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RATIONALE TBNA is an established procedure of sampling mediastinal lesions for diagnosis and staging of bronchogenic carcinoma and for diagnosing non-malignant intrathoracic lymphadenopathy. Literature search on conventional TBNA reveals wide variation in outcome, varying from 20 to 89%. In comparison, the yield of EBUS guided TBNA is 85% and it reaches 95% by Real Time EBUS-TBNA. We performed this study to analyse the yield of conventional TBNA and to decide when we should refer a patient for EBUS-TBNA in a tertiary care hospital in India. METHOD Over the period of 18 months, TBNA was performed on 142 consecutive patients. All the three described methods: Jabbing, Piggyback and Hub against the Wall technique were used. However, a combination of the above methods was used most of the times. All bronchoscopies were performed by single operator to avoid bias. All nodes greater than 0.5 cm in short axis diameter were punctured. Positive lymph node specimens were defined as those demonstrating lymphoid tissue on cytological specimens or yielding some diagnosis. RESULTS In 142 patients taken in the study, 196 nodes were sampled. Subcarinal node was the most commonly punctured node followed by Right Paratracheal. Average short axis diameter of subcarinal node was 1.633 + 0.918 cm and that of paratracheal node was 1.53 + o.71 cm. Average number of passes were four and Piggyback method was the most successful method. Positive results were obtained in 85.2 % of patients (n=121) while in 21 patients, result was negative. Out of the positively sampled nodes, 71.90 % (n=87) yielded positive diagnosis, while 28.09 % (n=34) yielded only lymphocytes. Of the positive cases, 60 cases (49.58 %) were of granulomatous etiology (41 tuberculosis and 19 sarcoidosis), 16 patients (13.22 %) had malignancy, and 2 had fungal etiology while pericardial fluid was aspirated in one case. DISCUSSION In expert hands, the yield of conventional TBNA can be quite high (85.2 % in this study). However, despite being a well-established bronchoscopic technique, it remains underutilised. In India, the cost of EBUS-TBNA is around $1000 while that of conventional TBNA is $300 and EBUS-TBNA is available in very few centres. Authors therefore recommend that before proclaiming EBUS-TBNA as the new gold standard, proper method of conventional TBNA should be learned, and patients should be referred for EBUS-TBNA only when pre-procedure imaging suggests lesion to be difficult to approach by conventional TBNA or when conventional TBNA fails to give a diagnosis. This abstract is funded by: none Am J Respir Crit Care Med 185;2012:A2992 Internet address: www.atsjournals.org Online Abstracts Issue

Introduction: The pituitary gland is also called the master gland of the body and its tumours represent 10- 15% of all intracranial tumors, with an annual incidence of 0.2-2.8 cases per 100,000 persons.Most are benign adenomas arising from the anterior pituitary (adenohypophysis), and most commonly present due to hormonal effects(includes hyperprolactinomia,Cushings Syndrome, acromegaly..),mass effect, as an incidental finding or infrequently with pituitary apoplexy.Objective: To describe the features of the patients with pituitary adenoma, different surgical approaches, and its outcome.Methodology: This is a prospective study of data of all patients operated from 2013 to 2015(3 years).The demographic factors of age, sex is studied along with the the size of adenoma, clinical symptoms before and after surgery, type of surgery, complications and final outcome.Result: The total number of cases was 18, with predominantly males (10 cases) than females (8 cases).The most common mode of presentation was with headache in 7 cases (39%), followed by visual changes in 6(33%). Hormonal changes was found in 10(56%) with pituitary apoplexy in 4 cases (22%). Tumour resection was complete in 92% of the cases and subtotal in the rest. There were no mortalities.Conclusion: Sublabial transphenoidal surgery is a effictive technique with low procedure related morbidity.

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