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Updated: Sep 12, 2026
Use of Electromagnetic Navigational Transthoracic Needle Aspiration (E-TTNA) for Sampling of Lung Nodules
Published on: May 23, 2015
Extent of Endobronchial Ultrasound Nodal Sampling and Risk of Pathologic N2 Upstaging in Clinical N0-N1 Non-Small
Min Jee Kim1, Jae Cheol Lee2, Chang-Min Choi1,2
1Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Background:
Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) is strongly recommended for mediastinal staging in resectable non-small cell lung cancer (NSCLC). However, the optimal sampling extent remains uncertain. This study aimed to evaluate whether the extent of nodal sampling during staging EBUS is associated with pathologic N2 upstaging in clinical N0-N1 NSCLC.
Methods:
This retrospective cohort included patients with cN0-N1 NSCLC who underwent preoperative EBUS-TBNA between January 2022 and December 2023. Patients were stratified into three groups according to the number of sampled lymph node stations at the N2/N3 levels: Group 1, ≤ 1 mediastinal station at N2 or N3; Group 2, one N2 and one N3 station; Group 3, ≥ 3 stations, including at least one N2 and one N3. The primary outcome was pathologic N2 upstaging, defined as N2 disease confirmed on surgical pathology despite preoperative stage N0-N1.
Results:
A total of 418 patients were included (mean age, 68.6 years; 64.1% male). Most had adenocarcinoma (75.4%) and cN0 disease (94.7%). Group distribution was 140 (33.5%) in Group 1, 92 (22.0%) in Group 2, and 186 (44.5%) in Group 3. Pathologic N2 upstaging occurred in 21/140 (15.0%) in Group 1, 8/92 (8.7%) in Group 2, and 8/186 (4.3%) in Group 3. The rate decreased with increasing sampling, with Group 3 showing a lower rate than Group 1 (p = 0.005).
Conclusions:
Comprehensive staging EBUS-TBNA with ≥ 3 N2/N3 stations was associated with a lower rate of occult N2 upstaging in clinical N0-N1 NSCLC, underscoring the importance of comprehensive nodal evaluation for accurate staging.
