Endobronchial ultrasound-guided transbronchial needle aspiration for lymph node staging of lung cancer

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a new modality for the evaluation of hilar and mediastinal lymph nodes. Although many centers have adopted this new device, little has been described concerning the actual procedure and the systematic mediastinal and hilar lymph node assessment in patients with lung cancer. Here we describe the standard for systematic visualization and biopsy of mediastinal and hilar lymph nodes in patients with primary lung cancer. Lymph node stations were defined based on the General Rules for Clinical and Pathological Recording of Lung Cancer (Sixth edition), by the Japan Lung Cancer Society. Lymph nodes were scanned starting from the hilum, working up to the upper mediastinum. All enlarged lymph nodes or suspicious nodes were biopsied under real time ultrasound guidance. N3 nodes were punctured first followed by N2 and N1 nodes to avoid contamination. The diagnostic accuracy of mediastinal lymph node staging in 105 lung cancer patients was 96.3%. We have never experienced any major complication. In conclusion, EBUS-TBNA is a safe and accurate tool for the assessment of the mediastinum as well as the hilum in patients with lung cancer.