title: Conventional and endobronchial ultrasound-guided transbronchial needle aspiration:  complementary procedures.
abstract: OBJECTIVE
  The diagnosis of mediastinal and hilar lymphadenopathy and staging lung cancer with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) are on the rise. Most reports have demonstrated high yields with EBUS-TBNA and superiority of this procedure over conventional TBNA (cTBNA), but the relative roles of these procedures remain undefined. We present a comprehensive comparison of EBUS-TBNA to cTBNA.
  
  
  METHODS
  We reviewed all of the bronchoscopies performed at our medical center from January 2009 through December 2010. We collected data on 82 EBUS-TBNAs and 209 cTBNAs performed. A cost analysis was subsequently performed.
  
  
  RESULTS
  EBUS-TBNA was performed more often in patients with known prior cancer and suspicion of recurrence or staging compared with cTBNA (42% vs 18%, P < 0.001). cTBNA was more likely to be performed in patients suspected of having malignancy and needing diagnostic specimens (70% vs 46%, P = 0.009). The overall yield in which a diagnostic specimen or lymphoid tissue was obtained was not different in each group: EBUS 84% vs cTBNA 86% (P = 0.75). The cancer yield was 57% in cTBNAs compared with 44% in EBUS-TBNAs (P < 0.0001), with EBUS-TBNA more often targeting smaller nodes (mean 15 ± 7 mm vs 21 ± 11 mm; P < 0.0001) and paratracheal sites (67% vs 49%, P = 0.003). Per-procedure cost using a Medicare scale was higher for EBUS than it was for cTBNA ($1195 vs $808; P < 0.001).
  
  
  CONCLUSIONS
  EBUS-TBNA and cTBNA are complementary bronchoscopic procedures, and the appropriate diagnostic modality can be selected in a cost-effective manner based upon the primary indication for TBNA, lymph node size, and lymph node location.
authors.affiliation: Department of Pulmonary/Critical Care, Wake Forest Baptist Health, Winston-Salem, NC 27157, USA. cbelling@wakehealth.edu
authors.forename: Christina R
authors.initials: CR
authors.lastname: Bellinger
authors.forename: Arjun B
authors.initials: AB
authors.lastname: Chatterjee
authors.forename: Robert
authors.initials: R
authors.lastname: Chin
authors.forename: John
authors.initials: J
authors.lastname: Conforti
authors.forename: Norman
authors.initials: N
authors.lastname: Adair
authors.forename: Edward
authors.initials: E
authors.lastname: Haponik
mesh_terms: D000704:Analysis of Variance; D001707:Biopsy, Needle / Q000379:methods*; D001999:Bronchoscopy / Q000191:economics; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008477:Mediastinal Diseases / Q000000981:diagnostic imaging / Q000473:pathology*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000473:pathology; D009367:Neoplasm Staging; D018709:Statistics, Nonparametric; D018084:Ultrasonography, Interventional / Q000191:economics