New diagnostic techniques: Endobronchial ultrasound-guided needle aspiration and electromagnetic navigation

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and electromagnetic navigation bronchoscopy (ENB) are relatively recent and very promising additions to the interventional bronchoscopy armamentarium. Although mediastinoscopy is the gold standard for mediastinal lymph node (MLN) staging for non-small cell lung cancer patients, EBUS-TBNA has emerged as a useful, less invasive staging technique that offers access to a wider range of MLN stations than mediastinoscopy. The negative predictive value (NPV) of EBUS-TBNA in patients with malignancy is somewhat lower than the NPV of mediastinoscopy; hence we recommend that a negative cytologic sample be confirmed with a surgical MLN biopsy (i.e., mediastinoscopy or thoracoscopy) if the pretest probability of malignancy is high or the implications of a false negative result are significant (i.e. clinically and radiologically suspected N2 disease). Electromagnetic navigation bronchoscopy (ENB) is a new diagnostic and therapeutic modality that allows access to peripheral lung lesions beyond the reach of a conventional bronchoscope. An experienced cytopathologist is critical to establishing an effective EBUS-TBNA and ENB program.