Author of

• 11856

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  P2.17 - Poster Session 2 - Bronchoscopy, Endoscopy (ID 183)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Pulmonology + Endoscopy/Pulmonary
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11860

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    P2.17-004 - Endobronchial Ultrasound Guided Transbronchial Needle Aspiration (EBUS-TBNA) Investigation of Mediastinal Lymphadenopathy of Unknown Aetiology (ID 1615)

    09:30 - 09:30  |  Author(s): P.A. Reid
    • Abstract

    Background
    Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) now offers an accurate and minimally invasive alternative to cervical mediastinoscopy for the pathological assessment of mediastinal and hilar lymphadenopathy. We aimed to establish amongst patients with mediastinal and hilar lymphadenopathy of unknown aetiology and without a radiological identified primary tumour; the yield from EBUS-TBNA for benign and malignant pathologies and the requirement for subsequent investigations in order to confirm a pathological diagnosis in non diagnostic TBNA samples.

    Methods
    We retrospectively reviewed 418 endobronchial ultrasound examinations performed between 03/01/2011 and 01/03/2013 at the Royal Infirmary of Edinburgh. All patients had a pre-sampling CT thorax and a maximum lymph node diameter of > 10mm. All cases without a radiological identified primary were included in the study. Final clinical diagnosis in relation to pathological diagnosis was achieved from the medical records as was the need for further investigations in order to achieve a pathological diagnosis.

    Results
    Of 418 EBUS procedures 340 were to stage lymph nodes with radiological primary lesion. 78 EBUS procedures were performed for the investigation of lymphadenopathy of unknown origin. Nodal sampling was achieved in 112 of 118 aspirates (95%). 32 patients (41%) had non diagnostic lymph node sampling. 72 (35.1%) had malignancy diagnosed by EBUS-TBNA (21 bronchogenic) with a further 5 suspicious of malignancy. A false negative for malignancy occurred in 1 patient who had lymphoma. Of 19 patients with a clinical suspicion of sarcoidosis 14 had non-caseating granulomatous lymphadenitis confirmed on TBNA and 3 patients had subsequent confirmation with invasive investigations. The yield then of EBUS FNA for sarcoidosis was 88% when considering those with subsequent pathological confirmation. Of 24 patients with negative sampling, 10 were considered reactive to underlying lung disease, although 11 remained without clear explanation. Follow up was variable within this group. 9 patients required further investigations to confirm disease. 3 patients required mediastinoscopy and 2 went on to have endoscopic ultrasound with core biopsy

    Conclusion
    EBUS-TBNA has an excellent yield for both begin and malignant pathologies causing mediastinal lymphadenopathy and should be considered as a non invasive alternative to mediastinoscopy where lymphoma is thought less likely.Where TBNA or FNA is non-diagnostic but the suspicion of malignancy is high, further investigations are indicated. Given the availability of CT scanning in today’s practice, lymphadenopathy of uncertain significance is an increasing clinical dilemma. Protocols have had to be developed for the management of incidental solitary pulmonary nodules and similar guidelines could be produced for the management of intra-thoracic lymphadenopathy incidental or otherwise to ensure a standardised investigative cycle and follow up.