Real-time, endobronchial ultrasound-guided, transbronchial needle aspiration: a new method for sampling mediastinal lymph nodes

¹ Thoraxklinik, University of Heidelberg, Germany
² Gentofte University Hospital, Copenhagen, Denmark
³ Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, United States

^* To whom correspondence should be addressed. E-mail: f{at}herth.net.

Accepted 2 May 2006

	Abstract

Purpose: Transbronchial needle aspiration (TBNA) is an established method for sampling mediastinal lymph nodes to aid in diagnosing lymphadenopathy and in staging lung cancers. Real-time, endobronchial ultrasound (EBUS) guidance is a new method of TBNA that may increase the ability to sample these nodes and, hence, to determine a diagnosis. We conducted a descriptive study to test this new method.

Methods: Consecutive patients referred for TBNA of mediastinal lymph nodes were included in the trial. When a node was detected, a puncture was performed under real-time ultrasound control. The primary endpoint was the number of successful biopsies. Diagnostic results from the biopsies were compared to operative findings. Lymph node stations were classified according to the recently adopted American Thoracic Society scheme.

Results: From 502 patients (mean age 59 years, range 24 to 82 years; 316 men), 572 lymph nodes were punctured, and 535 (94%) resulted in a diagnosis. Biopsies were taken from lymph nodes in region 2l (40 nodes ), 2r (53 nodes), 3 (35 nodes), 4r (86 nodes), 4l (77 nodes), 7 (127 nodes), 10r (38 nodes), 10l (43 nodes), 11r (40 nodes) and 11l (33 nodes). Mean (SD) diameter of the nodes was 1.6 cm (0.36 cm) and the range was 0.8 to 3.2 cm (SD ± 0.36; range 0.8 to 4.3). Sensitivity was 94%, specificity was 100%, and the positive predictive value was 100% calculated per patient. No complications occurred.

Conclusion: EBUS TBNA is a promising new method for sampling mediastinal lymph node. Compared to conventional TBNA, it appears to permit more and smaller nodes to be sampled and it is safe.

Keywords: endobronchial ultrasound, lung cancer, mediastinal lymphadenopathy, transbronchial needle aspiration

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