesion (OR: 19.449, 95%CI: 1.875-201.753; P = 0.013) were independently associated with malignant intrathoracic lymphadenopathy. No characteristics of the lymph nodes and EBUS-TBNA were associated with the location of malignant intrathoracic lymphadenopathy, and no major complication was observed.

CONCLUSION

EBUS-TBNA is a simple and accurate procedure for the diagnosis of intrathoracic lymphadenopathy with extrathoracic malignancy.

Keywords: Endobronchial ultrasound; Intrathoracic lymphadenopathy; Extrathoracic malignancy; Transbronchial needle aspiration; Diagnosis

Core Tip: This was a retrospective study of patients referred to Peking University Cancer Hospital from January 2013 to December 2018 for endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) due to intrathoracic lymphadenopathy. The specimens were defined as positive for malignancy, negative for non-malignancy (tuberculosis, sarcoidosis, etc.), and without definite diagnosis. Sensitivity, negative predictive value for malignancy, and overall accuracy were calculated. EBUS-TBNA was found to be a simple and accurate procedure for the diagnosis of intrathoracic lymphadenopathy with extrathoracic malignancy.