Negative Predictive Value of Granulomas on EBUS-TBNA in Suspected Extrathoracic Malignancy Christina R. Bellinger 1 • Deepankar Sharma 1 • Jimmy Ruiz 2,3 • Graham Parks 4 • Travis Dotson 1 • Edward F. Haponik 1 Received: 21 January 2016 / Accepted: 4 April 2016 / Published online: 25 April 2016 Ó Springer Science+Business Media New York 2016 Abstract Purpose Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a well-established diagnostic tool for lung cancer, sarcoidosis, and suspected metastatic extrathoracic malignancy. EBUS-TBNA carries a high diagnostic yield, but its negative predictive value (NPV) requires further clarification. Methods We reviewed EBUS-TBNA at our cancer center from 2008 to 2015. We identified negative diagnostic samples for adenopathy suspected to represent metastatic disease from extrathoracic malignancy. Results We reviewed 529 EBUS-TBNAs. Ninety patients underwent EBUS-TBNA sampling of the hilum and/or mediastinum (121 nodes, 14 masses) for suspected extrathoracic malignancy. Thirty-seven patients had nega- tive samples (lymph node, granulomas or non-diagnostic specimens). The overall NPV was 98 %. Granulomas (11 patients, 25 nodes) seen on histology had a 100 % NPV, including those that were FDG-PET (fluorodeoxyglucose positron emission tomography) avid (n = 14 nodes). Conclusion Negative EBUS-TBNA in patients with extrathoracic malignancy and suspected secondary hilar or mediastinal metastases can infer a high NPV especially if granulomas are seen on histology. Larger prospective investigations are needed to confirm the high NPV of EBUS- TBNA with granulomas in extrathoracic malignancies. Keywords EBUS-TBNA Á Granulomas Á Extrathoracic malignancy Abbreviations EBUS-TBNA Endobronchial ultrasound-guided transbronchial needle aspiration NPV Negative predictive value FDG-PET Fluorodeoxyglucose positron emission tomography CT Computed tomography SUV Maximum standardized uptake value Introduction Isolated intrathoracic hilar and mediastinal lymph node metastases from extrathoracic neoplasms can be observed in a variety of primary cancers. The most common solid tumors include breast, head and neck, colorectal, geni- tourinary (prostate, bladder, testes, and kidney), esophagus, melanoma, and sarcoma [1, 2]. Endobronchial ultrasound- guided transbronchial needle aspiration (EBUS-TBNA) is a well-established diagnostic tool for evaluating patients with hilar and mediastinal lymphadenopathy and has shown excellent accuracy with identifying lung cancer, sarcoidosis, and metastatic extrathoracic malignancy [1–3]. Approval from Institutional Review Board at Wake Forest University, ID IRB00013684. & Christina R. Bellinger cbelling@wakehealth.edu 1 Department of Pulmonary/Critical Care, Wake Forest Baptist Health, Medical Center Blvd, Winston Salem, NC 27157, USA 2 Department of Medicine, Section on Hematology and Oncology Comprehensive Cancer, Center of Wake Forest University, Winston Salem, NC 27157, USA 3 W.G. (Bill).Hefner Veteran Administration Medical Center, Salisbury, NC 28144, USA 4 Department of Pathology, Wake Forest Baptist Health, Winston Salem, NC 27157, USA 123 Lung (2016) 194:387–391 DOI 10.1007/s00408-016-9878-z