CHEST Guidelines-Endobronchial-Ultrasound-Guided-Biopsy-of-Mediasti

Endobronchial-Ultrasound-Guided-Biopsy-of-Mediasti

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The article addresses the use of endobronchial ultrasound (EBUS) in diagnosing metastatic lung cancer and the potential for false-positive results. Dr. Raymond Dieter Jr. highlighted a case where a false-positive EBUS suggested nodal metastasis, which was contradicted by subsequent surgery. EBUS is typically used to predict lymph node metastasis when lung cancer is suspected, employing criteria such as a positive PET scan and lymph node diameter. However, these criteria do not conclusively prove metastatic disease, necessitating further diagnostic procedures like mediastinoscopy or needle biopsies, each with its limitations, including the risk of false-negative or false-positive outcomes.<br /><br />In Dr. Dieter's case, a patient with adenocarcinoma was initially advised against surgery based on EBUS findings showing malignancy in right-side lymph nodes. However, surgical intervention revealed no metastatic nodes. The false-positive result was likely due to the EBUS needle passing from a lymph node to an adjacent primary tumor. This misinterpretation led to a different, initially less aggressive treatment being recommended. <br /><br />The response to Dr. Dieter’s letter highlights the rarity yet significance of false-positive results in EBUS. Typically, false positives occur due to anatomical complexity and operator variance, emphasizing the need for thorough understanding and careful technique to avoid needle contamination. The response also questions sections of Dr. Dieter’s case, like whether more invasive procedures could have been used for confirmation before surgery and which specific lymph nodes tested positive during EBUS.<br /><br />Overall, while false-positive results from EBUS are infrequent, they pose challenges requiring careful consideration of all diagnostic outcomes to ensure correct clinical decisions and patient management.

Keywords

endobronchial ultrasound

EBUS

metastatic lung cancer

false-positive results

lymph node metastasis

PET scan

mediastinoscopy

needle biopsies

adenocarcinoma

diagnostic procedures