An Algorithmic Approach for Assessment of Mediastinal Lesions Using Conventional Transbronchial Needle Aspiration and Endoscopic Ultrasonography in a Single Procedure

الملخص EN

Background.

In the era of endobronchial/esophageal ultrasound (EBUS-TBNA/EUS-FNA), many centers forgo conventional transbronchial needle aspiration (C-TBNA) in favour of EBUS-TBNA/EUS-FNA despite no conclusive evidence showing better yields with EBUS-TBNA/EUS-FNA.

Objectives.

Assess the feasibility of an algorithmic approach for mediastinal sampling beginning with C-TBNA utilizing rapid onsite cytologic evaluation.

Methods.

Descriptive analysis of 92 consecutive patients referred for adenopathy that underwent C-TBNA and subsequent EBUS-TBNA/EUS-FNA if C-TBNA was negative or nondiagnostic.

Results.

92 procedures were analyzed.

In 50 (54.3%) of cases, C-TBNA alone was sufficient.

EBUS-TBNA was performed after C-TBNA in 27 (29.3%) of cases and EUS-FNA in 33 (35.9%) of cases.

The yield was 92.9% for C-TBNA, 92.5% for EBUS-TBNA, and 89.7% for EUS-FNA.

There were no statistically significant differences in yields by LN station (P=0.51), the relationship between yield and LN size (P=0.37), or time difference in procedures following the algorithm compared to EBUS/EUS only procedures (33.7 minutes versus 32.4 minutes on average [95% CI for difference: −9.1 to 11.7], P=0.80).

Conclusions.

An algorithmic approach to assess the mediastinum using C-TBNA initially is feasible without sacrificing yield or procedure times.

C-TBNA was sufficient for diagnosis in 54.3% of cases and can be efficiently taught in an IP training program.