Endo-Bronchial Ultrasound-Guided Transbronchial Needle Aspiration For Diagnosis Of Mediastinal Lymphadenopathy And Analysis Of False Negatives

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive option for the pathological examination of intrathoracic lymph nodes. This study aimed to assess the diagnostic accuracy of EBUS-TBNA in mediastinal lymphadenopathy. Methods: This study retrospectively reviewed 389 patients that had undergone EBUS-TBNA and were radiologically confirmed to have mediastinal and hilar lymph node enlargement over a 6-year period. Demographic and clinical data and pathology results were collected and analyzed. Results: From 389 patients (219 men) with a mean age of 55.1 years, 389 lymph nodes were punctured and 376 resulted in a diagnosis. Biopsy specimens were taken from lymph nodes in regions 2, 4, 7, 10, and 11. Mean diameter of the nodes was 22.6 +/- 5.2 mm on computerized tomography (CT) and 21.5 +/- 3.7 mm on EBUS. Regarding the diagnostic performance of EBUS-TBNA, sensitivity was 93.0% and specificity was 100.0%, with a diagnostic yield of 89.2%. The negative predictive value (NPV) was 45.7% and the positive predictive value (PPV) was 100.0%. A few minor complications occurred. The diagnostic yield increased over time and reached a plateau after approximately 60 performances. Conclusion: EBUS-TBNA should be considered the initial investigation for patients with mediastinal and hilar lymphadenopathy. It is safe and has high diagnostic value.