Table 1.
Investigation | Sensitivitya(%) | Specificity (%) |
Advantages | Disadvantages |
---|---|---|---|---|
CT | 51 | 86 | Delineates anatomy | Uses 1 cm short-axis diameter cut-off for malignancy 40% of enlarged nodes are benign 20% of normal-sized nodes contain malignancy |
PET | 74 | 85 | High negative predictive value for stage 1 disease Accurate systemic staging |
25% false-positive rate inaccurate in lymph nodes >1 cm |
Transbronchial needle aspiration |
78 | 99 | Cost-effective Allows simultaneous airway inspection |
Variability in results and utilization Usually limited to enlarged nodes in stations 4 and 7 |
Mediastinoscopy | 78 | 100 | Considered gold standard Allows detection of micrometastases and extracapsular extension |
Risks of general anesthesia and surgery Lymph nodes in stations 5, 6, 8, 9 and 11 are not accessible to standard technique |
Endoscopic ultrasound |
84 | 99.5 | High sensitivity in paraesophageal lymph node stations Access to celiac-axis nodes, liver, left adrenal gland Can detect malignancy in normal-sized nodes Minimally invasive and complementary to endobronchial ultrasound |
Requires specialized training and equipment Lymph node stations 2r, 4r, 6, 10 and 11 and endobronchial tree cannot be assessed |
Endobronchial ultrasound |
90 | 100 | High sensitivity for majority of mediastinum Can detect malignancy in normal-sized nodes May be easily repeated Minimally invasive and complementary to endoscopic ultrasound |
Requires specialized training and equipment Lymph node stations 5, 6, 8 and 9 cannot be assessed |