Transbronchial versus Transesophageal Ultrasound-guided Aspiration of Enlarged Mediastinal Lymph Nod

Transbronchial versus Transesophageal Ultrasound-guided Aspiration of Enlarged Mediastinal Lymph Nod

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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 Rationale: Transesophageal and transbronchial, ultrasound-guided, fine-needle aspiration of enlarged mediastinal lymph nodes have become popular, but have never been compared directly. Objectives: To compare the relative diagnostic yield and ability of the trans- esophageal and transbronchial approaches to reach abnormal me- diastinal lymph nodes. Methods: 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. Measurements: Percentage of successful biopsies, percentage of pa- tients diagnosed, and biopsy time were measured from when the lymph node was identified with ultrasound. Main Results: Among 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 5 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 wereencountered. Conclusions: 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. Keywords: 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).
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This note was uploaded on 02/23/2011 for the course HTEC 50 taught by Professor Hassel,patricia during the Spring '11 term at DeAnza College.

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Transbronchial versus Transesophageal Ultrasound-guided Aspiration of Enlarged Mediastinal Lymph Nod

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