title: First endoscopic procedure for diagnosis and staging of mediastinal lymphadenopathy.
abstract: OBJECTIVE
  To compare a first diagnostic procedure of transbronchial needle aspiration (TBNA) with selection of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) or TBNA for mediastinal lymphadenopathy.
  
  
  METHODS
  Sixty-eight consecutive patients with mediastinal lymphadenopathy on computed tomography (CT), who required cytopathological diagnosis, were recruited. The first 34 underwent a sequential approach in which TBNA was performed first, followed by EUS-FNA if TBNA was unrevealing. The next 34 underwent a selective approach where either TBNA or EUS-FNA was selected as the first procedure based on the CT findings.
  
  
  RESULTS
  The diagnostic yield of TBNA as the first diagnostic procedure in the sequential approach was 62%. In the selective approach, the diagnostic yield of the first procedure was 71%. There was no significant difference in the overall diagnostic yield, but there were significantly fewer combined procedures with the selective approach.
  
  
  CONCLUSIONS
  Selecting either EUS-FNA or TBNA as the first diagnostic procedure achieved a comparable diagnostic yield with significantly fewer procedures than performing TBNA first in all patients.
authors.affiliation: Department of Medicine, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074, Singapore. kay_leong_khoo@nuhs.edu.sg
authors.forename: Kay-Leong
authors.initials: KL
authors.lastname: Khoo
authors.forename: Khek-Yu
authors.initials: KY
authors.lastname: Ho
authors.forename: Christopher Jen-Lock
authors.initials: CJ
authors.lastname: Khor
authors.forename: Barbro
authors.initials: B
authors.lastname: Nilsson
authors.forename: Tow-Keang
authors.initials: TK
authors.lastname: Lim
mesh_terms: D000368:Aged; D001707:Biopsy, Needle; D001999:Bronchoscopy; D005260:Female; D006801:Humans; D008206:Lymphatic Diseases / Q000175:diagnosis*; D008297:Male; D008477:Mediastinal Diseases / Q000175:diagnosis*; D008875:Middle Aged; D014463:Ultrasonography