Author of

• 16722

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  P1.04 - Poster Session with Presenters Present (ID 456)

  • Event: WCLC 2016
  • Type: Poster Presenters Present
  • Track: Pulmonology
  • Presentations: 1
  • Moderators:
  • Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)

  • 16736

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    P1.04-014 - Diagnostic Yield in Patients Undergoing Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Diagnosis of Lung Cancer (ID 4791)

    14:30 - 14:30  |  Author(s): S. Touray
    • Abstract

    Background:
    Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA) is an established diagnostic tool in the evaluation of lung cancer with a variable diagnostic yield, ranging from 62 % - 93 %[1–4]. Although the procedure can be performed under moderate sedation (MS) or general anesthesia (GA) [5], the impact of sedation type on the diagnostic yield has yielded variable results with some authors reporting a higher yield with deep sedation[6], whereas others note no difference between MS and GA[5]. We present findings of a retrospective study that looked at the diagnostic yield using an artificial airway under GA compared to conscious sedation through a natural airway in patients undergoing EBUS-TBNA .
    
    Methods:
    Demographic information on age, sex, race and co-morbidities were used to compute an age adjusted Charlson Co-morbidity index for each of 88 patients. Pathology reports were reviewed and an EBUS-TBNA was determined to be diagnostic if any of the sampled lymph nodes yielded a diagnosis. Assessment of the impact of using an artificial airway under GA on diagnostic yield was determined using multivariate logistic regression. Continuous variables are presented as means (± SD) and categorical variables are reported as counts and percentages. For all tests, two-sided P values < 0.05 were considered statistically significant.
    
    Results:
    Patients in the GA group were older (65 years versus 57.6, p= 0.005), had a higher age-adjusted Charlson comorbidity index, (3.7 versus 1.9, p < 0.001) and a higher ASA classification (3 versus 2 p=0.004). Average lymph node size was smaller in the artificial airway group (16.2 mm versus 20.7mm, p = 0.01). Despite these differences, the diagnostic yield was the same (61.4 % in each group). In multivariate analyses, female sex and lymph node size were the only predictors of a diagnostic EBUS-TBNA. OR 3.3, 95 % CI, 1.23 – 9.1 for female gender, (p= 0.02) and 1.1, 95 % CI, 1.00 – 1.18 for lymph node size (p= 0.04). Diagnoses made were: adenocarcinoma of the lung 42.6 %, Sarcoidosis 16.7 %, Small cell lung cancer 14.8 %, Squamous cell carcinoma 11.1 %.
    
    Conclusion:
    EBUS-TBNA performed under general anesthesia through an artificial airway was not associated with an increased diagnostic yield, and therefore concious sedation should be considered where appropriate, with general anesthesia reserved for those patients who are older, and with a higher perioperative risk. More research assessing the determinants of a positive diagnosis including physician pretest likelihood and PET/CT avidity are needed to improve diagnostic outcomes.