An Algorithmic Approach for Assessment of Mediastinal Lesions Using Conventional Transbronchial Needle Aspiration and Endoscopic Ultrasonography in a Single Procedure
Background. In the era of endobronchial/esophageal ultrasound (EBUS-TBNA/EUS-FNA), many centers forgo conventional transbronchial needle aspiration (C-TBNA) in favour of EBUS-TBNA/EUS-FNA despite no conclusive evidence showing better yields with EBUS-TBNA/EUS-FNA. Objectives. Assess the feasibility...
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| Format: | Article |
| Language: | English |
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Wiley
2017-01-01
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| Series: | Canadian Respiratory Journal |
| Online Access: | http://dx.doi.org/10.1155/2017/1971629 |
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| author | Andrew Burkett Harmanjatinder S. Sekhon Craig Burkett Shaheed W. Hakim Kayvan Amjadi |
| author_facet | Andrew Burkett Harmanjatinder S. Sekhon Craig Burkett Shaheed W. Hakim Kayvan Amjadi |
| author_sort | Andrew Burkett |
| collection | DOAJ |
| description | Background. In the era of endobronchial/esophageal ultrasound (EBUS-TBNA/EUS-FNA), many centers forgo conventional transbronchial needle aspiration (C-TBNA) in favour of EBUS-TBNA/EUS-FNA despite no conclusive evidence showing better yields with EBUS-TBNA/EUS-FNA. Objectives. Assess the feasibility of an algorithmic approach for mediastinal sampling beginning with C-TBNA utilizing rapid onsite cytologic evaluation. Methods. Descriptive analysis of 92 consecutive patients referred for adenopathy that underwent C-TBNA and subsequent EBUS-TBNA/EUS-FNA if C-TBNA was negative or nondiagnostic. Results. 92 procedures were analyzed. In 50 (54.3%) of cases, C-TBNA alone was sufficient. EBUS-TBNA was performed after C-TBNA in 27 (29.3%) of cases and EUS-FNA in 33 (35.9%) of cases. The yield was 92.9% for C-TBNA, 92.5% for EBUS-TBNA, and 89.7% for EUS-FNA. There were no statistically significant differences in yields by LN station (P=0.51), the relationship between yield and LN size (P=0.37), or time difference in procedures following the algorithm compared to EBUS/EUS only procedures (33.7 minutes versus 32.4 minutes on average [95% CI for difference: −9.1 to 11.7], P=0.80). Conclusions. An algorithmic approach to assess the mediastinum using C-TBNA initially is feasible without sacrificing yield or procedure times. C-TBNA was sufficient for diagnosis in 54.3% of cases and can be efficiently taught in an IP training program. |
| format | Article |
| id | doaj-art-876e622c96d94fdab6d300dcef3483a6 |
| institution | OA Journals |
| issn | 1198-2241 1916-7245 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Canadian Respiratory Journal |
| spelling | doaj-art-876e622c96d94fdab6d300dcef3483a62025-08-20T02:09:02ZengWileyCanadian Respiratory Journal1198-22411916-72452017-01-01201710.1155/2017/19716291971629An Algorithmic Approach for Assessment of Mediastinal Lesions Using Conventional Transbronchial Needle Aspiration and Endoscopic Ultrasonography in a Single ProcedureAndrew Burkett0Harmanjatinder S. Sekhon1Craig Burkett2Shaheed W. Hakim3Kayvan Amjadi4Division of Respiratory Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, CanadaDepartment of Pathology and Laboratory Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, CanadaDepartment of Statistical Sciences, University of Toronto, Toronto, ON, CanadaDepartment of Pathology and Laboratory Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, CanadaDivision of Respiratory Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, CanadaBackground. In the era of endobronchial/esophageal ultrasound (EBUS-TBNA/EUS-FNA), many centers forgo conventional transbronchial needle aspiration (C-TBNA) in favour of EBUS-TBNA/EUS-FNA despite no conclusive evidence showing better yields with EBUS-TBNA/EUS-FNA. Objectives. Assess the feasibility of an algorithmic approach for mediastinal sampling beginning with C-TBNA utilizing rapid onsite cytologic evaluation. Methods. Descriptive analysis of 92 consecutive patients referred for adenopathy that underwent C-TBNA and subsequent EBUS-TBNA/EUS-FNA if C-TBNA was negative or nondiagnostic. Results. 92 procedures were analyzed. In 50 (54.3%) of cases, C-TBNA alone was sufficient. EBUS-TBNA was performed after C-TBNA in 27 (29.3%) of cases and EUS-FNA in 33 (35.9%) of cases. The yield was 92.9% for C-TBNA, 92.5% for EBUS-TBNA, and 89.7% for EUS-FNA. There were no statistically significant differences in yields by LN station (P=0.51), the relationship between yield and LN size (P=0.37), or time difference in procedures following the algorithm compared to EBUS/EUS only procedures (33.7 minutes versus 32.4 minutes on average [95% CI for difference: −9.1 to 11.7], P=0.80). Conclusions. An algorithmic approach to assess the mediastinum using C-TBNA initially is feasible without sacrificing yield or procedure times. C-TBNA was sufficient for diagnosis in 54.3% of cases and can be efficiently taught in an IP training program.http://dx.doi.org/10.1155/2017/1971629 |
| spellingShingle | Andrew Burkett Harmanjatinder S. Sekhon Craig Burkett Shaheed W. Hakim Kayvan Amjadi An Algorithmic Approach for Assessment of Mediastinal Lesions Using Conventional Transbronchial Needle Aspiration and Endoscopic Ultrasonography in a Single Procedure Canadian Respiratory Journal |
| title | An Algorithmic Approach for Assessment of Mediastinal Lesions Using Conventional Transbronchial Needle Aspiration and Endoscopic Ultrasonography in a Single Procedure |
| title_full | An Algorithmic Approach for Assessment of Mediastinal Lesions Using Conventional Transbronchial Needle Aspiration and Endoscopic Ultrasonography in a Single Procedure |
| title_fullStr | An Algorithmic Approach for Assessment of Mediastinal Lesions Using Conventional Transbronchial Needle Aspiration and Endoscopic Ultrasonography in a Single Procedure |
| title_full_unstemmed | An Algorithmic Approach for Assessment of Mediastinal Lesions Using Conventional Transbronchial Needle Aspiration and Endoscopic Ultrasonography in a Single Procedure |
| title_short | An Algorithmic Approach for Assessment of Mediastinal Lesions Using Conventional Transbronchial Needle Aspiration and Endoscopic Ultrasonography in a Single Procedure |
| title_sort | algorithmic approach for assessment of mediastinal lesions using conventional transbronchial needle aspiration and endoscopic ultrasonography in a single procedure |
| url | http://dx.doi.org/10.1155/2017/1971629 |
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