Chest
Volume 125, Issue 1, January 2004, Pages 322-325
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Bronchoscopy
Conventional vs Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: A Randomized Trial

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Study objective

Our group performed a randomized trial to assess whether the addition of endobronchial ultrasound (EBUS) guidance will lead to better results than standard transbronchial needle aspiration (TBNS). EBUS guidance seems to be beneficial in increasing the yield of TBNA but has not been proven to be superior to conventional procedures in a randomized trial.

Methods

Consecutive patients who were referred for TBNA were randomized to an EBUS-guided and a conventional TBNA arm. Patients with subcarinal lymph nodes were randomized and analyzed separately (group A) from all other stations (group B). A positive result was defined as either lymphocytes or a specific abnormality on cytology.

Results

Two hundred patients were examined (100 patients each in groups A and B). Half of the patients underwent EBUS-guided TBNA rather than conventional TBNA. In group A, the yield of conventional TBNA was 74% compared to 86% in the EBUS group (difference not significant). In group B, the overall yields were 58% and 84%, respectively. This difference was statistically highly significant (p < 0.001). The average number of passes was four.

Conclusion

EBUS guidance significantly increases the yield of TBNA in all stations except in the subcarinal region. It should be considered to be a routine adjunct to TBNA. On-site cytology may be unnecessary, and the number of necessary needle passes required is low.

Section snippets

Materials and Methods

Between June 2001 and March 2002, all patients referred for TBNA of enlarged mediastinal lymph nodes were randomized in an EBUS-guided and a conventional TBNA arm. Lymph node stations were classified after the recent American Thoracic Society proposal.11 The trial was approved by the institutional review board, and informed consent was obtained from all patients. No patients were excluded from the trial.

As subcarinal lymph nodes are easily accessible by any method, these patients were

Results

Two hundred patients (75 women and 125 men; mean [± SD] age, 51.9 ± 22.6 years) were examined, 100 in each group. The mean lymph node size was 1.76 ± 0.47 cm (range, 0.8 to 4.3 cm) in group A and 1.53 ± 0.43 cm (range, 0.7 to 2.3 cm) in group B. There was no statistical differentiation in demographics between the conventional and the EBUS-guided arm in each group (Table 1). The main indications for TBNA were for the diagnosis of enlarged lymph nodes with unknown origin and cancer staging,

Discussion

TBNA is a well-established bronchoscopic technique but remains underutilized, and the yield varies widely.5 This fact may be due to the long learning curve and its associated frustrations. Additionally, conventional TBNA is a fairly blind technique preventing target visualization. This makes accessing smaller lymph nodes and nodes in some locations more difficult. Limited options currently exist to improve yield. The most commonly recommended are ROSE and, recently, the passing of the needle up

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