OBJECTIVES: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a key diagnostic modality for lung cancer, yet its accuracy varies based on several factors. This study aims to identify factors influencing the diagnostic accuracy of EBUS-TBNA for lung cancer detection. METHODS: A retrospective case-control study was conducted on lung cancer patients diagnosed at Gaozhou People's Hospital from October 2021 to September 2023. Patients with lung cancer confirmed by EBUS-TBNA, bronchoscopy with direct biopsy, or surgical intervention were re-evaluated using EBUS-TBNA. Based on diagnostic accuracy, they were classified into an accurate group (n = 204) and an inaccurate group (n = 41). An external validation cohort included 58 lung cancer patients. Data collection encompassed patient demographics and EBUS-TBNA findings. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to determine factors influencing detection accuracy. A generalized linear model incorporating independent influencing factors was developed to estimate the likelihood of inaccurate EBUS-TBNA detection of lung cancer. RESULTS: Smoking history [dds ratio (OR), 7.948
CONCLUSION: Smoking history, pathologic subtype, lesion size and aspirate sample characteristics significantly affected the diagnostic accuracy of EBUS-TBNA in lung cancer detection. These insights underscore the importance of considering these factors in clinical practice to optimize EBUS-TBNA's diagnostic performance.