Performance of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for the Diagnosis of Isolated Mediastinal and Hilar Lymphadenopathy

Abstract

Background: Although many studies have assessed the diagnostic utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the context of a specific disease, few studies have assessed the overall diagnostic yield, sensitivity, and negative predictive value in patients with isolated mediastinal and hilar lymphadenopathy (IMHL). Objective: We evaluated the performance of EBUS-TBNA for diagnosing IMHL in a population with a high prevalence of concurrent or preexisting non-pulmonary malignancy. Methods: A retrospective chart review of patients who underwent EBUS-TBNA from October 2008 to April 2014 was performed to identify patients with IMHL. Patients with known or suspected primary pulmonary malignancy were excluded. When available, EBUS-TBNA results were cross-referenced with further diagnostic investigation or clinical diagnosis based on follow-up. Results: EBUS-TBNA was used to sample 765 lymph nodes from 350 patients. One hundred and fourteen (33.3%) patients had a concurrent or preexisting non-pulmonary malignancy. The overall yield of EBUS-TBNA for specific diagnosis was 300/350 (86%). The diagnostic yield for sarcoidosis, lymphoproliferative disease, metastatic lymphadenopathy from extrathoracic malignancy, and necrotizing granuloma was 123/149 (83%), 27/33 (82%), 20/25 (80%), and 13/19 (68%), respectively. Amongst 50 patients with non-diagnostic EBUS-TBNA, 25 yielded an insufficient sample and another 25 yielded only benign lymphoid material which was not representative of the underlying pathology. Overall, EBUS-TBNA had a sensitivity of 89%, a diagnostic yield of 86%, and a negative predictive value of 79%. Conclusion: For patients with isolated hilar or mediastinal lymphadenopathy and a high background prevalence of concurrent and preexisting non-pulmonary malignancy, EBUS-TBNA is a reliable first-line diagnostic investigation.

Diff-Quik Cytology Smears from Endobronchial Ultrasound Transbronchial Needle Aspiration Lymph Node Specimens as a Source of DNA for Next-Generation Sequencing Instead of Cell Blocks

“…Previously samples such as pleural fluids, bronchoscopic brushes, and CT fine-needle aspiration (FNA) samples were more common and were evaluated for molecular testing by single-gene approaches [2]. Mediastinal and hilar nodes can be easily sampled using EBUS-TBNA with few side effects and a 95% sensitivity for diagnosing malignancy [5, 7-9]. The EBUS-TBNA procedure can be accompanied by rapid on-site evaluation (ROSE) of sample material, using air-dried and Diff-Quik-stained cytology smears to provide immediate feedback for the proceduralist [10-12].…”

Delayed diagnosis of lung cancer due to misdiagnosis as worsening of sarcoidosis: a case report

“…Performing EBUS-TBNA is preferable over surgical procedure in patients with mediastinal and hilar lymphadenopathies [20,21], and is an essential procedure to diagnose sarcoidosis [22]. The diagnostic yield of EBUSguided TBNA is as high as 86 to 91.4% in patients with pulmonary sarcoidosis [20,23]. Although Ernst et al reported the diagnostic yield of EBUS-TBNA to be 91% in patients with single hilar lymph node [24], access to hilar lymph nodes may be more difficult compared to other intrathoracic lymph nodes.…”

Comparison of transbronchial needle aspiration with and without ultrasound guidance for diagnosing benign lymph node adenopathy

“…Second, the sample size of some of the studies was small; further studies with larger samples are needed size to confirm the diagnostic accuracy of EBUS-TBNA [13,15,16,18,19,23,34,35]. Third, most studies enrolled both malignant and benign lymphadenectasis patients, rather than specifically focusing on benign lymphadenopathy [13,17,19,23,36]. In addition, studies performed in western countries were mainly concerned with sarcoidosis, whereas those done in Asian countries focused on tuberculosis [12, 14-16, 18, 34, 35].…”

“…The diagnostic efficiency of the various biopsy methods remains controversial. The reported diagnostic rate of cTBNA in patients with benign mediastinal LN enlargement varies between 21.4 and 76% [6][7][8][9][10][11], while that of EBUS-TBNA varies between 74.5 and 96% [12][13][14][15][16][17][18][19]. However, these studies used single-arm designs and had relatively small sample sizes.…”