Abstract
INTRODUCTION: Accurate assessment of mediastinal lymph node involvement is crucial for treatment planning in lung cancer. Combined endobronchial and endoscopic ultrasound (CUS) offers high sensitivity and negative predictive value (NPV), but false negative (FN) results remain a concern due to their potential impact on treatment strategies. AIM: We aimed to analyze factors associated with FN CUS results in patients with lung cancer. MATERIAL AND METHODS: We conducted a retrospective analysis of a prospective database of adult patients with lung cancer clinical stage I-IVA, staged using positron emission tomography (PET), computed tomography (CT), and CUS, who underwent lung resection. The analyzed data included age, sex, body mass index (BMI), tumor histology and grade, lobar location, stage of the disease and maximum standardized uptake values (SUV(max)) of the primary tumor and lymph nodes. RESULTS: Among 775 analyzed patients, there were 86 (11%) FN results. The risk of FN CUS results was significantly associated with female sex (p = 0.014), adenocarcinoma histology (p = 0.039), higher clinical stage determined using both CT (p = 0.001-0.036) and PET (p = 0.001-0.028), higher SUV of N2 nodes (p < 0.001), and higher SUV of N1 nodes (p = 0.012). No significant association was found between the risk of FN CUS results and patients' age (p = 0.421), BMI (p = 0.921), or primary tumor characteristics, including lobar location (p = 0.29-0.99), grade (p = 0.67-0.88), and SUV(max) (p = 0.12). CONCLUSIONS: FN CUS results are more likely in women, with adenocarcinoma histology and higher clinical stage determined using CT and PET. Age, BMI, and primary tumor lobar location, grade, and SUVmax are not predictors of FN.