Endobronchial ultrasound guided transbronchial needle aspiration (EBUS TBNA) is performed by using special bronchoscope which has ultrasound probe at its tip that could demonstrate lymph node out side the airway and allow for real time observation of transbronchial needle aspiration. However, the high expenses and special training required, the impacts of this method on clinical practice guideline (CPG) need to be evaluated.
Consecutive patients were done EBUS TBNA for evaluation of their mediatinal lymphnodes. The indications were preoperative evaluation for lung cancer and isolated mediastinal lymphadenopathy. All lymph node stations were examined by EBUS and sizes were recorded. Patients were separated in three groups. Group one included proven lung cancer patients who had no distance metastasis and mediastinal lymph nodes diameter less than 1 cm. Group two was the same as group one except mediastinal lymph nodes diameter were equal or greater than 1 cm. Group three included patients who only had mediastinal lymphadenopathy without lung lesion.
There were 158 patients in the study. The number of patient in group 1, 2 and 3 were 32, 89 and 37 respectively. The mean size of the mediastinal lymph node which detected by EBUS was 1.34 cm (range 0.36–3.81 cm). TBNA were done in 164 nodes out of 353 nodes found by EBUS. Most common enlarged mediastinal node was at station 7 and station 4R and 3 were less in sequence. In all three groups, malignant cell were established in 71 patients (44.9%). In group 1 malignancy was found in 5 (15.6%), 55 patients (61.8%) in group 2 and 11 patients (29.7%) in group 3 had malignant cell in their node.
EBUS TBNA can save 49.5% of mediastinoscopy procedure. If only enlarged mediastinal lymph node would be considered for mediastinoscopy, EBUS TBNA can save up to 61.5%.In isolated mediastinal lymphadenopathy, the benefit decrease because of low negative predictive value.
EBUS TBNA has impact on CPG for assessment of mediastinal node in lung cancer and mediastinal lymphadenopathy patients.
Jamsak Tscheikuna, No Financial Disclosure Information; No Product/Research Disclosure Information