# Evaluation of Mediastinal Lymphadenopathy in Patients With Non-small Cell Lung Cancer Using Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration

## TL;DR

This study shows that endobronchial ultrasound-guided transbronchial needle aspiration improves the accuracy of diagnosing and staging non-small cell lung cancer, especially in regions where tuberculosis is common.

## Contribution

The study demonstrates EBUS-TBNA's effectiveness in reducing misclassification of mediastinal lymphadenopathy in NSCLC patients in tuberculosis-endemic areas.

## Key findings

- EBUS-TBNA revealed malignancy in 85.07% of sampled lymph nodes.
- The procedure modified nodal staging in 16.67% of cases, with no complications observed.

## Abstract

Introduction

Lung cancer is the leading cause of cancer-related deaths worldwide. Accurate staging of mediastinal lymphadenopathy is crucial, particularly in tuberculosis-endemic regions where benign causes can mimic malignancy. Imaging modalities like computed tomography (CT) and positron emission tomography (PET) scans detect lymph node enlargement but lack specificity. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive technique that enables real-time sampling for histopathological diagnosis. This study evaluates the role of EBUS-TBNA in diagnosing enlarged mediastinal lymph nodes in non-small cell lung cancer (NSCLC) patients and its impact on staging.

Methods

A cross-sectional study was conducted at a tertiary care center in India from May 2023 to August 2024. Thirty NSCLC patients with mediastinal lymphadenopathy (≥10 mm) underwent EBUS-TBNA for histopathological evaluation. Patients with sub-centimetric nodes or severe comorbidities were excluded. CT and PET scans and EBUS findings were analyzed for malignancy, granulomas, or benign conditions.

Results

Among the 30 patients, 25 (83.33%) were male, with a mean age of 59.09±9.95 years. Cough was the most common symptom, affecting 24 patients (80%). A total of 67 lymph nodes were sampled using EBUS-TBNA, revealing malignancy in 57 (85.07%), tuberculosis in two (2.99%), and benign findings in eight (11.94%). Among the 54 18F-fluorodeoxyglucose (FDG)-avid lymph nodes, 44 (81.48%) were malignant, two (3.7%) had tuberculosis, and eight (14.81%) were benign. EBUS-TBNA modified nodal staging in five cases (16.67%), resulting in downstaging for four patients (13.33%) and upstaging for one patient (3.33%). No complications were observed.

Conclusion

EBUS-TBNA is a valuable tool for diagnosing and staging NSCLC, reducing misclassification in tuberculosis-endemic regions. It enhances accuracy by distinguishing malignancy from benign conditions, emphasizing the need for histopathological confirmation. Integrating EBUS-TBNA with imaging can optimize lung cancer management and treatment planning.