First endoscopic procedure for diagnosis and staging of mediastinal lymphadenopathy.
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.
Khoo
Kay-Leong
KL
Department of Medicine, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074, Singapore. kay_leong_khoo@nuhs.edu.sg
Ho
Khek-Yu
KY
Khor
Christopher Jen-Lock
CJ
Nilsson
Barbro
B
Lim
Tow-Keang
TK
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