EBUS-TBNA in positron emission tomography (PET) positive mediastinal lymph nodes in previously radically treated malignancies

Introduction: Mediastinal lymph node enlargement is a common finding in the follow-up of patients with previous radically treated malignancies. PET is routinely used and highs the suspicion of recurrence but histological confirmation is mandatory to plan the correct therapy. Aims and objectives: The aim of this study is to evaluate the role of EBUS-TBNA for histological evaluation in patients with radically treated previous malignancies who developed during the follow-up a PET positive mediastinal lymph node. Methods: Prospected collected data from December 2011 until March 2014 of patients that underwent EBUS-TBNA. Results: One-hundre-eithteen patients out of 859 patients meet the inclusion criteria. Fifty percent of patients (n=59) had the same diagnosis of the previous oncological disease. 46.6% of patients (n=55) had a different diagnosis from the previous tumor and 37.3% of them (n=44) had a benign condition. 9.3% of patients had a different malignancy. In 3.4% of patients (n=4) the sample was false negative. Overall sensitivity, specificity, negative predicted value and diagnostic accuracy were respectively: 94.6% (95% CI: 86.7% to 98.5%), 100% (95% CI: 92.0% to 100%), 91.7% (95% CI: 80.0% to 97.7%), 96.6% (95% CI: 91.6% to 99.1%). Conclusion: Pathological confirmation of PET positive mediastinal lymph nodes in patients with a previously treated malignancy is mandatory to plan a correct treatment. EBUS-TBNA demonstrated a different pathological diagnosis in a high percentage of patients showing a high sensitivity, diagnostic accuracy and negative predicted values confirming its strategic role in the mediastinal investigation in thoracic oncology.