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Clinical studies in lung cancer
P194 The rise of EBUS: the fall of mediastinoscopy?
  1. H Tan,
  2. S Binukrishnan,
  3. P A Smith,
  4. C Smyth,
  5. M Walshaw,
  6. K Mohan
  1. Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK

Abstract

Introduction EBUS is a minimally invasive procedure that can be used instead of mediastinoscopy to investigate mediastinal lymphadenopathy, including the staging of lung malignancy. However, its impact on the use of mediastinoscopy is unknown. We wished to determine the efficacy of a recently introduced EBUS-TBNA service and its impact on the number of cervical mediastinoscopies at our institution.

Methods We analysed the results of a prospectively recorded database of all cases referred for EBUS-TBNA over a 1-year period following its introduction in June 2009, and compared them with the number of cervical mediastinoscopies performed in the year before and after its implementation.

Results 216 patients underwent EBUS-TBNA (1st quarter 30, 2nd 56, 3rd 56, and 4th 74), with an average time from referral to procedure 5 days (range 1–15). Two who were intolerant were excluded from subsequent analysis: of the remainder 189 underwent lymph node biopsy, 16 peribronchial lesions and 9 a combination. 346 lymph node stations (144 lower paratracheal, 104 subcarinal, 83 hilar, 9 upper paratracheal, 3 paraoesophageal, 2 lobar and 1 retrotracheal) were biopsied with an average size of 1.3 cm (0.5–6): <1 cm nodes were biopsied in 50 patients (65 lymph nodes). Adequate samples were obtained in 203 patients (95%): 105 carcinoma, 27 sarcoidosis, 2 tuberculosis, 2 cysts, 1 cryptococcus, 1 lymphoma, and 65 benign lymphoid tissues. Of the latter, 36 were confirmed benign by surgery or clinical follow-up, 2 await mediastinoscopy/resection, 22 could not be confirmed, 3 were subsequently diagnosed as lymphoma and 2 with sarcoidosis. 2 patients (>6 biopsies each) developed self-limiting pyrexia (<12 h) and 1 patient developed a COPD exacerbation, which required intensive treatment for 24 h. During the same period, 67 patients underwent mediastinoscopy compared to 105 in the preceding 12 months (37% reduction).

Conclusion Our experience suggests that EBUS is a safe and effective alternative to mediastinoscopy in the diagnosis of patients with mediastinal lymphadenopathy and the staging of lung cancer patients. Its introduction was accompanied with a reduction in the use of cervical mediastinoscopy, saving NHS costs and improving the experience of patients undergoing this diagnostic pathway.

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