title: Factors Influencing the Diagnostic Yield of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration.
abstract: We describe the diagnostic performance of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in a heterogeneous population of patients with mediastinal lymphadenopathy secondary to suspected cancer (lung and nonlung) or recurrence after cancer therapy in a large academic cancer institute. A review was done of all patients referred for real-time EBUS-TBNA over an 18-month period at our institution. Cytological analysis of EBUS-TBNA aspirates was compared with a reference standard of definitive pathologic tissue diagnosis or a composite of ≥6 months' clinical follow-up with radiographic imaging. Adequate tissue was obtained in 225/236 procedures (95.3%) and a reference standard was available in 214. The overall diagnostic yield of EBUS-TBNA in those procedures with a reference standard was 87.4%. The sensitivity, specificity and diagnostic accuracy of EBUS-TBNA for malignancy was 86.1%, 100% and 92.9%, respectively. The sampling accuracy of EBUS-TBNA decreased with lymph node size ≤5 mm and with paratracheal location. Other factors, such as airway distortion and calcification, are also associated with less accurate EBUS-TBNA results. In a diverse population of patients with suspected cancer or recurrence, EBUS-TBNA is minimally invasive and highly accurate. Factors such as lymph node size and location influence the result of EBUS-TBNA.
authors.affiliation: *Department of Respiratory Medicine, Cork University Hospital, Ireland Departments of †Pulmonary Medicine ‡Anesthesiology §Biostatistics ∥Thoracic Surgery, University of Texas MD Anderson Cancer Center.
authors.forename: Marcus P
authors.initials: MP
authors.lastname: Kennedy
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Jimenez
authors.forename: Rodolfo C
authors.initials: RC
authors.lastname: Morice
authors.forename: Mona
authors.initials: M
authors.lastname: Sarkiss
authors.forename: Xiudong
authors.initials: X
authors.lastname: Lei
authors.forename: David
authors.initials: D
authors.lastname: Rice
authors.forename: Georgie A
authors.initials: GA
authors.lastname: Eapen