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Volume 15
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10.3390/diagnostics15172136
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

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

by
Joshua M. Boster
1,*,
S. Michael Goertzen
1,
Paula V. Sainz
1,
Macarena R. Vial
2,
Jhankruti K. Zaveri-Desai
1,
Luis D. Luna
1,
Anum Waqar
1,
Horiana B. Grosu
1,
Roberto F. Casal
1,
Carlos A. Jimenez
1,
David E. Ost
1,
Bruce F. Sabath
1,
Julie Lin
1,
Mike Hernandez
3 and
Georgie A. Eapen
1
1
Interventional Pulmonology Section, Department of Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
2
Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago 7610658, Chile
3
Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
*
Author to whom correspondence should be addressed.
Diagnostics 2025, 15(17), 2136; https://doi.org/10.3390/diagnostics15172136
Submission received: 21 June 2025 / Revised: 31 July 2025 / Accepted: 23 August 2025 / Published: 24 August 2025
(This article belongs to the Section Clinical Diagnosis and Prognosis)
Versions Notes

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.
Keywords: lung cancer; stereotactic body radiation therapy; bronchoscopic ultrasound; endobronchial ultrasound; staging lung cancer; stereotactic body radiation therapy; bronchoscopic ultrasound; endobronchial ultrasound; staging

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MDPI and ACS Style

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.; et al. Additive Value of EBUS-TBNA for Staging Non-Small Cell Lung Cancer in Patients Evaluated for Stereotactic Body Radiation Therapy. Diagnostics 2025, 15, 2136. https://doi.org/10.3390/diagnostics15172136

AMA Style

Boster JM, Goertzen SM, Sainz PV, Vial MR, Zaveri-Desai JK, Luna LD, Waqar A, Grosu HB, Casal RF, Jimenez CA, et al. Additive Value of EBUS-TBNA for Staging Non-Small Cell Lung Cancer in Patients Evaluated for Stereotactic Body Radiation Therapy. Diagnostics. 2025; 15(17):2136. https://doi.org/10.3390/diagnostics15172136

Chicago/Turabian Style

Boster, Joshua M., S. Michael Goertzen, Paula V. Sainz, Macarena R. Vial, Jhankruti K. Zaveri-Desai, Luis D. Luna, Anum Waqar, Horiana B. Grosu, Roberto F. Casal, Carlos A. Jimenez, and et al. 2025. "Additive Value of EBUS-TBNA for Staging Non-Small Cell Lung Cancer in Patients Evaluated for Stereotactic Body Radiation Therapy" Diagnostics 15, no. 17: 2136. https://doi.org/10.3390/diagnostics15172136

APA Style

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

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