Safety and Costs of Endobronchial Ultrasound-Guided Nodal Aspiration and Mediastinoscopy

Verdial, Francys C.; Berfield, Kathleen S.; Wood, Douglas E.; Mulligan, Michael S.; Roth, Joshua A.; Francis, David O.; Farjah, Farhood

doi:10.1016/j.chest.2019.09.021

Cited by 28 publications

(27 citation statements)

References 41 publications

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“…Several studies have compared the cost-effectiveness and safety of EBUS-TBNA for diagnosis versus mediastinoscopy 13 , 14 . Certainly according to current guidelines for lung cancer PET-CT and EBUS-TBNA have an algorithm before mediastiscopy is performed 15 .…”

Section: Discussionmentioning

confidence: 99%

Priority of PET-CT vs CT Thorax for EBUS-TBNA 22G vs 19G: Mesothorax Lymphadenopathy

Huang¹,

Hu²,

Wu³

et al. 2021

J. Cancer

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Introduction: Lung lesions and undiagnosed mesothorax lymphadenopathy is an issue that several doctors face in the everyday clinical practice. PET-CT and CT of the thorax are usually the first examinations to identify characteristics of the lesions before biopsy. Patients and Methods: We performed a retrospective study with 450 patients that had EBUS-TBNA with 22G, Upgraded 22G and 19G needles with and without PET-CT in order to identify the cost effeteness of performing EBUS-TBNA before or after PET-CT. All centers used the same PET-CT equipment and EBUS-TBNA system. Three types of needle were used for the endoscopy in order to identify similarities and differences for the cost-effectiveness. The costs in every center for every examination and materials were the same. Results: There were more block slices for 19G>22Gupgraded>21G>22G and there was cost-effectiveness when in general PET-CT was performed prior to biopsy of any lesion. 19G needle was more effective for lymphomas, while 22Gupgraded and 21G needles were more cost-effective when used for smaller lesions for primary lung cancer of metastatic disease. Conclusions: We have been using PET-CT and EBUS-TBNA in the everyday clinical practice according to the current guidelines for initial disease staging and re-staging. However; we can also use both in a cost effective method based on the initial radiologic findings.

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Section: Discussionmentioning

confidence: 99%

Priority of PET-CT vs CT Thorax for EBUS-TBNA 22G vs 19G: Mesothorax Lymphadenopathy

Huang¹,

Hu²,

Wu³

et al. 2021

J. Cancer

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“…Previous studies showed that no statistically signi cant difference was identi ed between EBUS-TBNA and mediastinoscopy in diagnostic sensitivity to evaluate malignant lymph nodes with previous imaging results indicating the enlargement of mediastinal and/or hilar lymph nodes or adjacent lesions in lungs (Figueiredo et al 2020). However, compared to mediastinoscopy, EBUS-TBNA was a less invasive procedure with low costing and better tolerability for patients (Sampsonas et al 2018;Verdial et al 2020). Currently, EBUS-TBNA has gradually replaced mediastinoscopy and been recommended by multiple guidelines as the rst choice for TNM staging in lung cancers.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic value of endobronchial ultrasound elastography combined with rapid onsite cytological evaluation in endobronchial ultrasound-guided transbronchial needle aspiration

Huang¹,

Lü²,

Wang³

et al. 2021

Preprint

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Background: Endobronchial ultrasound (EBUS) elastography has been applied in EBUS-guided transbronchial needle aspiration (EBUS-TBNA) to identify malignant lymph nodes based on the tissue stiffness. Rapid onsite cytological evaluation (ROSE) has been widely used for onsite evaluation of the adequacy of the samples and guiding the sampling during EBUS-TBNA. The aim of the study is to investigate the diagnostic value of combined EBUS elastography and ROSE in evaluating of mediastinal and hilar lymph nodes status.Methods: A retrospective chart review was performed from December 2018 to September 2020. Patients’ demographic, EBUS elastography score, ROSE, pathologic and clinical outcomes were collected. The EBUS elastography scores were classified as follows: Type 1, predominantly non-blue; Type 2, partially blue and partially non-blue; Type 3, predominantly blue. Receiver operating characteristic (ROC) curve was used to compare the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio among EBUS elastography, ROSE, and EBUS combined with ROSE groups for evaluation of malignant lymph nodes.Results: A total of 247 patients (345 lymph nodes) were included in our study. The sensitivity and specificity of EBUS elastography group in the diagnosis of malignant lymph nodes were 90.51% and 57.26%, respectively. The sensitivity and specificity in the ROSE alone group were 96.32% and 79.05%, respectively. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of EBUS elastography combined with ROSE group were 86.61%, 92.65%, 11.78, and 0.14, respectively, and the area under curve was 0.942.Conclusions: The combination of EBUS elastography and ROSE significantly increased the diagnostic value of EBUS-TBNA in evaluating mediastinal and hilar lymph nodes status.

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“…While modestly more accurate, TTNA biopsy has higher complication rates than bronchoscopy; major complication rates (pneumothorax requiring intervention, haemothorax, air embolism, needle tract seeding, and death) are approximately 5%, compared with <1% for EBUS. [14][15][16][17][18]…”

Section: Pathways To Diagnose Suspected Lung Cancersmentioning

confidence: 99%

Diagnosis and treatment of early lung cancer

McLellan¹,

Marshall²,

Dent³

et al. 2020

Aust J Gen Pract

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Safety and Costs of Endobronchial Ultrasound-Guided Nodal Aspiration and Mediastinoscopy

Cited by 28 publications

References 41 publications

Priority of PET-CT vs CT Thorax for EBUS-TBNA 22G vs 19G: Mesothorax Lymphadenopathy

Priority of PET-CT vs CT Thorax for EBUS-TBNA 22G vs 19G: Mesothorax Lymphadenopathy

Diagnostic value of endobronchial ultrasound elastography combined with rapid onsite cytological evaluation in endobronchial ultrasound-guided transbronchial needle aspiration

Diagnosis and treatment of early lung cancer

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