Targeting Area in Metastatic Lymph Nodes in Lung Cancer for Endobronchial Ultrasonography-guided Transbronchial Needle Aspiration

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Abstract
Study Objective Location of the tumor tissue within the metastatic lymph nodes from lung cancer should be determined to improve the results of endobronchial ultrasound-guided transbronchial needle aspiration. Methods We histopathologically investigated 128 metastatic lymph nodes (LNs), that were less than or equal to 20 mm in short axis, and classified these as follows. Type I was minimal invasive metastasis, including type Ia (marginal metastasis occupying <25% of the LN) and type Ib (marginal invasive metastasis occupying 90% of the LN. Results Among 72 LNs with metastatic adenocarcinoma, types I, II, and III accounted for 32%, 6%, and 62%, respectively. Among 44 LNs with metastatic squamous cell carcinoma, types I, II, and III accounted for 27%, 27%, and 46%, respectively. Ten (22%) out of 45 nodes with adenocarcinoma and 6 (24%) out of 25 nodes with squamous cell carcinoma, greater than 5 mm in short axis, were classified as types Ia and Ib. Types Ia and Ib LNs have no metastasis at the center. Conclusions In about one-fifth to one-fourth of metastatic LNs, greater than equal to 5 mm and less than or equal to 20 mm in diameter, of adenocarcinoma and squamous cell carcinoma, these metastases can only be detected in biopsy specimens collected from the marginal area of the LN.