Clinical Utility and Economic Impact of Conventional Transbronchial Needle Aspiration of Mediastinal Lymphadenopathies in Bronchogenic Carcinoma

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• 作者：Jorge Castelao Naval ; ^{castelao@castelao.es} ; Jos&#233 ; Luis Izquierdo Alonso ; Jos&#233 ; Gallardo Carrasco ; Ignacio Sá ; nchez Herná ; ndez ; Carlos Almonacid Sá ; nchez ; Jesú ; s Ferná ; ndez Franc&#233 ; s ; Pilar Resano Barrio ; Olga Mediano San Andr&#233 ; s
• 关键词：Tansbronchial needle aspiration ; Mediastinal lymph nodes ; Bronchogenic carcinoma ; Staging ; Clinical utility ; Cost
• 刊名：Archivos de Bronconeumología (English Edition)
• 出版年：2013
• 出版时间：February, 2013
• 年：2013
• 卷：49
• 期：2
• 页码：41-46
• 全文大小：353 K

文摘

Objectives

To analyse the clinical utility and economic impact of conventional transbronchial needle aspiration (TBNA) in patients with diagnosis of bronchogenic carcinoma (BC) and mediastinal lymphadenopathies in thoracic computed tomography (CT). To assess the predictive factors of valid aspirations.

Patients and methods

Retrospective observational study between 2006 and 2011 of all TBNA performed in patients with final diagnosis of BC and accessible hilar or mediastinal lymphadenopathies on thoracic CT.

Results

We performed TBNA on 267 lymphadenopathies of 192 patients. In 34.9 % of patients, two or more lymph nodes were biopsied. Valid aspirations were obtained in 153 patients (79.7 % ) that were diagnostic in 124 patients (64.6 % ). Multivariate analysis showed that factors associated with valid or diagnostic results are the diameter of the lymph node and the number of lymph nodes explored. TBNA was the only endoscopic technique that provided the diagnosis of BC in 54 patients (28.1 % ). Staging mediastinoscopy was avoided in 67.6 % of patients. The prevalence of mediastinal lymph node involvement was 74.4 % , sensitivity of TBNA was 86.2 % and negative predictive value was 63.6 % . Including mediastinoscopy and other avoided diagnostic techniques, TBNA saved 451.57 € per patient.

Conclusions

TBNA is a clinically useful, cost-effective technique in patients with BC and mediastinal or hilar lymphadenopathies. It should therefore be performed on a regular basis during diagnostic bronchoscopy of these patients.