Polish Journal of Thoracic and Cardiovascular Surgery
eISSN: 1897-4252
ISSN: 1731-5530
Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery
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1/2026
vol. 23
 
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abstract:
Original paper

False-negative results of combined endobronchial and endoscopic ultrasound in mediastinal staging of lung cancer

Karolina Gambuś
1
,
Konrad Moszczyński
2
,
Sofiia Popovchenko
3
,
Artur Szlubowski
4
,
Adam Ćmiel
5
,
Piotr Kocoń
6
,
Błażej Kużdżał
7

  1. Department of Ophthalmology, Ludwik Rydygier Hospital, Krakow, Poland
  2. Department of Coronary Artery Disease and Structural Heart Disease, Institute of Cardiology, Warsaw, Poland
  3. Department of Anatomy, Jagiellonian University Collegium Medicum, Krakow, Poland
  4. Department of Endoscopy, John Paul II Hospital, Krakow, Poland
  5. Department of Applied Mathematics, AGH University of Science and Technology, Krakow, Poland
  6. Department of Thoracic Surgery, John Paul II Hospital, Krakow, Poland
  7. Maria Skłodowska-Curie National Institute of Oncology, National Research Institute, Krakow, Poland
Kardiochirurgia i Torakochirurgia Polska 2026; 23 (1): 8–13
DOI: https://doi.org/10.5114/kitp.2026.160677
Online publish date: 2026/04/04
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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 (SUVmax) 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 SUVmax (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.

keywords:

lung cancer, staging, endobronchial ultrasound, endoscopic ultrasound
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