Endobronchial Ultrasound Staging During Navigation Bronchoscopy for Peripheral Pulmonary Nodules in the Real World: Which Patients Will Benefit?

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Abstract
Background/Objectives: 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. Methods: 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). Results: 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%). Conclusions: 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.

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