title: Transbronchial vs transesophageal needle aspiration using an ultrasound bronchoscope for the diagnosis of mediastinal lesions: a randomized study.
abstract: BACKGROUND
  The purpose of this study was to compare the tolerance, efficacy, and safety of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) with transesophageal endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) with an endobronchial ultrasound scope for the first pathologic diagnosis of lesions accessible by both procedures.
  
  
  METHODS
  Patients who had lesions accessible by both EBUS-TBNA and EUS-FNA were enrolled and were randomized to undergo either procedure. Patients quantified tolerance, and operators charted the quality of examination using a 100-mm visual analog scale (VAS).
  
  
  RESULTS
  A specific diagnosis was made in 50 of 55 patients (91%) in the EBUS-TBNA group and in 48 of 55 patients (87%) in the EUS-FNA group (P = .76). Compared with EBUS-TBNA, EUS-FNA was associated with a shorter duration of procedure (median, 15.3 min vs 11.3 min; P < .001), lower doses of IV midazolam (mean, 4.4 mg vs 4 mg; P = .02) and intraairway lidocaine (mean, 303 mg vs 189 mg; P < .001), less frequent oxygen desaturations (23 of 55 vs two of 55, P < .001), and higher operator satisfaction (P < .001). There was no significant difference in patient tolerance according to the patients' VAS. Lymph node infection occurred in one patient in the EBUS-TBNA group and in two patients in the EUS-FNA group.
  
  
  CONCLUSIONS
  Both EBUS-TBNA and EUS-FNA provide high accuracy with good tolerance, although the occurrence of infectious complications should be monitored carefully. EUS-FNA has the advantage of comparable tolerance with fewer doses of anesthetics and sedatives, a shorter procedure time, and fewer oxygen desaturations during the procedure.
  
  
  BACKGROUND
  UMIN Clinical Trials Registry; No.: UMIN000005757; URL: http://www.umin.ac.jp/ctr/.
authors.affiliation: Department of Respiratory Medicine, Nagoya Medical Center, Nagoya University Hospital, Nagoya, Japan. Electronic address: masahideo@aol.com.
authors.forename: Masahide
authors.initials: M
authors.lastname: Oki
authors.affiliation: Department of Respiratory Medicine, Nagoya Medical Center, Nagoya University Hospital, Nagoya, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Saka
authors.affiliation: Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Ando
authors.affiliation: Department of Respiratory Medicine, Nagoya Medical Center, Nagoya University Hospital, Nagoya, Japan.
authors.forename: Rie
authors.initials: R
authors.lastname: Tsuboi
authors.affiliation: Department of Respiratory Medicine, Nagoya Medical Center, Nagoya University Hospital, Nagoya, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Nakahata
authors.affiliation: Department of Respiratory Medicine, Nagoya Medical Center, Nagoya University Hospital, Nagoya, Japan.
authors.forename: Saori
authors.initials: S
authors.lastname: Oka
authors.affiliation: Department of Respiratory Medicine, Nagoya Medical Center, Nagoya University Hospital, Nagoya, Japan.
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Kogure
authors.affiliation: Department of Respiratory Medicine, Nagoya Medical Center, Nagoya University Hospital, Nagoya, Japan.
authors.forename: Chiyoe
authors.initials: C
authors.lastname: Kitagawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001980:Bronchi; D020680:Bronchoscopes; D001999:Bronchoscopy; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000295:instrumentation* / Q000379:methods*; D004947:Esophagus; D005260:Female; D006801:Humans; D008297:Male; D008479:Mediastinal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D008875:Middle Aged; D011446:Prospective Studies