Conventional vs. endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of mediastinal lymphadenopathies

The aim of this study was to determine whether or not radial probe endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) is superior to conventional TBNA in the diagnosis of mediastinal lymphadenopathies in routine clinical practice. Consecutive patients, who were referred for TBNA, were randomized to conventional TBNA and EBUS-guided TBNA groups. Patients were also grouped according to the anatomic location of the pathologic lymph nodes to evaluate if there was a difference in the diagnostic yield with respect to lymph node station. Patients with subcarinal lymph nodes were designated as group A and patients with lymph nodes at station 2 (upper paratracheal), 3 (prevascular and retrotracheal), and 4 (lower paratracheal) were designated as group B. A 21-G aspiration needle was used during the procedure. Sixty patients with a mean age of 56.15 +/- 15.32 years were included in the study. Thirty patients each underwent EBUS-TBNA and conventional TBNA. The overall diagnostic yield of conventional TBNA was 33.3% (10/30), while EBUS-TBNA had a yield of 66.7% (20/30; p=0.010). In patients with subcarinal lymph nodes, the yield of conventional TBNA was 33.3% (4/12) compared to 62.5% (5/8) in the EBUS-guided group (p=0.362). In patients with mediastinal lymph nodes other than subcarinal lymph nodes, EBUS-TBNA had a significantly higher yield compared to conventional TBNA [33.3% (6/18) vs. 68.2% (15/22) for conventional and EBUS-TBNA groups, respectively; p=0.028]. In conclusion, the diagnostic yield of EBUS-TBNA was superior to the yield of conventional TBNA at stations other than subcarinal region. We suggest that EBUS is a useful tool to guide TBNA in the evaluation of mediastinal lymph nodes.