Additive Value of EBUS-TBNA for Staging Non-Small Cell Lung Cancer in Patients Evaluated for Stereotactic Body Radiation Therapy

Joshua M. Boster; S. Michael Goertzen; Paula V. Sainz; Rodríguez Vial, Macarena; Jhankruti K. Zaveri-Desai; Luis D. Luna; Anum Waqar; Horiana B. Grosu; Roberto F. Casal; Carlos A. Jimenez; David E. Ost; Bruce F. Sabath; Julie Lin; Mike Hernandez; Georgie A. Eapen

doi:10.3390/diagnostics15172136

Additive Value of EBUS-TBNA for Staging Non-Small Cell Lung Cancer in Patients Evaluated for Stereotactic Body Radiation Therapy

Journal

Diagnostics

ISSN

2075-4418

Date Issued

2025-08-24

Author(s)

Joshua M. Boster

S. Michael Goertzen

Paula V. Sainz

Rodríguez Vial, Macarena

Facultad de Medicina Clínica Alemana Universidad del Desarrollo

Jhankruti K. Zaveri-Desai

Luis D. Luna

Anum Waqar

Horiana B. Grosu

Roberto F. Casal

Carlos A. Jimenez

David E. Ost

Bruce F. Sabath

Julie Lin

Mike Hernandez

Georgie A. Eapen

Type

journal-article

DOI

10.3390/diagnostics15172136

URL

https://hdl.handle.net/123456789/11503

Abstract

Background/Objectives: Patients with non-small cell lung cancer (NSCLC) being evaluated for stereotactic body radiation therapy (SBRT) are frequently staged non-invasively with positron emission tomography/computed tomography (PET/CT). Performing endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in addition to PET/CT scanning may increase clinical certainty in lymph node staging, but the magnitude of added benefit of EBUS-TBNA over non-invasive staging methods is unclear. Methods: A single-center prospective cohort study involving patients with suspected or confirmed Stage I or IIa NSCLC referred for EBUS-TBNA prior to SBRT was performed. The primary outcome was concordance between PET/CT and EBUS-TBNA for nodal metastases. Secondary endpoints included sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of PET/CT, and clinical outcomes based on staging results. Results: Among 115 patients, the concordance between PET/CT and EBUS-TBNA was 84.3% (95% CI: 0.76 0.90). EBUS-TBNA led to a stage shift in 15.7% of cases: 4 of 98 PET/CT N0 patients (4.1%) had nodal metastases, while 14 of 17 PET/CT N1 patients (82.4%) were downstaged to N0. PET/CT sensitivity was 42.9% (95% CI: 0.09–0.81), specificity 87% (95% CI: 0.79–0.93), PPV 17.6% (95% CI: 0.04–0.43), and NPV 95.9% (95% CI: 0.90–0.99). PET/CT-positive, EBUS-TBNA-negative patients had worse survival (HR 4.25, 95% CI: 1.24–14.53, p = 0.021) compared with double-negative patients. Conclusions: EBUS-TBNA improves staging accuracy over PET/CT in early-stage NSCLC, impacting SBRT candidacy. However, PET/CT-positive, EBUS-TBNA-negative patients had worse outcomes in comparison to double-negative patients, suggesting a need for additional therapy or surveillance in that population.

Cite this document

Boster, J. M., Goertzen, S. M., Sainz, P. V., Vial, M. R., Zaveri-Desai, J. K., Luna, L. D., Waqar, A., Grosu, H. B., Casal, R. F., Jimenez, C. A., Ost, D. E., Sabath, B. F., Lin, J., Hernandez, M., & Eapen, G. A. (2025). Additive value of ebus-tbna for staging non-small cell lung cancer in patients evaluated for stereotactic body radiation therapy. Diagnostics, 15(17), 2136. https://doi.org/10.3390/diagnostics15172136