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H.J. Norton
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P3.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 214)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Locoregional Disease – NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.03-011 - General Anesthesia Is Not Required for Safe, Accurate Endoscopic Diagnosis of Malignant and Non-Malignant Disease in the Mediastinum (ID 1303)
09:30 - 09:30 | Author(s): H.J. Norton
- Abstract
Background:
Since its introduction in the early to mid 2000’s, endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) of mediastinal lymph nodes has been shown to be superior to “blind” TBNA for the diagnosis of malignancy and sarcoidosis in multiple studies. There is no consensus, however, regarding the optimal method of procedural sedation for EBUS. The purpose of this retrospective study was to determine differences in sampling accuracy and safety between a group of patients undergoing EBUS with moderate sedation and a group with general anesthesia.
Methods:
A retrospective chart review was performed of 51 consecutive patients undergoing convex probe EBUS-guided TBNA over a six-month period at a large, community-based referral hospital. Fifteen procedures were performed under general anesthesia and 36 with moderate sedation using midazolam and fentanyl after topical preparation of the upper airway with lidocaine. Twenty nodal biopsies were performed on the 15 general anesthesia patients, and 47 biopsies were performed on the 36 patients from the moderate sedation group. Rapid on-site cytologic evaluation (ROSE) was used for most cases.
Results:
No statistically significant difference was found in any measured variable between the two groups, specifically sample adequacy (85% in the general anesthesia [GA] group vs. 83% in the moderate sedation [MS] group; p = 1.0; 95% confidence interval (CI), -17.0 to 21.0%) or frequency of adverse events (6.7% GA vs. 5.6% MS; p = 1.0; 95% confidence interval (CI), -13.6 to 15.8%). There was no significant difference in the mean size of lymph nodes biopsied (16.4 mm GA vs. 18.3 mm MS; p = 0.28). Additionally, there was no difference in the proportion of biopsies taken from individual nodal stations or in the numbers and types of diagnoses made between the two groups. Adverse events were mild and included self-limited, non-cardiac chest pain in a patient receiving GA, and two episodes of desaturation in the MS group that resolved with temporary interruption of the procedure.
Conclusion:
As payor scrutiny and emphasis on quality, cost-effective health care increases, convex probe EBUS-guided biopsy utilizing moderate sedation remains an effective, accurate method of diagnosing malignant and non-malignant disease in the mediastinum without the added cost of general anesthesia and without compromising patient safety. Certainly general anesthesia can be an invaluable resource for bronchoscopic procedures in high-risk patients with morbid obesity, sleep apnea, heavy home narcotic or sedative use and other complex comorbidities, but healthcare facilities without anesthesia services can acquire and effectively employ convex EBUS technology with confidence.
