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Developments in the delivery of lung cancer care
P219 Is there a role for conventional transbronchial needle aspiration in the endobronchial ultrasound era?
  1. U H Oltmanns,
  2. P Perera,
  3. M Slade
  1. Papworth Hospital, Papworth Everard, Cambridge, UK

Abstract

Introduction and Objectives It is believed by some that endobronchial ultrasound (EBUS) will render conventional transbronchial needle aspiration (cTBNA) obsolete. We sought to explore this question.

Methods Data on both conventional (n=33) and a randomly selected equal number of EBUS-guided TBNA (n=33), performed to biopsy mediastinal lymph nodes (LN), between August 2008 and May 2010, were extracted from a prospective database of bronchoscopy procedures. Measured variables were age, sex, sampled LN stations and sizes, sample results and final diagnoses for LN and underlying patient diagnosis.

Results Thirty-eight LN from 4 different LN stations in the cTBNA group and 46 LN from 5 different LN stations in the EBUS group were sampled. LN were significantly larger in the cTBNA group (median 2.65 cm, range 0.90–7.00 cm) compared to the EBUS-TBNA group (median 1.45 cm, range 0.60–3.00 cm; p<0.001). Accurate diagnoses were obtained in 29/33 (88%) cTBNA cases and 26/33 (79%) EBUS-TBNA (p=0.51, Fisher's exact test). cTBNA confirmed 23 lung cancers, 1 lymphoma, 3 benign conditions and 2 true negative cases confirmed surgically. Four false negative LN samples were diagnosed with lung cancer (n=3) and sarcoidosis (n=1) by other methods. EBUS-TBNA provided an accurate diagnosis in 26 patients (lung cancer, n=14; other malignancy, n=2; benign cases, n=7; true negative, n=3). Five false negative cases were subsequently diagnosed with lymphoma (n=1), lung cancer (n=3) and other malignancy (n=1). One non-diagnostic sample without further diagnostic clarification was considered false negative. A further sample with possible malignant cell contamination was considered false positive.

Discussion In a centre with access to both techniques, selected patients with mediastinal or hilar lymphadenopathy can be investigated with cTBNA without compromising diagnostic accuracy. Across the UK, cTBNA is potentially widely available, and requires minimal capital investment compared to EBUS-TBNA. We believe that cTBNA remains an attractive first-line diagnostic procedure for chest physicians.

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