PURPOSE: To report diagnostic yield and associated costs for endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in a consecutive series of patients with mediastinal lymphadenopathy.
METHODS: We report diagnostic yield and associated procedure-related costs for a consecutive series of 52 patients with mediastinal lymphadenopathy of unclear etiology who underwent EBUS-TBNA at a large urban County Hospital between January 2010 and April 2011. All procedures were performed by a single operator (CFC) in a bronchoscopy suite, with the patient under conscious sedation. We used Medicare reimbursement rates to estimate costs, and compared costs for observed resource utilization with expected resource utilization under the assumption that mediastinoscopy would be performed in lieu of EBUS-TBNA.
RESULTS: The mean age (SD) was 56 (12) years; 58% were men, 48% were non-white and 40% were Hispanic. Final diagnosis was malignant in 32 patients (including 26 patients with lung cancer and 6 patients with non-lung primaries), benign in 12 patients, and uncertain in 8 patients. The yield of EBUS-TBNA among cases with a final diagnosis was 97% for malignancy (31/32) and 75% for benign disease (9/12). Overall diagnostic yield was 77% (40/52). A benign diagnosis was established in 3 cases by transbronchial biopsy during the same bronchoscopic procedure. There were no procedure-related complications. Eight patients with isolated lymphadenopathy would have required mediastinoscopy had the patients not been lost to follow-up. Total procedure-related costs were $1029 compared with expected costs of $2981 if EBUS-TBNA had not been available, for a net cost savings of $1952 per patient.
CONCLUSIONS: EBUS-TBNA under conscious sedation has a high diagnostic yield for both malignant and benign disease. Compared with mediastinoscopy, EBUS-TBNA saves approximately $1952 per patient with mediastinal lymphadenopathy.
CLINICAL IMPLICATIONS: In the current era of cost-consciousness, when cutting losses may be as important as generating profit, public hospitals should consider investing in EBUS-TBNA technology to expedite diagnosis and reduce costs for patients with mediastinal lymphadenopathy of unclear etiology.
DISCLOSURE: The following authors have nothing to disclose: Ching-Fei Chang, Andrew Morado, Michael Gould
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