. Author manuscript; available in PMC: 2012 Jul 23.

Published in final edited form as: Nat Rev Clin Oncol. 2009 May;6(5):278–286. doi: 10.1038/nrclinonc.2009.39

Table 1.

Comparison of techniques for mediastinal lymph-node staging in non-small-cell lung cancer

Investigation	Sensitivity^a(%)	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

Values from American College of Chest Physician Clinical Practice Guidelines.^3,13 Adapted from Pastis, N. J. & silvestri, G. A. Tissue procurement: bronchoscopic techniques. in Lung Cancer Principles and Practice 3rd edn 358–371 (Lippincott Williams & Wilkins, New York, 2003).