[Transbronchial needle aspiration in the study of mediastinal lymph nodes: yield and cost-effectiveness].
OBJECTIVE
The role of different techniques for mediastinal staging in patients with suspected lung cancer is a subject of debate. The aim of this study was to analyze the diagnostic yield and cost-effectiveness of transbronchial needle aspiration in the mediastinal staging of lung cancer in patients being evaluated in a tertiary hospital.


METHODS
This was a retrospective, observational study of the results of transbronchial needle aspiration in patients with suspected lung cancer and mediastinal lymph node involvement. A cost-effectiveness analysis of the systematic use of this technique was also performed.


RESULTS
One-hundred ninety-four patients (85% men, 15% women) were evaluated. The diagnosis of lung cancer was confirmed in 157 (81%). Cytology samples obtained by transbronchial needle aspiration were adequate in 147 (76%) of the 194 cases. When only the adequate samples were included in the analysis, transbronchial needle aspiration showed a sensitivity of 88%, specificity of 100%, positive predictive value of 100%, negative predictive value of 64%, and efficiency of 90%. Mediastinoscopy was avoided in 44 (34%) of the 127 patients with localized non-small cell lung cancer, with an estimated saving of euro 119,456.


CONCLUSIONS
Transbronchial needle aspiration has a high diagnostic yield and obviates the need for mediastinoscopy in a significant percentage of cases. This finding is of diagnostic and economic significance.
Servei de Pneumologia, Institut Clínic del Tòrax, IDIBAPS, Hospital Clínic, CIBER Enfermedades Respiratorias, Barcelona, Spain.
Pilar
P
Martínez-Olondris
María
M
Molina-Molina
Antoni
A
Xaubet
Ramón María
RM
Marrades
Patricio
P
Luburich
José
J
Ramírez
Antoni
A
Torres
Carlos
C
Agustí
D001707:Biopsy, Needle / Q000191:economics* / Q000379:methods; D001980:Bronchi; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D012189:Retrospective Studies