Endobronchial ultrasound-guided transbronchial needle aspiration in intrathoracic lymphadenopathy with extrathoracic malignancy

Table 1 Patient characteristics, n = 80

Characteristics	n (%) or mean ± SD
Age (yr)	58.5 ± 8.8
Male sex	36 (45.0)
Site of the primary extrathoracic malignancy
Breast	18 (22.5)
Colon	12 (15.0)
Rectal	11 (13.8)
Gastric	11 (13.8)
Renal cell	7 (8.8)
Thyroid	6 (7.5)
Head and neck1	5 (6.3)
Endometrial	3 (3.8)
Hepatic cell	2 (2.5)
Other2	5 (6.3)
Site of intrathoracic lymphadenopathy
Mediastinal only	43 (53.8)
Mediastinal and hilar	21 (26.2)
Hilar only	16 (20.0)
Status of the extrathoracic malignancy
Metachronous	66 (82.5)
Synchronous	14 (17.5)
CT findings
Intrathoracic nodal enlargement with pulmonary lesion	39 (48.8)
Short axis of the target lymph node in mm	18.1 ± 6.7
PET-CT findings
Patients with PET-CT examination	49 (61.3)
SUVmax of the target lymph nodes	9.2 ± 5.0

¹Oropharyngeal (n = 2), nasopharyngeal (n = 1), laryngeal (n = 1), and parotid (n = 1).

²Cervical (n = 1), ovarian (n = 1), melanoma (n = 1), pancreatic (n = 1), and prostate (n = 1).

CT: Computed tomography; PET: Positron emission tomography; SUV_max: Maximum standardized uptake.

Table 2 Primary extrathoracic malignancy site and the final pathologic result of the intrathoracic lymphadenopathy

Extrathoracic malignancy	n (%)	Location			EBUS			Surgery			Follow-up
		Paratracheal	Subcarinal	Hilar and lobar	ETM LNM	PLC LNM	Benign	ETM LNM	PLC LNM	Benign	FO	ETM LNM
Breast cancer	18 (22.5)	12	8	8	11	3	2	-	-	1	1	-
Colon cancer	12 (15.0)	8	4	4	7	3	-	-	-	-	1	1
Rectal cancer	11 (13.8)	4	2	8	7	3	-	1	-	-	-	-
Gastric cancer	11 (13.8)	7	5	6	6	2		-	-	1	1	-
Renal cell cancer	7 (8.8)	6	4	2	6	-	-	1	-	-	-	-
Thyroid cancer	6 (7.5)	6	2	2	1	2	3	-	-	-	-	-
Head and neck cancer1	5 (6.3)	3	3	2	3	-	-	-	1	1	-	-
Endometrial cancer	3 (3.8)	1	2	2	2	-	1	-	-	-	-	-
Hepatic cell cancer	2 (2.5)	1	1	0	2	-	-	-	-	-	-	-
Other2	5 (6.3)	4	2	4	2	-	2	-	-	-	1	-
Total	80 (100.0)	52	33	38	47	13	9	2	1	3	5

¹Oropharyngeal cancer (n = 2), nasopharyngeal cancer (n = 1), laryngeal cancer (n = 1), and parotid cancer (n = 1).

²Cervical cancer (n = 1), ovarian cancer (n = 1), melanoma (n = 1), pancreatic cancer (n = 1), and prostate cancer (n = 1).

EBUS: Endobronchial ultrasound-guided transbronchial needle aspiration; ETM: Extrathoracic malignancy; FO: Favorable outcome; LNM: Lymph node metastasis; PLC: Primary lung cancer.

Table 3 Risk factors of being malignant for intrathoracic lymphadenopathy

Covariates	Univariate analysis		Multivariate analysis
	OR (95%CI)	P	OR (95%CI)	P
Sex
Female	1
Male	1.720 (0.727-4.071)	0.217
Age (yr)
≤ 60	1
> 60	1.647 (0.696-3.900)	0.257
Size of sampled lymph node	1.113 (1.036-1.196)	0.003	1.200 (1.024-1.407)	0.024
Site of lymphadenopathy
Mediastinal and hilar	1
Mediastinal only	1.244 (0.528-2.932)	0.617
Hilar only	6.788 (0.819-56.257)	0.076
Status of synchronous lung lesion
Without	1		1
With	8.082 (2.292-28.501)	0.001	19.449 (1.875-201.753)	0.013
Status of synchronous ETM
Synchronous	1
Metachronous	1.057 (0.629-1.776)	0.834
SUVmax of sampled lymph node	0.987 (0.887-1.098)	0.806

ETM: Extrathoracic malignancy; SUV_max: Maximum standardized uptake.

Table 4 Factors influencing endobronchial ultrasound-guided transbronchial needle aspiration accuracy in intrathoracic malignant lymphadenopathy, n = 94

Covariates	Accurate number,	Univariate analysis
	n (%)	OR (95%CI)	P value
Sex
Female	46 (92.0)	1
Male	41 (93.2)	1.783 (0.310-10.246)	0.571
Age (yr)
≤ 60	47 (92.2)	1
> 60	40 (93.0)	1.702 (0.296-9.785)	0.551
Location of sampled lymph node
Hilar	27 (93.1)	1
Paratracheal	36 (92.3)	2.000 (0.312-12.815)	0.465
Subcarinal	24 (92.3)	2.667 (0.260-27.381)	0.409
Determination of target lymph node
PET-CT and CT	52 (90.0)	1
CT only	35 (97.2)	3.365 (0.377-30.052)	0.277
Size of short axis in sampled lymph node in mm	18.9 ± 7.0	1.093 (0.975-1.248)	0.191
SUVmax of sampled lymph node	8.8 ± 5.1	0.877 (0.753-1.015)	0.077
Number of passes per lymph node, times, median (range)	2 (1-5)	2.097 (0.691-6.253)	0.193
Histological specimen acquired
No	7 (87.5)	1
Yes	80 (93.0)	2.286 (0.233-22.387)	0.478
Operator of EBUS-TBNA
Dr. LSJ	70 (92.1)	1
Dr. WQ	17 (94.4)	1.124 (0.133-11.085)	0.863

Data are presented as n (%) or mean ± SD, unless otherwise indicated. CT: Computed tomography; EBUS-TBNA: Endobronchial ultrasound-guided transbronchial needle aspiration; PET-CT: Positron emission tomography-computed tomography; SUV_max: Maximum standardized uptake.