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Original Research: Pulmonary Procedures |

Transbronchial vs Transesophageal Needle Aspiration Using an Ultrasound Bronchoscope for the Diagnosis of Mediastinal LesionsDiagnosing Mediastinal Lesions by Ultrasound Scope: A Randomized Study

Masahide Oki, MD, FCCP; Hideo Saka, MD, FCCP; Masahiko Ando, MD; Rie Tsuboi, MD; Masashi Nakahata, MD; Saori Oka, MD; Yoshihito Kogure, MD; Chiyoe Kitagawa, MD
Author and Funding Information

From the Department of Respiratory Medicine (Drs Oki, Saka, Tsuboi, Nakahata, Oka, Kogure, and Kitagawa), Nagoya Medical Center; and the Center for Advanced Medicine and Clinical Research (Dr Ando), Nagoya University Hospital, Nagoya, Japan.

CORRESPONDENCE TO: Masahide Oki, MD, FCCP, Department of Respiratory Medicine, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya 460-0001, Japan; e-mail: masahideo@aol.com


FOR EDITORIAL COMMENT SEE PAGE 1201

Part of this article was presented in abstract form at CHEST 2013, October 27, 2013, Chicago, IL.

FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(5):1259-1266. doi:10.1378/chest.14-1283
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BACKGROUND:  The purpose of this study was to compare the tolerance, efficacy, and safety of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) with transesophageal endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) with an endobronchial ultrasound scope for the first pathologic diagnosis of lesions accessible by both procedures.

METHODS:  Patients who had lesions accessible by both EBUS-TBNA and EUS-FNA were enrolled and were randomized to undergo either procedure. Patients quantified tolerance, and operators charted the quality of examination using a 100-mm visual analog scale (VAS).

RESULTS:  A specific diagnosis was made in 50 of 55 patients (91%) in the EBUS-TBNA group and in 48 of 55 patients (87%) in the EUS-FNA group (P = .76). Compared with EBUS-TBNA, EUS-FNA was associated with a shorter duration of procedure (median, 15.3 min vs 11.3 min; P < .001), lower doses of IV midazolam (mean, 4.4 mg vs 4 mg; P = .02) and intraairway lidocaine (mean, 303 mg vs 189 mg; P < .001), less frequent oxygen desaturations (23 of 55 vs two of 55, P < .001), and higher operator satisfaction (P < .001). There was no significant difference in patient tolerance according to the patients’ VAS. Lymph node infection occurred in one patient in the EBUS-TBNA group and in two patients in the EUS-FNA group.

CONCLUSIONS:  Both EBUS-TBNA and EUS-FNA provide high accuracy with good tolerance, although the occurrence of infectious complications should be monitored carefully. EUS-FNA has the advantage of comparable tolerance with fewer doses of anesthetics and sedatives, a shorter procedure time, and fewer oxygen desaturations during the procedure.

TRIAL REGISTRY:  UMIN Clinical Trials Registry; No.: UMIN000005757; URL: http://www.umin.ac.jp/ctr/

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