title: Impact of Endobronchial Ultrasound Guided Transbronchial Needle Aspiration on Diagnostic Yield of Bronchoscopy in Patients with Mediastinal Lymph Node Enlargement.
abstract: Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) had an enormous impact on the current advancement in diagnostic bronchoscopy. The aims of the present study were: (1) to evaluate the added value of EBUS-TBNA to routine diagnostic bronchoscopy performed in patients with mediastinal lymph node enlargement and (2) to identify factors that affect the diagnostic yield of EBUS-TBNA. We retrospectively analyzed 712 EBUS-TBNA procedures out of the 4081 bronchoscopies performed in the years 2009-2014. The number of EBUS-TBNA procedures increased from 61 (8.8 % of all bronchoscopies) in 2009 to 160 (21.4 %) in 2014. In 625 (87.8 %) patients adequate cytological material was obtained. Based on cytological examination of EBUS-TBNA aspirates, specific diagnosis was made in 367 (51.5 %) patients. The forceps biopsy of endobronchial lesions provided specific diagnosis in only 204 (28.6 %) patients. The percentage of patients with EBUS-TBNA based diagnosis increased steadily from 34.4 % in 2009 to 65.0 % in 2014 (p < 0.0001). The median lymph node diameter in patients with positive EBUS-TBNA findings was 20 (IQR 15-30) mm and was significantly larger than that in patients with negative EBUS-TBNA results (15 (IQR 10-20) mm, p = 0.0001). The highest diagnostic yield (78.5 %) was found in patients with lymph node dimension between 31 mm and 40 mm. We conclude that EBUS-TBNA is a valuable diagnostic method in an unselected group of patients with mediastinal lymph node enlargement. The percentage of positive EBUS-TBNA diagnoses is related to lymph node dimensions. The overall efficacy of EBUS-TBNA improves with increasing years of experience.
authors.affiliation: Medical Student Research Group 'Alveolous', Medical University of Warsaw, Warsaw, Poland.
authors.forename: K
authors.initials: K
authors.lastname: Osinka
authors.affiliation: Department of Internal Medicine, Pneumology and Allergology, Medical University of Warsaw, 1A Banacha St, 02-097, Warsaw, Poland.
authors.forename: M
authors.initials: M
authors.lastname: Zielińska-Krawczyk
authors.affiliation: Department of Internal Medicine, Pneumology and Allergology, Medical University of Warsaw, 1A Banacha St, 02-097, Warsaw, Poland. piotr.korczynski@wum.edu.pl.
authors.forename: P
authors.initials: P
authors.lastname: Korczyński
authors.affiliation: Department of Pathology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: B
authors.initials: B
authors.lastname: Górnicka
authors.affiliation: Department of Internal Medicine, Pneumology and Allergology, Medical University of Warsaw, 1A Banacha St, 02-097, Warsaw, Poland.
authors.forename: R
authors.initials: R
authors.lastname: Krenke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001999:Bronchoscopy / Q000379:methods*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008206:Lymphatic Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008297:Male; D008479:Mediastinal Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult
keywords: Bronchoscopy; Endobronchial ultrasound; Lung tumor; Mediastinal lymph nodes; Sarcoidosis; Transbronchial needle aspiration