REAL TIME VISUALIZATION OF MEDIASTINAL LYMPH NODES WHILE DOING ENDOBRONCHIALULTRASOUND GUIDED TRANS BRONCHIAL NEEDLE ASPIRATION (EBUS-TBNA) USING CONVEX PROBE GIVES BETTER DIAGNOSTIC YIELD THAN CONVENTIONAL TBNA AND MEDIASTINOSCOPY:

Abstract

Introduction:Real time visualisation of mediastinal lymph nodes makes it easy to Hit & Run with convex probe while doing Endobronchial Ultrasound guided Trans Bronchial Needle Aspiration (CP-EBUS-TBNA) whichgives better safety profile, diagnostic yield and is gradually replacingConventional Trans Bronchial Needle Aspiration( C-TBNA) and Mediastinoscopy. We analysed retrospectively the diagnostic yield of EBUS-TBNA done at Asian Institute of Medical Sciences, a tertiary hospital at Faridabad in Haryana. Materials and Methods: We pulled in the dataof EBUS-TBNA done on patients with Mediastinal lymphadenopathy short axis nodal diameter >0.5 cm, on computed tomography of thorax from Nov 2016 to May 2019. The procedures were done under conscious sedation by multiple operators who had done 20 EBUS-TBNA independently. A sample that was positive for AFB smears/malignant cells or granuloma was considered to be diagnostic. Results: The study included 250 patients (156 males) with mean age 49.6 years. EBUS-TBNA detected 427enlarged mediastinal nodes with average diameter of 14.45±8.56 mm. A total of 376 lesions were sampled of which subcarinal lymph node was the most common station (86.4%) followed by Pre & Paratracheal (11.6 %). Average of 1.5 lymph nodes was sampled per patient with 3 passes per lymph node. The procedure had a diagnostic yield of 86 %. Majority of the patients were diagnosed with Granulomatous pathology (44.8 %): Sarcoidosis (24 %)followed by Tuberculosis (20 %). Malignancy was diagnosed in 12 % of patients of which non small cell cancer constituted the major diagnosis(50%). No complication was observed. Conclusion: EBUS- TBNA is very safe procedure with consistent good diagnostic yieldwith multiple operators beyond learning curves than for C- TBNA which require extensive training and expertise of the operator besides size and location of the lesion, though the availability due tohigher costs limits its usage.