Accuracy of Endobronchial Ultrasound-Directed Transbronchial Needle Aspiration (EBUS-TBNA) for Diagnosis of Mediastinal Lymphadenopathy in Patients With Suspected Malignancy

Tupayachi, M. G.; Hosein, Peter J.; Nguyen, Dao M.; Thurer, Richard; Garcia, Maria Alice Amorim; Raez, Luis E.; Donna, Elio

doi:10.1378/chest.10801

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“…Disease-specific accuracy was 81.7%, 84% and 78.9% in the diagnosis of cancer, NSCLC and non-cancer lesions, respectively. The accuracy achieved was largely comparable with those reported in literature (14)(15)(16)(17). The sensitivities for all pathologies, cancer, NSCLC and non-cancer were 55.1, 48.8, 48.3, and 60%, respectively.…”

Section: Discussionsupporting

confidence: 85%

Diagnostic Accuracy of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA) in Real Life

et al. 2020

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Background: EBUS-TBNA is an integral tool in the diagnosis and staging of lung cancer and other diseases involving mediastinal lymphadenopathy. Most studies attesting to the performance of EBUS-TBNA are prospective analyses performed under strict protocols. The objective of our study was to compare the accuracy of EBUS-TBNA to surgery in diagnosing hilar and mediastinal pathologies in a tertiary hospital, staffed by pulmonologists with and without formal interventional pulmonary training. Methods: We retrospectively analyzed subjects who underwent EBUS-TBNA followed by a confirmatory surgical procedure from January 2012 to December 2018. The primary outcome was to evaluate the accuracy of EBUS-TBNA in the diagnosis of all mediastinal disease. Secondary analyses determined the accuracy of EBUS-TBNA in cancer, NSCLC, and non-malignant lesions individually. Results: One hundred and forty-three subjects had an EBUS-TBNA procedure followed by surgery. EBUS-TBNA for all pathologies had an accuracy of 81.2% (CI 95% 73.8-87.4) and sensitivity of 55.1% (CI 95% 41.5-68.3). The accuracy and sensitivity of individual groups were: cancer (81.7, 48.8%), NSCLC (84, 48.3%), and non-malignancy (78.9, 60%). The NSCLC group had 15 false negatives and 5 (33.3%) of them were due to non-sampling of EBUS accessible nodes. Missed sampling led to a change in the final staging in 8.6% of NSCLC subjects. Conclusion: The accuracy of EBUS-TBNA across all groups was comparable to those reported previously. However, the sensitivity was comparatively lower. This was primarily due to the large number of EBUS-TBNA accessible lymph nodes that were not sampled. This data highlights the need for guidelines outlining the best sampling approach and lymph node selection.

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Section: Discussionsupporting

confidence: 85%