DOES ENDOBRONCHIAL ULTRASONOGRAPHY HAVE A PLACE IN THE THORACIC SURGEON’S ARMAMENTARIUM?
Sebastien Gilbert1, David O. Wilson2, Neil A. Christie1, James D. Luketich1, Matthew J. Schuchert1; 1Heart, Lung, and Esophageal Surgery Institute, University of Pittsburgh Medical Center, Pittsburgh, PA; 2The Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA
Comment on this Abstract
Objective: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a promising tool in the evaluation of the mediastinum. To remain key players in this field, surgeons should acquire the skills and critically appraise this new technology.
Methods: Retrospective analysis of EBUS-TBNA experience in an academic thoracic surgery unit.
Results: Over 7 months, 23 patients (median age=70; male=15; female=8) had EBUS-TBNA. Diagnoses included: lung cancer or mass (14; 61%), mediastinal lymphadenopathy (ML) (4; 17%), and other (5; 22%). Nineteen patients (83%) had a PET scan and the mediastinum was positive in 18 (95%). Indications for EBUS-TBNA were positive PET scan (18; 78%) or ML alone (5; 22%). EBUS-TBNA was negative for cancer in 13 (56%), positive in 5 (22%), and non-diagnostic in 5 (22%). Among 18 PET-positive cases, EBUS-TBNA was negative in 10 (56%; 1/10 false negative), positive in 4 (22%), and non-diagnostic in 4 (22%). Of 14 patients with suspected lung cancer, 8 (57%) were either diagnosed with small cell cancer or downstaged from radiologic stage IIIa lung cancer. Mediastinoscopy was performed in 5 cases (22%) after a non-diagnostic (n=2) or negative EBUS-TBNA (n=3). The diagnostic yield was not operator dependent (pulmonologist vs surgeon; p > 0.05). Mediastinoscopy was not clinically required in 15 patients. There were no complications and all patients were discharged within 24 hours (91% same day).
Conclusion: EBUS-TBNA provided clinically relevant data in 74% (17/23) overall and 72% (13/18) of patients with abnormal PET scans. EBUS-TBNA may be a useful, minimally invasive adjunct or alternative to mediastinoscopy.
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