Endobronchial ultrasound-guided transbronchial needle aspiration in diagnosing intrathoracic lymphadenopathy in patients with nasopharyngeal cancer

Objective: This study aimed to assess the efficacy of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in detecting intrathoracic lymph nodes in patients with nasopharyngeal carcinoma (NPC). Methods: Retrospective data analysis was conducted on individuals who underwent EBUS-TBNA between June 2015 and June 2022. Patients with NPC and enlarged intrathoracic lymph nodes were included. Specimens were categorized as malignant or non-malignant, with final non-malignancy confirmation procedures, or 12 months of clinical follow-up. Results: Among 97 patients, 59 (60.8%) had NPC with intrathoracic lymph node metastasis, 3 (3.1%) had primary lung cancer involving nodes, and 25 (25.8%) showed benign characteristics. Ten cases (10.3%) were false-negative on initial EBUS-TBNA but confirmed as metastatic on follow-up. For NPC patients with intrathoracic lymphadenopathy, EBUS-TBNA exhibited 86.1% sensitivity (62/72), 71.4% negative predictive value (25/35), and 89.7% accuracy (87/97). Multivariate analysis identified increased lymph node short axis (OR: 1.200, 95% CI: 1.024-1.407; P = 0.041), metachronous NPC (OR: 11.274, 95% CI: 2.289-55.528; P = 0.003), and synchronous lung lesions (OR: 19.449, 95% CI: 1.875-201.753; P = 0.001) as independent predictors of malignant intrathoracic lymphadenopathy. Longer lymph node short axis (OR: 1.305, 95% CI: 1.044-1.631; P = 0.019) was independently associated with EBUS-TBNA accuracy. Conclusion: EBUS-TBNA effectively diagnoses intrathoracic lymphadenopathy in NPC patients.