Transbronchial versus Transesophageal
Ultrasound-guided Aspiration of Enlarged
Mediastinal Lymph Nodes
Felix J. F. Herth, William Lunn, Ralf Eberhardt, Heinrich D. Becker, and Armin Ernst
Department of Internal Medicine, Pneumology and Critical Care Medicine, Thoraxklinik at the University of Heidelberg, Heidelberg, Germany;
and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
Transesophageal and transbronchial, ultrasound-guided,
fine-needle aspiration of enlarged mediastinal lymph nodes have
become popular, but have never been compared directly.
To compare the relative diagnostic yield and ability of the trans-
esophageal and transbronchial approaches to reach abnormal me-
diastinal lymph nodes.
A total of 160 patients with
enlarged lymph nodes in one of eight mediastinal lymph node
stations underwent transbronchial and transesophageal biopsies in
a crossover design. Each of the eight stations was allocated 20
patients. Two needle punctures were done with each approach.
Percentage of successful biopsies, percentage of pa-
tients diagnosed, and biopsy time were measured from when the
lymph node was identified with ultrasound.
the 106 men and 54 women (mean age 53.2 years), transbronchial
aspiration was successful in 85%, and transesophageal aspiration
was successful in 78% (p
0.2). For each station, the number of
positive samples for the transbronchial/transesophageal approaches
was: 2R: 19/13; 2L: 16/19; 3: 17/15; 4R: 19/12; 4L: 17/20; 7: 19/20;
10R: 18/9; and 10L: 17/18. Combining both approaches produced
successful biopsies in 97% and diagnoses in 94% of patients. Mean
biopsy times were 3.2 minutes for the transbronchial approach and
4.1 minutes for the transesophageal approach. The transbronchial
approach was superior in nodes 2R, 4R, and 10R. No complications
In experiencedhands, enlargedmedi-
astinal lymph nodes may be aspirated with either the transbronchial
or transesophageal approach. These nonsurgical approaches have
similar diagnostic yields, although the transbronchial approach is
superior for right-sided lymph nodes. Combining both approaches
provides results similar those of mediastinoscopy.
endobronchial ultrasound; endoesophageal ultrasound; lung
cancer; mediastinal lymphadenopathy; transbronchial needle aspiration
Enlarged mediastinal lymph nodes and mediastinal masses are
a common diagnostic problem for chest physicians. In patients
with lung cancer, evaluating mediastinal nodes is crucial for
proper staging (1, 2) and for assessing the extent of the disease.
Mediastinoscopy is a surgical procedure commonly per-
formed in this circumstance and is considered to be the reference
standard for establishing a diagnosis. It requires use of an op-
erating room and general anesthesia, and the sensitivity of the
procedure has been reported to be as low as 81% (3).