To compare the effect of different levels of sedation for adequacy and diagnostic yield on endobronchial ultrasound guided transbronchial needle aspiration (EBUS TBNA).
A retrospective review of prospectively collected data was performed at two academic institutions with interventional pulmonary fellowships. The first fifty EBUS cases that were performed by each interventional fellow at the start of their fellowship were compared. Each institution practiced EBUS with primarily two different methods of sedation (deep vs. moderate sedation). Adequacy of EBUS TBNA was determined by a lymph node aspiration showing either a specific diagnosis or lymphocytes. A non-diagnostic TBNA was defined as either a different diagnosis obtained by another more definitive procedure (i.e. mediastinoscopy and repeat EBUS) or if a diagnosis was not confirmed.
EBUS was performed in the moderate sedation group for suspected carcinoma (41 patients), lymphoma (3 patients), sarcoidosis (4 patient), and infectious etiology (2 patients). EBUS was performed in the deep sedation group for suspected carcinoma (38 patients), lymphoma (2 patients), sarcoidosis (8 patients), and infectious etiology (2 patients).The specimen adequacy of EBUS TBNA was 92% in the moderate sedation group and 98% in the deep sedation group (p= 0.362). The diagnostic yield was 70% in the moderate sedation group and 84% in the deep sedation group (p=0.153). There were two patients in the moderate sedation group that were initially nondiagnostic, but had a diagnosis with a repeat EBUS under deep sedation.
Both methods of sedation had a similar adequacy. The diagnostic yield was higher with general anesthesia, but was not statistically significant.
Deep sedation for EBUS may offer a slight improvement in diagnostic yield over conscious sedation, however other factors including patient preference and procedure time need to be evaluated.
Lonny Yarmus, No Financial Disclosure Information; No Product/Research Disclosure Information