Clinical utility and economic impact of conventional transbronchial needle aspiration of mediastinal lymphadenopathies in bronchogenic carcinoma.
OBJECTIVE
To analyze the clinical utility and economic impact of conventional transbronchial needle aspiration (TBNA) in patients with diagnosis of bronchogenic carcinoma (BC) and mediastinal lymphadenopathies in thoracic computed tomography (CT). To assess the predictive factors of valid aspirations.


METHODS
Retrospective observational study between 2006 and 2011 of all TBNA performed in patients with final diagnosis of BC and accessible hilar or mediastinal lymphadenopathies on thoracic CT.


RESULTS
We performed TBNA on 267 lymphadenopathies of 192 patients. In 34.9% of patients, two or more lymph nodes were biopsied. Valid aspirations were obtained in 153 patients (79.7%) that were diagnostic in 124 (64.6%). Multivariate analysis showed that factors associated with valid or diagnostic results are the diameter of the lymph node and the number of lymph nodes explored. TBNA was the only endoscopic technique that provided the diagnosis of BC in 54 patients (28.1%). Staging mediastinoscopy was avoided in 67.6% of patients. The prevalence of mediastinal lymph node involvement was 74.4%, sensitivity of TBNA was 86.2% and negative predictive value was 63.6%. Including mediastinoscopy and other avoided diagnostic techniques, TBNA saved 451.57 € per patient.


CONCLUSIONS
TBNA is a clinically useful, cost-effective technique in patients with BC and mediastinal or hilar lymphadenopathies. It should therefore be performed on a regular basis during diagnostic bronchoscopy of these patients.
Sección de Neumología, Hospital Universitario de Guadalajara, Guadalajara, España. castelao@castelao.es
Jorge
J
Castelao Naval
José Luis
JL
Izquierdo Alonso
José
J
Gallardo Carrasco
Ignacio
I
Sánchez Hernández
Carlos
C
Almonacid Sánchez
Jesús
J
Fernández Francés
Pilar
P
Resano Barrio
Olga
O
Mediano San Andrés
D000368:Aged; D001707:Biopsy, Needle / Q000191:economics / Q000379:methods*; D001999:Bronchoscopy / Q000191:economics / Q000379:methods*; D002283:Carcinoma, Bronchogenic / Q000000981:diagnostic imaging / Q000191:economics / Q000473:pathology / Q000556:secondary*; D017046:Cost Savings / Q000706:statistics & numerical data*; D003365:Costs and Cost Analysis / Q000706:statistics & numerical data; D005260:Female; D006785:Hospitals, University / Q000191:economics; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000191:economics / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008481:Mediastinoscopy / Q000191:economics; D008482:Mediastinum; D008875:Middle Aged; D009367:Neoplasm Staging / Q000191:economics; D011237:Predictive Value of Tests; D015995:Prevalence; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013030:Spain; D014057:Tomography, X-Ray Computed