PURPOSE: Endobronchial ultrasound guided biopsy is rapidly becoming a pervasive technique for sampling mediastinal lymph nodes. The majority of published series to date investigating yield are from interventional pulmonary supported centers. Our purpose was to report the results of the first 100 endobronchial ultrasound (EBUS) guided biopsies at an academic center performed by non-interventional pulmonary trained clinicians.
METHODS: We retrospectively reviewed the first 100 EBUS cases at a major university center without a dedicated interventional pulmonologist. Relevant data were collected on the first 100 sequential patients undergoing EBUS-guided mediastinal sampling at our institution. We report the indications for EBUS, lymph node size, location, diagnostic yield, PET scan characteristics when available, and complications. Procedures were performed with moderate sedation via an oral route. Final diagnosis was confirmed with surgery or follow up over a six month period for non-diagnostic biopsies.
RESULTS: The two most common indications for EBUS were known or suspected malignancy (79/100) and sarcoidosis (14/100). We obtained definitive lymph node tissue in 93 cases. Two cases were aborted prior to biopsy because of patient tolerance, and five cases showed no evidence of lymph node tissue. The most commonly biopsied sites were subcarinal (71/100), followed by right paratracheal (57/100). Our overall diagnostic yield was 82%. The yield was 88% (45/51) when cancer was the final diagnosis, but only 68% (17/25) for granulomatous disease. There were eleven false negative EBUS biopsies, 7 with granulomatous inflammation, and 4 for malignancy.
CONCLUSION: Endobronchial ultrasound is a safe and effective tool for mediastinal lymph node evaluation in a non-interventional pulmonary program. In our experience, diagnostic yield was highest for malignancy. Lower yields and higher false negative rates were observed with granulomatous inflammation.
CLINICAL IMPLICATIONS: Based on our results, additional sampling should be considered for suspected granulomatous disease.
DISCLOSURE: Michael Nead, No Financial Disclosure Information; No Product/Research Disclosure Information