title: Impact of EBUS-TBNA on modalities for tissue acquisition in patients with lung cancer.
abstract: BACKGROUND
  The impact of the introduction of Endobronchial ultrasound with real-time guided transbronchial needle aspiration (EBUS-TBNA) on the use of diagnostic modalities for tissue acquisition in patients with lung cancer is unknown.
  
  
  METHODS
  A retrospective review of 328 consecutive patients diagnosed with lung cancer at a university teaching hospital, where they first presented in London in 2007, 2009 and 2011. EBUS was introduced in 2008.
  
  
  RESULTS
  In total, 316 patients were included in the analysis. Comparing 2007 with 2011 data, there has been a significant reduction in standard bronchoscopy (P < 0.0001) and mediastinoscopy (P = 0.02). The proportion of cases diagnosed by EBUS-TBNA significantly increased from 0% in 2007 to 26.7% in 2009 and 25.4% in 2011 (P < 0.0001). In the same period there has also been an increased trend in the proportion of patients going directly to surgery without pathological confirmation with a 9.6% increase in diagnoses obtained at thoracotomy (P = 0.0526).
  
  
  CONCLUSIONS
  The use of diagnostic modalities that provide information on diagnosis and staging in a single intervention are increasing. At our hospital, the use of EBUS-TBNA for providing a lung cancer diagnosis is increasing and this has led to a significant reduction in standard bronchoscopies and mediastinoscopies. These changes in practice may have implications for future service provision, training and commissioning.
authors.affiliation: Department of Thoracic Medicine, University College London Hospital, 250 Euston road, London NW1 2PG, UK. n.navani@ucl.ac.uk.
authors.forename: R J
authors.initials: RJ
authors.lastname: José
authors.forename: P
authors.initials: P
authors.lastname: Shaw
authors.forename: M
authors.initials: M
authors.lastname: Taylor
authors.forename: D R
authors.initials: DR
authors.lastname: Lawrence
authors.forename: P J
authors.initials: PJ
authors.lastname: George
authors.forename: S M
authors.initials: SM
authors.lastname: Janes
authors.forename: N
authors.initials: N
authors.lastname: Navani
mesh_terms: D000368:Aged; D001999:Bronchoscopy / Q000706:statistics & numerical data; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D008481:Mediastinoscopy / Q000706:statistics & numerical data; D009367:Neoplasm Staging / Q000379:methods; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D020858:Tissue and Organ Harvesting / Q000379:methods*