Use of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration in the Diagnosis of Mediastinal Lesions
Marcia Jacomelli1, Juliana P. Franceschini2, Iunis Suzuki1, Addy Palomino1, Paulo Rogério Scordamaglio1, Marcelo Gregório1, Altair Costa1, Ricardo S. Santos1
1Hospital Israelita Albert Einstein, São Paulo, Brazil, 2ProPulmão, São Paulo, Brazil
BACKGROUND: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure that has been demonstrated to have good diagnostic yield in the diagnosis of mediastinal lesions. The current study was conducted to investigate the use of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of mediastinal lymphadenopathy.
METHODS: A total of 199 patients submitted to EBUS-TBNA at a private hospital from June 2013 to December 2019 were included in this retrospective cross-sectional study. All accessible mediastinal and hilar lymph nodes were systematically explored and punctured using EBUS-TBNA. Material analysis included cytological smear and cytopathological analysis of paraffin-embedded cell blocks.If EBUS-TBNA did not result in a formal pathological diagnosis, patients were subsequently referred for a transthoracic needle aspiration biopsy or a surgical diagnostic procedure. RESULTS: The mean age was 61.4 (±5.9) years, with a predominance of males (56.3%). The major indications for the EBUS-TBNA comprised mediastinal staging for lung cancer (n=109), mediastinal lymphadenopathy (n=32), mediastinal staging for other types of cancer (n=44) and mediastinal lymphoma (n=12). In all of the 391 biopsied lymph nodes, representative samples were obtained in 361 (92.3%). malignant lesions were presented in 134 samples and benign lesions in 141 samples. The sensitivity, specificity and accuracy of EBUS-TBNA in this sample were 94.2%, 100.0% and 95.5%, respectively. There were no major complications related to the procedure.
CONCLUSIONS: EBUS-TBNA can systematically evaluate the status of mediastinal lesions and improve the accuracy of preoperative lymph node staging, being an excellent option for diagnostic approach.