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| Endobronchial Ultrasound-Guided Fine-Needle Aspiration of Mediastinal Lymph Nodes: The Thoracic Surgeon's Perspective | |
Rafael S. Andrade, Shawn S. Groth, Natasha M. Rueth, Jonathan D'Cunha, Michael A. Maddaus; Surgery, University of Minnesota, Minneapolis, MN
Methods: We performed an Institutional Review Board-approved review of our prospectively maintained database of all patients who underwent EBUS-FNA of MLNs by thoracic surgeons at our institution from September 1, 2006 through September 30, 2008. We included patients in our analysis if (1) EBUS-FNA cytology revealed malignancy or (2) non-malignant cytology (normal lymph node, benign pathology, or nondiagnostic samples) was verified with a confirmatory procedure (i.e., mediastinoscopy, thoracoscopy, or thoracotomy) that sampled the same MLN stations as sampled by EBUS-FNA. We excluded the 10 initial procedures required to overcome our learning curve. These criteria ensured the most accurate representation of our sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy. Results: Over the study period, 166 patients underwent EBUS, 155 with FNA. Of these, 77 met our inclusion criteria. We report a sensitivity of 91.1%, a specificity of 96.8%, a NPV of 88.2%, a PPV of 97.6%, and a diagnostic accuracy of 93.4%. We performed an additional procedure in 59% of patients in the same anesthetic setting as EBUS-FNA: 41% underwent a diagnostic procedure (mediastinoscopy [21%], endoscopic ultrasound-guided FNA [11%], thoracoscopy [9%], thoracotomy [0.2%]) and 35% underwent a therapeutic procedure (pulmonary resection [23%], tracheostomy [5%], intravenous port placement [5%], gastrostomy tube placement [4%], and pleurodesis [1%]). Conclusion: Thoracic surgeons can perform EBUS-FNA with excellent results and have the distinct ability to combine EBUS-FNA with additional diagnostic and therapeutic procedures in a single anesthetic setting. EBUS-FNA adds to the thoracic surgeon’s unique capacity to expedite diagnostic work-up and treatment thereby streamlining patient care. Back to 2009 Annual Meeting Back to Program Outline Back to Main Program |
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