Chest
BronchoscopyConventional vs Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: A Randomized Trial
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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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