PURPOSE: Previously, we developed a new technique, the outer sheath method (OSM), to avoid puncturing bronchial cartilage. We showed that the OSM was useful in a few patients with mediastinal and/or hilar lymphadenopathy last year. However, a few cases could not be diagnosed due to the presence of bronchial cartilage. The aim of this study was to further evaluate the diagnostic yield of EBUS-TBNA using OSM.
METHODS: Outer sheath method (OSM) was developed to avoid puncturing the bronchial cartilage using an outer plastic sheath to house the needle, to press against to the bronchial wall. The sheath with the bronchoscope is then moved along the bronchial wall to locate the most suitable puncture site between the cartilaginous rings. After a suitable site was decided, a puncture was performed. We assessed if OSM could contribute to the diagnostic yield of patients with mediastinal and/or hilar lymphadenopathy. Between November 2005 and May 2007, we performed EBUS-TBNA without OSM in 85 patients; age 25-85 (mean.64.0), male 53, female 32 (group A). We then performed EBUS-TBNA with OSM in 85 patients; age 25-86 (mean.61.0), male 59, female 26, between August 2008 and March 2010 (group B).
RESULTS: For group A, 79 of 85 patients were available for analysis. The sensitivity, specificity, and diagnostic accuracy rate of EBUS-TBNA in distinguishing benign from malignant lymph nodes were 91.5%, 100%, 93.7% in group A. In group B, 73 of 85 patients were analyzed. The sensitivity, specificity, and diagnostic accuracy rate were 95.7%, 100%, 97.3%. For group A, 4 specimens of bronchial cartilage were obtained and we could not get diagnosis. There were two cases in group B. These two bronchial cartilages were too small to influence the diagnosis of EBUS-TBNA.
CONCLUSION: The diagnostic yield of EBUS-TBNA improved using OSM.
CLINICAL IMPLICATIONS: Our study established that performing the OSM on patients with mediastinal and/or hilar lymphadenopathy results in a high diagnostic yield and was able to avoid puncturing the center of the bronchial cartilage.
DISCLOSURE: Takeo Inoue, No Financial Disclosure Information; No Product/Research Disclosure Information