Current Thoracic Surgery

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive effective, simple procedure and has replaced mediastinoscopy in diagnosis of mediastinal lymphadenopathies. But still there is an effort to increase diagnostic value of EBUS-TBNA and to meet additional information to guide biopsy especially in false negative situations.

Materials and Methods: In this retrospective study between December 2022 and December 2023, 90 patients, 176 lymph nodes were sampled with EBUS-TBNA. Patients' characteristics, lymph node density on CT, PET-CT findings, pathological diagnosis by EBUS-TBNA, and surgery were all written down.

Results: Sensitivity, specificity, negative predictive value, and positive predictive value of EBUS-TBNA were 78.8%, 95.8%, 85%, and 90.3%, respectively. Mean SUV-max values in PET tomography were 2.66±0.56 in benign lymph nodes, whereas it was 9.26±2.34 in malignant lymph nodes and this was significantly higher than benign lymph nodes (p<0,001). For detecting malignancy, cut-off value of SUV-max was found 6.02±1.84 and sensitivity and specificity were 55.3%, 95.8% respectively (AUC= 0,895 95% CI (0,844- 0,946), p<0.001). Mean tomographic lymph node density was 25.05±4.67 HU in benign lymph nodes. Also mean tomographic lymph node density was 31.55±5.34 HU and significantly higher than benign lymph nodes (p=0.03). Cut-off value of density for detecting malignancy was found 29,05±4.78 and sensitivity and specificity were 65.0%, 56.2% respectively (AUC= 0,585 95% CI (0,500-0,670), p=0.05).

Conclusions: EBUS has a key role in differential diagnosis of lymphadenopathies. PET tomography SUV-max value and tomographic lymph node density could help clinician to increase diagnostic value of EBUS in borderline suspicious lymphadenopathies.