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. 2022 Jun;14(6):2122-2130.
doi: 10.21037/jtd-22-521.

Positron emission tomography/computed tomography and endobronchial ultrasound-guided transbronchial needle aspiration to evaluate the status of N2 in preoperative non-small cell lung cancer: a diagnostic test

Shiwei Nie  1 , Wencheng Yu  2 , Xilin Hu  1 , Hanlin Xu  1 , Ruran Wen  1 , Wenjie Jiao  1 , Kaihua Tian  1
Affiliations

Positron emission tomography/computed tomography and endobronchial ultrasound-guided transbronchial needle aspiration to evaluate the status of N2 in preoperative non-small cell lung cancer: a diagnostic test

Shiwei Nie et al. J Thorac Dis. 2022 Jun.

Abstract

Background: As a minimally invasive method, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) was more accurate than non-invasive methods such as positron emission tomography (PET) and computed tomography (CT) to evaluate the lymph nodes in preoperative non-small cell lung cancer (NSCLC). PET/CT has more anatomical advantages than PET scanning and is more accurate in lung cancer staging. However, no relevant studies have comparatively evaluated PET/CT and EBUS-TBNA for NSCLC patients.

Methods: A total of 112 patients were included in this retrospective analysis. The golden diagnosis of N2 status was postoperative pathological results. In EBUS-TBNA puncture specimens, if clear malignant tumor cells could be seen, the results were taken as positive. In PET/CT image analysis, the CT values, short diameter, and maximum standardized uptake value (SUVmax) of each lymph node were recorded to evaluate N2 status. The results of PET/CT and EBUS-TBNA were compared with the final pathological results, and respective sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. - Then, the patients were divided into adenocarcinoma group and squamous cell carcinoma group -and the results were calculated and compared with the above method.

Results: The results showed that EBUS-TBNA had a higher diagnostic value for mediastinal lymph nodes than PET/CT, and the difference was statistically significant (P<0.001). In NSCLC patients, the results showed that the sensitivity (P=0.013), specificity (P<0.001), PPV (P<0.001), NPV (P<0.001), and accuracy (P<0.001) of EBUS-TBNA were higher than that of PET/CT (AUC =0.954 and 0.636, respectively). In adenocarcinoma cases, specificity (P<0.001), PPV (P<0.001), NPV (P<0.001), and accuracy (P<0.001) of EBUS-TBNA were higher than that of PET/CT (AUC =0.957 and 0.596, respectively).In cases with squamous cell carcinoma, specificity (P=0.003), PPV (P<0.001), and accuracy (P<0.001) of EBUS-TBNA were higher than PET/CT (AUC =0.952 and 0.657, respectively).

Conclusions: For preoperative diagnosis of mediastinal lymph node metastases in NSCLC, EBUS-TBNA is more accurate than PET/CT. For those patients with suspected mediastinal lymph node metastasis, EBUS-TBNA should be preferred method to evaluate the status of mediastinal lymph nodes.

Keywords: Non-small cell lung cancer (NSCLC); endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA); mediastinal lymph node staging; positron emission tomography/computed tomography (PET/CT).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-22-521/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
ROC curves for assessing the sensitivity and specificity of EBUS and PET/CT in predicting the status of N2. (A) ROC curves predicting the status of N2 in NSCLC; (B) ROC curves predicting the status of N2 in LUAD; (C) ROC curves predicting the status of N2 in LUSC. NSCLC, non-small cell lung cancer; EBUS, endobronchial ultrasound; PET/CT, positron emission tomography/computed tomography; LUAD, lung adenocarcinoma; LUSC, lung squamous cell carcinoma; ROC, receiver operator characteristic.
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