Endobronchial Ultrasound Staging During Navigation Bronchoscopy for Peripheral Pulmonary Nodules in the Real World:...

The prevalence of lung cancer in patients with a peripheral pulmonary nodule referred for navigation bronchoscopy (NB) is high. Combining NB with a systematic EBUS for staging is common practice. We investigated the added value of performing EBUS in the population referred for NB in relation to the available pre-procedural [¹⁸F]FDG-PET and CT imaging information.

This single-center study evaluated all consecutive patients who underwent an NB in an academic referral center. [¹⁸F]FDG-PET and CT scoring of lymphadenopathy was based on routine [¹⁸F]FDG-PET and/or contrast-enhanced chest (ce) CT imaging reports and were correlated to outcome of systematic EBUS and subsequent surgery (when available).

In total, 403 patients were included for analysis of which 327 underwent EBUS (81.1%). In 138/403 patients (35%) who had positive lymph nodes on [¹⁸F]FDG-PET (86.5%) or ceCT (13.5%), 12 lung cancer patients were diagnosed with N+ disease by EBUS (8.4%). An additional nine EBUS-negative patients were diagnosed with N+ disease after surgery (5.4%). In the group of patients with imaging-negative lymph nodes (65.8%), no metastatic lymph nodes were found by EBUS, and surgery revealed occult nodal metastasis in eight patients (3.1%).

In patients with peripheral pulmonary nodules referred for NB, EBUS may be safely omitted when [¹⁸F]FDG-PET or ceCT imaging does not indicate presence of nodal involvement.