The Diagnostic Utility of Real-Time EBUS-TBNA for Hilar and Mediastinal Lymph Nodes in Conventional TBNA Negative Patients

Abstract

There are many causes of mediastinal and hilar lymphadenopathy, such as neoplasms, granulomatous diseases, infections and reactive hyperplasia. Nowadays, the popularity of endobronchial ultrasound-guided transbronchial needle aspiration (EBUSTBNA) is increasing in the diagnosis of mediastinal and hilar lymphadenopathy. We aimed to investigate the diagnostic value of EBUS-TBNA in patients with mediastinal and/or hilar lymphadenopathy and previously conventional TBNA-negative or inadequate results. Retrospective analysis was performed in 64 patients with previously conventional TBNA- negative or inadequate results and consequently undergoing EBUS-TBNA between July 2007 and August 2011. One hundred and twenty three lymph nodes were sampled by EBUS-TBNA in 64 patients with no complications. In the 63 (98.4%) cases with adequate results, the sensitivity, diagnostic accuracy, and NPV of EBUS-TBNA per patient was 90.5%, 90.6%, and 66.6%, respectively. In a total of 122 (99.1%) adequately sampled lymph nodes, the diagnostic sensitivity, accuracy, and NPV of EBUS-TBNA per nodal station were 87.8%, 90.1%, and 65.7%, respectively. Non-small cell lung cancer (NSCLC) (n = 21, 33.3%) and sarcoidosis (n = 16, 25.3%) were the most common malignant and benign diseases in the patients with adequate samples by EBUS-TBNA. The relationships of diagnostic accuracy with the number of lymph nodes sampled, number of passes per node, or size of lymph nodes were both insignifi cant (p >0.05). EBUS-TBNA is a sensitive and accurate method for the assessment of mediastinal and hilar lymph nodes in patients with conventional TBNA negative results.