PURPOSE: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a technique that allows biopsy of mediastinal/hilar lymph nodes and pulmonary masses. The availability of EBUS in the rural community settings is increasing. The purpose of this study is to evaluate the diagnostic yield of this technique in a small South Texas community hospital with a large Hispanic population.
METHODS: This retrospective study was performed in a 209 bed community hospital in the Rio Grande Valley, bordering Mexico. Consecutive cases of EBUS were reviewed from August 2009 until January 2011. The procedures were performed by 4 pulmonologists. Rapid on-site cytologic examination (ROSE) was available for all procedures by an EBUS trained cytopathologist. Patient demographics, lymph node location, cytology results, and complications, were reviewed. Pathologist judged specimen adequate based on presence of lymphocytes, which was considered as positive diagnostic yield.
RESULTS: A total of 98 EBUS procedures were performed. Ten procedures (10%) targeted a lung mass in addition to lymph nodes. The diagnostic yield of the test was 94%. Six procedures (6%) were reported as non-diagnostic specimen. Fifty-nine patients (60%) were Hispanic (H). There were 38 patients with diagnosis of cancer (39%; 24 H, 14 Non-H [NH]); of those 11 (28.9%; 6H, 6NH) were adenocarcinoma; 9 (23.6%; 6H, 3NH) squamous cell carcinoma; 3 (8%; 2H, 1NH) small cell carcinoma; 3 (8%; 3NH) lymphoma, and 12 (31.5%; 10H, 2NH) other metastatic cancer. Fifty-four patients (55%; 29H, 25NH) had no evidence of malignancy in lymph nodes. Five had granulomatous lymphadenitis (4H, 1NH). One was compatible with sarcoidosis (NH). There were no complications reported on any of these procedures.
CONCLUSIONS: First, EBUS-TBNA with ROSE is a high yield test, even in rural hospitals, and is comparable with larger academic teaching institutions. Second, there was a higher rate of malignancy in our Hispanic population compared to Non-Hispanics. Third, there were no complications derived from the procedure.
CLINICAL IMPLICATIONS: Our experience supports a high diagnostic yield for EBUS-TBNA, and favorable safety profile. It should encourage other pulmonologists to incorporate this technique into their regular practice.
DISCLOSURE: The following authors have nothing to disclose: Mario Gomez, Rosemary Recavarren, Ricardo Abreu, Juan Ortiz, Adolfo Kaplan
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