SESSION TYPE: Bronchoscopy and Interventional Procedures Posters
PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM
PURPOSE: Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) has become an accepted noninvasive technique for evaluating the mediastinal and hilar areas. Because EBUS-TBNA is performed under real-time ultrasound guidance, the yield and safety is improved over blind TBNA. We endeavored to study the diverse indications, diagnoses and yield of EBUS-TBNA in an urban community hospital where the procedure has been newly initiated.
METHODS: This is a retrospective analysis of all patients who underwent EBUS-TBNA from Aug 2010 to Sept 2011 at the Washington Hospital Center. Data collected included baseline demographics, indications for the procedure, procedure details [lymph node (LN) size, number of passes, adequacy of the biopsy (e.g. presence of lymphocytes)], final diagnoses, and complications . The diagnoses made by EBUS-TBNA were compared to follow-up pathology. In patients with non-diagnostic procedures, subsequent evaluation (further tissue evaluation, repeat imaging, and/or 6 month follow-up) were reviewed to determine the final diagnosis.
RESULTS: One hundred seventeen patients (43.6% male; mean age 61years) underwent EBUS-TBNA with the most common indications being mediastinal lymphadenopathy (27.9%), lung mass (27.1%), and pulmonary nodule(17.7%). Total lesions sampled were 321. The average size was 15.3mm(range 2-60mm) and average number of passes was 3 (range 1-8). For all diagnoses, the diagnostic yield, sensitivity, specificity, and negative predictive value of EBUS-TBNA was 97%, 92.7%, 100%,and 95.2%, respectively. Malignancy was diagnosed in 68 [adenocarcinoma (26.4%), squamous cell (17.6%), undifferentiated non-small cell (16.1%), small cell (19.1%), metastatic (11.7%), others (5.8% -neuroendocrine and lymphoma]. Benign diagnoses [sarcoidosis n=13, reactive lymphadenopathy n=19, TB n=2, others (histoplasmosis, amyloidosis, pneumoconioses, carcinoid tumor, heart failure) n=7) were clearly made by EBUS-TBNA in 46.1% with the remainder confirmed by radiographic resolution. One patient developed hypoxia so the procedure was aborted.
CONCLUSIONS: The diagnostic yield of EBUS-TBNA remains high even when a facility is beginning to perform this procedure. Malignancy and sarcoidosis are the most common diagnoses obtained in this urban hospital setting.
CLINICAL IMPLICATIONS: EBUS-TBNA is effective and high yield diagnostic procedure that should be considered the initial option for evaluation of mediastinal or hilar lesions.
DISCLOSURE: The following authors have nothing to disclose: Anindita Chowdhury, Vikramjit Mukherjee, Jessica Wang Memoli
No Product/Research Disclosure InformationWashington Hospital Center, Washington, DC