Endobronchial Ultrasound for Staging of Lung Cancer

Accurate preoperative staging in patients with non-small cell lung cancer is of paramount importance. It will guide choices of treatment and determine prognosis and outcome. Over the last years, different techniques have become available. For primary staging of the mediastinum and also in PET-positive mediastinal lesions, the findings should always be cyto- or histologically confirmed. Endobronchial ultrasound (EBUS) is a relatively new technique that provides a better view into the mediastinum. EBUS-guided transbronchial needle aspiration is an additional ultrasound technique, which allows a real-time ultrasound-controlled needle aspiration. Its specificity is high but the negative predictive value is limited. Because of this, if it yields negative results, an invasive surgical technique is indicated. However, if fine needle aspiration is positive, this may be valid as proof of N2 or N3 disease. For staging of early cancer lesions as carcinoma in situ and also for the differentiation of tumor ingrowths in central mediastinal structures, the radial EBUS system is an excellent technique to improve T staging.