Comparison of transbronchial needle aspiration with and without ultrasound guidance for diagnosing benign lymph node adenopathy

Abstract

Abstract Background Transbronchial needle aspiration (TBNA) is a minimally invasive procedure performed to diagnose lymph node (LN) adenopathy. TBNA with and without endobronchial ultrasound (EBUS) guidance has a high diagnostic yield for malignant LN enlargement, but the value for diagnosing benign LN enlargement has been less thoroughly investigated. Methods We retrospectively evaluated 3540 patients with mediastinal LN enlargement who received TBNA. One hundred sixty-six patients with benign mediastinal lymphadenopathy were included and 293 LNs were biopsied. A positive result was defined as a specific histological abnormality. Conventional TBNA (cTBNA) and EBUS-TBNA, as well as cTBNA and transbronchial forceps biopsy (TBFB), were compared. The subgroup analysis was stratified by disease type and LN size. Results A diagnosis was made in 76.84% of the EBUS-TBNA and 61.31% of the cTBNA (P 20 mm the difference was marginal. These findings were confirmed in a group of independent patients who received cTBNA plus EBUS-TBNA. The diagnostic yield did not differ between cTBNA and TBFB, but significantly increased to 76.67% when both modalities were employed. Conclusions EBUS-TBNA is the preferred minimally invasive diagnostic method for benign mediastinal LN disease. Combined cTBNA and TBFB is a safe and feasible alternative when EBUS is unavailable.

Keywords

• Transbronchial needle aspiration (TBNA)
• Endobronchial ultrasound TBNA (EBUS-TBNA)
• Transbronchial forceps biopsy (TBFB)
• Benign mediastinal lymphadenopathy